El presidente de la Sociedad Española de Medicina Preventiva, Salud Pública e Higiene, el doctor Francisco Botía, y el doctor Ángel Asensio, miembro de la citada sociedad, han participado en reuniones con el ECDC, el Ministerio de Sanidad, Servicios Sociales e Igualdad y otras sociedades científicas, para valorar la situación actual del uso de antimicrobianos en España.

1. Hospital Antimicrobial Use
and Resistances.
Point Prevalence Surveys
(EPINE)

2. EPINE
Scope
representativeness
Antimicrobial use
Selected antimicrobial-microorganism
resistances
Summary

3. EPINE: a series of Point Prevalence Surveys
Anual: since 1990
National study
Non compulsory
Representativeness:
(more than half acute care inpatients)
Monitoring antimicrobial resistance since 1999
2012: udpdated ECDC methodology
Includes data on Community-onset infections

4. Year of the survey
123
135
163
171
186
201
206
214
224
233
243 243 246
241
258 257
253
266
276 278
287 287
271
282
269
277
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
100
150
200
250
300
Number of hospitals

5. Year of the survey
38,5
42,2
44,3
46,9
49,7
51,3
51,9 51,7
53,7 53,7
55,3
56,3
54,8 54,8 54,8
57,4
57,9
61,5
62,5
62 61,8
61,2
53,9
56,7
55,7
57,2
35
40
45
50
55
60
65
# of patients (thousands)
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

6. Size of theSize of the
hospitalhospital
HospitalsHospitals PatientsPatients
NN %% NN %%
≤200 beds 126 45,49 10.170 17,79
201 to 500 beds 81 29,24 17.430 30,48
>500 beds 49 17,69 25.937 45,36
Total 277 100,00 57.183 100,00

9. SAUR (O/E): 1.33 (95%CI 1.18-1.50; P 91)
01234
SAUR(O/E)-EU
Standardized AU ratio (SAUR), based on patient risk factors (standard risk adjustment)

10. Prevalence of antimicrobial use%
Year of the survey
Tendencia p<0,0001
33,8 34,5 34,9 34,4 34,6
35,6 36,1 35,8
36,7 36
36,8 37,1 37
38,7
39,7 39,5
40,7 40,2
41,6
42,4 41,9
45,7 45,7 45,4 46,1
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
0
8
16
24
32
40
48
ECDC-PPS

11. Asensio A, et al. (EPINE WG). Trends in yearly prevalence of third-generation
cephalosporin and fluoroquinolone resistant Enterobacteriaceae infections and antimicrobial use in Spanish
hospitals, Spain, 1999 to 2010. Euro Surveill. 2011;16:36-9

12. Asensio A, et al. (EPINE WG). Trends in yearly prevalence of third-generation
cephalosporin and fluoroquinolone resistant Enterobacteriaceae infections and antimicrobial use in Spanish
hospitals, Spain, 1999 to 2010. Euro Surveill. 2011;16:36-9

16. EPINE PPS 2012-2015
13,3
7,3
5,3
9,8
2,2
2,7
13,2
6,7
5
9,7
2,2
2,7
13,2
6,8
5
10,2
2,3
2,9
13,1
6,5
5,1
10,4
2,3
3
Pen+pen inhib.
3-4G cephalosp
Carbapenems
Quinolones
Gly copeptides
Antimy cotics
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Prevalence of use (%)
2012 2013 2014 2015

19. [0,10]
(10,20]
(20,40]
(40,60]
(60,100]
<10 isolates/not incl.
MRSA%
(% of S. aureus)
43%

20. EPINE PPS 1993-2015
22
19 18
25 25
29
40
36 37
45
41
45
42
44
48 48
51
43 43 43
40
35
41
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
0
5
10
15
20
25
30
35
40
45
50
55
60
Proportion of resistance (%) ECDC-PPS

