Status of Resistance
The most urgent antibiotic resistance problems identified by APUA-Croatia members are:
- Lack of regulation in human use
- Lack of regulation in agricultural use
- Lack of updated antibiotic use and treatment guidelines
- Lack of continuing medical education on antibiotic use for prescribers
- Acinetobacter baumanni resistant to carbapenems (23%), Pseudomonas aeruginosa carbapenem resistant (12%)
APUA-Croatia was founded in September of 2002. Antibiotic resistance is an issue of great importance to the Croatian medical and scientific community. In 1996, the Committee for Antibiotic Resistance Surveillance at the Croatian Academy for Medical Sciences established a national antibiotic resistance surveillance network, which gathers information from 25 of the 31 existing microbiology labs in Croatia. APUA-Croatia was established under the Committee for Antibiotic Resistance Surveillance and includes all previous committee members.
Chapter Objectives and Priorities
- To support the existing surveillance network, which collects yearly data from the participating laboratories, including the provision of external quality control
- To educate its members through regular courses and symposia and disseminate a yearly report on antibiotic resistance to optimize empiric antibiotic therapy
- Continuous antibiotic resistance surveillance
- Antibiotic consumption surveillance at the national level
- Patient and Prescriber education
APUA-Croatia has seen rates of MRSA decrease from 23% in 2006 to 15% in 2010. Incidence of MRSA also decreased from .66/1000 bed days in 2007 to 12/1000 bed days in 2010. At the same time, rates of P. aeruginosa have been continually high (26% in BSI and 12% in clinical isolates) and carbapenem resistance has increased (34% in 2010). Dr. Smilja Kalenic (National Committee for Nosocomial Infection Control) and Dr. Arjana Tambic Andrasevic (APUA-Croatia President) report that though there are several active infection control activities occurring in Croatia, resistance levels are still high in hospitals. While all hospitals in Croatia have infection control committees and infection control nurses, Dr. Kalenic and Dr. Andrasevic note that not all have satisfactory operating infection control teams. Other areas for improvement include outcome indicators, antibiotic consumption in hospitals, antibiotic stewardship programs, and the lack of national intervention strategies to support local infection control team efforts.
Within Croatia, many strategic partnerships have evolved. The Croatian Committee for Antibiotic Resistance Surveillance collaborates with the Croatian Ministry of Health and Social Welfare (MHSW) Reference Center for Antibiotic Resistance Surveillance at the University Hospital for Infectious Diseases. Croatia has also developed an extensive network of microbiology laboratories, and with the foundation of the APUA chapter in 2003, surveillance activities have expanded to antibiotic consumption. Activities related to antibiotic resistance control are coordinated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA), an MHSW intersectorial coordination mechanism (ICM). The ICM’s establishment in 2006 brought together key organizations dedicated to ABR control, including APUA-Croatia, the Croatian Committee for Antibiotic Resistance Surveillance, and the National Committee for Nosocomial Infection Control. This collaborative group developed the ISKRA national guidelines on MRSA control and surgical prophylaxis.
Croatia participated in a national hand hygiene campaign after the Croatian Minister of Health signed the WHO pledge regarding HAI in 2009. This campaign is being implemented in 37 out of 43 acute care hospitals in Croatia. Croatia also began a campaign targeting hospital antibiotic use in 2010, on the recommendation of the ECDC. Various national symposia are also held to commemorate European Antibiotic Awareness Day and Hand Hygiene Day. APUA-Croatia also takes part in ongoing education programs, including a program at the Nursing School, a course for physicians and nurses to start in 2012, and two postgraduate education courses about multidrug-resistant organisms.
Chapter President: Arjana Tambic Andrasevic, M.D., PhD., microbiologist, University Hospital for Infectious Diseases, Zagreb
Chapter Secretary/Treasurer: Marina Payerl pal, M,D., microbiologist, Public Health Laboratory, Cakovec
Tera Tambic, M.D., PhD., microbiologist, Croation Academy of Medical Sciences-president of the Croatian Committee for Antibiotic Resistance Surveillance
Smiljia Kalenic, M.D., PhD., microbiologist, Clinical Hospital Center, Zagreb
Vesna Madaric, M.D., Infectious Disease doctor, General Hospital, Koprivnica
Vera Vlahovic Palcevski, M.D. clinical pharmacologist, Clinical Hospital, Rijeka