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DANMAP 2015 3D
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2015 2. danmap - 20 years of microbiological diagnostics combined with a close collabo- ration between the clinical microbiologist and the treating clinician. microbiological diagnosis is also performed in the primary sector, where most gp´s perform microscopy and culturing of urines for an identification and resistance testing of the infectious agent in their uti patients. the system is surveilled through mikap (www.mikap.dk), a system developed for quality assurance of microbiology on regional level. again, this also includes close collaboration with the local clinical microbiologi- cal laboratory and includes advice on how diagnostics are to be performed. national guidelines on the use
of medicine have existed for many years, published through the danish
medicinal informa- tion a/s, a daughter company of the danish pharmaceutical industry. information on the use of the different drugs is written by danish experts and includes a chapter on the use of antibiotics for the different organ systems and infection types that is restrictive and follows the mentioned rule on using penicillins whenever possible. also regional and local guidelines on the consumption of antibiotics have been developed over the years, often in collaboration between the clinical microbiologist and special- ists in infectious diseases and in some situations in response to the occurrence of new resistant mechanisms and strains. an example of this is the antibiotic intervention group from bispebjerg hospital, where the occurrence of esbl-producing klebsiella pneumoniae was worrisome and resulted in an antibiotic programme abandoning the use of cephalosporins in all acutely ill patients combined with reduction of all fluoroqui- nolones and encouragement to the use of penicillins if possible (see textbox 8, danmap 2010). as mentioned earlier the council of antibiotics was established in 2010 and a national action plan on the use of antimicrobials was issued the same year. this plan has been supported by the national health authori- ties who on a regular basis publish guidelines for the rational use of medicine (www.irf.dk) which also covers the use of antimicrobials for specific infectious diseases. new guidelines on prescribing antibiotics in primary health care and hospitals from the danish health and medicines authority were issued in 2012. these recommend the reduced use of cephalosporins and define rules for the consumption of fluoroquinolones in the primary health sector as well as re- stricted use of these and the carbapenems at danish hospitals (see textbox 3, danmap 2012). in addition the danish council of ethics published a recom- mendation on the ethical use of antibiotics in danish context in january 2014. initiatives directed towards the education of the danish popu- lation on a more rational use of antibiotics cover the participa- tion in the yearly european antibiotic awareness day and the establishment of a homepage containing the material of the campaign as well as more information on the subject of bacte- rial infections and how and when to treat them. denmark has also participated in developing a danish model of the e-bug system, where school material for teachers and students is developed, aiming at the education of future generations. the e-bug system is funded by the directorate-general for health and consumers of the european commission (see textbox 2, danmap 2011). current initiatives include the development of national guidelines on a more rational use of antimicrobials devel- oped in collaboration between the five danish regions and medical specialists covering the different disease topics. also most hospitals are working on developing local guidelines on the implementation of antibiotic stewardship based on local resistances and pathogenic strains (see textbox 5.1 danmap 2014) visions for the surveillance of antimicrobial drug resistance from a one health perspective the danmap monitoring programme has been innovative in setting up the first pro- gramme in the world to monitor antimicrobial consumption and resistance in farm animals, meat products and humans. the annual report has been a model for many other monitoring programmes internationally. the foundation danmap provides for research within the field of antimicrobial resistance is ex- emplary. furthermore, danmap is more than data and a report: it is a network and collaboration between various groups from different disciplines and institutions, all striving towards the common goal of fighting the threat to humankind posed by antimicrobial resistance. the design of danmap in 2016 largely remains a solution to the challenges that were identified 20 years ago. with the realization that the occurrence of antimicrobial resistance in one country is affected by the global antimicrobial resis- tance pandemic, and with the technological breakthroughs in recent years, there is considerable potential for improvement. danmap was not designed as a rapid monitoring and report- ing system. thus, the annual reports present data that are a snapshot in time and may not reflect the most recent trends, new emerging types of resistance or current outbreaks. fur- thermore, economic considerations dictate that the number of samples that can be included in the monitoring programme is limited, and accordingly the sensitivity, in terms of detecting new types of resistance, is limited. real-time monitoring of amr in human health care ? the miba system hence, in order to create data that the industry, researchers, clinicians and decision makers can act on, there is a need to
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