If we are to continue to be able to treat simple diseases such as pneumonia and urinary infections, as well as more critical infections such as MRSA, we must reduce our use of antibiotics.
High consumption of broad-spectrum antibiotics in particular can make bacteria resistant, and this means that otherwise minor diseases can no longer be treated and may become fatal.
Five hospital departments in the Capital Region of Denmark have therefore participated in a national learning and quality project, the objective of which is to focus on overconsumption and how hospitals can reduce consumption.
The Capital Region of Denmark was the facilitator of the project, which was launched in 2017 as a collaboration between Danish Regions and the Ministry of Health.
Through targeted work at departments, all participants have managed to reduce their consumption or convert part of their consumption from broad-spectrum antibiotics to narrow-spectrum antibiotics.
Facts about antibiotic resistance
- According to the World Health Organization (WHO), antibiotic resistance is one of the biggest threats to global health.
- The WHO European Centre for Disease Prevention and Control estimates that 33,000 Europeans die every year due to infections from antibiotic-resistant bacteria. This corresponds to six people for every 100,000. However, in Denmark this figure is just below two per 100,000 due to better monitoring and prevention.
- Almost 90% of antibiotics used for humans are prescribed by general practitioners, medical specialists and dentists, whereas around 10% are given at hospitals.
- In 2017, total Danish antibiotic consumption was 152 tonnes of active substance, of which 101 tonnes were used to treat animals (primarily in pig production), and 51 tonnes were used to treat humans.
Sources: WHO, Statens Serum Institut (SSI)
For example, the Department of Intensive Care and Therapy at Rigshospitalet managed to cut their broad-spectrum antibiotics consumption by as much as 64% and total consumption by 13%. For Jakob Steen Andersen, consultant, it is all about helping to ensure that doctors can treat patients with infections in the future.
“We have a lot of critically ill patients with infections, septicaemia, or similar, and consequently we use large amounts of antibiotics. However, we'd like to be able to earmark the critical antibiotics for situations where no other options exist," said Jakob Steen Andersen.
Treatment adjusted along the way
According to Jakob Steen Andersen, consultant at the Department of Intensive Care at Rigshospitalet, the solution to the problem is not just to avoid treating the patient with antibiotics, because the patient will risk dying. But in many cases, the patient can do with a less critical antibiotic.
"Every day that passes without finding the right treatment, the likelihood of the patient dying doubles. Therefore, we overshoot the mark with the first antibiotic treatment. We have to make sure we don’t undershoot, because then the patient will die. So, we start out with the antibiotic that we know will work, and then we de-escalate the treatment as we receive new test results," said Jakob Steen Andersen.
Good experiences inspire others
The intensive care physician stressed that collaboration with other specialist groups and departments, especially microbiologists and infection specialists, has benefitted them all.
"We've been working closely with other colleagues, sharing knowledge across departments and learning new things. We've become more aware of why we use antibiotics like we do and that other departments may have another way of doing things. This has also led us to update or merge some of our guidelines," said Jakob Steen Andersen.
National goals have become local
Bettina Lundgren, head of centre and chairman of the Capital Region of Denmark's committee for infection hygiene and task force for reducing hospital-acquired infections, believes that the knowledge-sharing and inspiration are behind the good results in both the Capital Region of Denmark and throughout Denmark.
Facts about LKT Antibiotika
LKT Antibiotika is a learning and quality team and national network addressing challenges in the antibiotics area.
The goals are to:
- Reduce overall antibiotic consumption at hospitals
- Reduce consumption of critical antibiotics
- Ensure unchanged or falling 30-day mortality following bacteria in the blood
The goal to reduce both consumption of critical antibiotics and total consumption will be achieved through four specific initiatives:
- Indication for use antibiotics
- Choice of antibiotic
- Reassessment of treatment
- Treatment period
"The project has established a framework for the work that makes sense professionally, and this has made it one of the most effective and meaningful quality projects we've seen, with impressive results at all departments in the project," said Bettina Lundgren and added:
"The departments have different patients and different challenges, but through this project the departments have set their own local goals for their patients. National goals have suddenly become more relevant for the individual employee at the department. And this has been very effective," said Bettina Lundgren.
Still room for improvement
Even though the national project has now ended, work on reducing or converting antibiotic consumption will continue in the Capital Region of Denmark. Antibiotics are not only used at the five selected departments, but across all hospitals.
"Overall, there is still room for improvement across all the hospitals in the region. Only a fraction participated in the project, so it's still possible to spread the good word even more," said Bettina Lundgren.