21. EPINE PPS 1993-2015
National Hand
Hygiene campaign

22. EPINE PPS 2012-2015
24 23 22
43
40
35
41
36
30
28
33
2012 2013 2014 2015
0
10
20
30
40
50
60
Proportion of resistance (%)
Surgical Respiratory
Blood other
All EARSS

23. EPINE PPS 2012-2015
43
40
35
41
33
31 32
38
2012 2013 2014 2015
0
5
10
15
20
25
30
35
40
45
50
Proportion of resistance (%)
Community
EARSS
Hospital

24. EPINE PPS 2012-2015
4
5
3
66
8
3
8
1
3
2 2
3
2 2 2
2012 2013 2014 2015
0
1
2
3
4
5
6
7
8
9
10
Proportion of resistance (%)
E. faeciumEARSS E. faecalis Hosp
E. faecalis Com E. faeciumHosp
E. faeciumCom

25. EPINE PPS 2012-2015
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
0
5
10
15
20
25
30
35
40
45
50
Proportion of resistance (%)
3GC/Escher. coli Carb/Escher. coli
3GC/K. pneumoniae Carbapenem/K. pneumoniae
3GC/Enterobacter spp Carb/Enterobacter spp

26. EPINE PPS 2012-2015
14
13
12
19
13
14
20
22
20
19 19
2012 2013 2014 2015
0
5
10
15
20
25
Proportion of resistance (%)
Hospital
Community
EARS

27. EPINE PPS 2012-2015
17
20
18
21 20
25
33
38
42
44
38
2012 2013 2014 2015
0
5
10
15
20
25
30
35
40
45
50
Proportion of resistance (%)
Hospital
Community
EARS

28. EPINE PPS 2012-2015
0,8 1,2
2,3
12
13
17
12
2
4
6 6
2012 2013 2014 2015
0
2
4
6
8
10
12
14
16
18
20
Proportion of resistance (%)
Community
Hospital
EARS

29. 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
0
10
20
30
40
50
60
70
80
90
100
Proportion of resistance (%)
Carb/P. aeruginosa
Carb/A. baumanii
EPINE PPS 1999-2015
ECDC-PPS

30. EPINE PPS 2012-2015
16,4 17,6 18,520 21 21
23
29
37
32
34
2012 2013 2014 2015
0
5
10
15
20
25
30
35
40
45
50
Proportion of resistance (%)
Hospital Community P. aeruginosa EARSS

31. EPINE PPS 2012-2015
68
43
38
26
74
63 64 62
2012 2013 2014 2015
0
10
20
30
40
50
60
70
80
90
100
Proportion of resistance (%)
Hospital Community EARS

32. Antimicrobial use is among the highest in Europe:
For carbapenems, 3-4G cephalosporins, quinolones and antimycotics
Former intensive use of quinolones and 3G cephalosporins
Increase resistance of enterobacteriaceae to Quinolones and 3GC
Intensive use of carbapenems
increase resistance of enterobacteriaceae to carbapenems
Rates of resistance
MRSA:
▪ Is high
▪ Decreasing since 2010 associated to Hand Hygiene campaign
▪ Much higher than that reported by EARSS laboratories
▪ Resistance in the community is increasing toward hospital levels

33. Enterobacteriaceae resistances
E. coli and K pneumoniae 3GC resistance:
▪ high
▪ Community infections: reaching HAI levels
E. coli resistant to Carbapenem: 1-2% of the HAIs
K. pneumoniae resistant to carbapenems
▪ High: 12-17% of HAI isolates
▪ Community-onset infections: increasing: 2-6% in 2015
Non fermenting GN bacilli resistance
P. aeruginosa resitance to carbapenems is high and increasing in the
last 4 years
A. baumanii resistant to carbapenem is high but decreasing.
Rates of resistance reported by PPS are higher than those
reported by EARSS net

34. Hospital Antimicrobial use
and Resistance.
Point Prevalence Surveys
(EPINE)