6 countries in 1 article, let’s have a short trip on this antibiotic awareness day

TAE stands for Trainee Association of ESCMID, which was created to increase and support the scientific and medical contribution of young clinical microbiologists and infectious disease specialists all over Europe (see here).


Apropos the World Antibiotic Awareness Week #WAAW  and the European Antibiotic Awareness Day #EAAD2017, TAE Steering Committee members have shared with us how their countries approach these initiatives. Throughout their stories you will be able to have a glance to Europe’s diversity. We hope you enjoy the read.


Thanks TAE friends!


Turkey (Cansu Çimen) 

There is a Rational Drug Use Unit managed by the Ministry of Health in Turkey (see here) and The World Antibiotic Awareness Week, which is scheduled to take place on 18 November by the World Health Organization, is celebrated on an intense schedule with the efforts of the Turkish Agency for Drug and Medical Devices (TİTCK) in Turkey.

For this purpose, the “Rational Antibiotic Use and Awareness Symposium” was organized in Istanbul for the first time in 2014. The symposium invites participants from many different sectors such as the authorities of the Ministry of Health and the provincial organization directors, physicians, pharmacists, dentists, veterinarians, other health personnel, academicians, representatives of associations, and medical faculties. The antimicrobial consumption and antimicrobial resistance surveillance data of Turkey are shared with the participants of the antibiotic data used in the animal husbandry sector by the managers working in the relevant units of the ministries. In addition to presentations focusing on socioeconomic dimension of antimicrobial resistance, there are topics such as vaccination, hygiene and travel health which are simple but very effective methods to prevent infections with the contributions of academicians who are infectious specialists. Every year in this period, prepared by the World Health Organization posters, brochures, fact sheets and so on. visual and printed media materials are published and distributed in Turkish. Apart from this, the press organs are invited to the symposium. For this purpose, the symposium is aimed to be included in visual, audio and print media tools.

As in every hospital in Turkey, there is a physician in the hospital where I work, who is involved in rational antibiotic use team and transfers the work done at the district and province level. Brochures describing and supporting the use of rational antibiotics distributed by specialists of infection diseases and infection control nurses in every period of the year are becoming more important this week of the year and informative meetings are being held for healthcare workers in our hospital. In addition to these events this year, we plan to include public spots on digital screens in our outpatient clinics. In addition, the infection control committee, which consists of pharmacist, infectious diseases and clinical microbiologist, internal medicine specialist, intensive care specialist and infection control nurse, meets at certain times of the year and discusses antibiotic use rates of hospitals, surveillance results, antimicrobial resistance percentages and data. As a result of these meetings, the accessed data are also regularly shared with the hospital staff.


Caroline Rönnberg (Sweden)

Sweden has a very low rate of antibiotic resistance compared with Europe as a whole. Antibiotic guidelines are stringent and the knowledge about the necessity of antibiotic treatment quite high in the general population. The Swedish strategic programme against antibiotic resistance (Strama) has played a big role in spreading antibiotic awareness since 1995.Their activities include:

  • educating health care professionals
  • distributing information pamphlets
  • and most importantly, publishing concrete treatment guidelines for both hospital care and outpatients.

Primary care units have been identified as prescribing the bulk of unnecessary antibiotics and financial incentives have been implemented to combat this problem. National surveillance of antibiotic resistance is carried out by the Public Health Agency (Folkhälsomyndigheten) and statistics and strategies can be found on their webpage (see here). Health care hygiene (Vårdhygien) and Infection control (Smittskydd) are separate public authorities collaborating with all relevant instances including directly with health care units. Also, strict rules apply for antibiotic use in livestock and antibiotics are prohibited for use as growth factors.

One of the duties of clinical microbiologists is to inform clinicians about positive blood cultures and give advice on antibiotic treatment, both empirically and based on resistance testing. Infectious disease consultants take on the task of hands on prescribing of antibiotics for most complicated infections in all types of patients. An antibiotic stewardship measure in the form of an “infection tool” has been implemented to monitor antibiotic prescribing. It works as a pop-up window in the patient record where the type of infection needs to be indicated when prescribing an antibiotic. Furthermore, all patients are screened for MRSA at admission and discharge, and targeted patients are additionally screened for ESBL and VRE. All carriers of MRSA are treated in a special MRSA ward and outpatient clinic after discharge.


David Ong (The Netherlands)

In the past decades antimicrobial stewardship has been one of the most important factors contributing to low levels of antimicrobial resistance in the Netherlands when compared to most neighbouring countries.

At national level, there is intensive collaboration on coordinated activities between the national societies of clinical microbiologists, infectious diseases specialists and hospital pharmacists to optimize antimicrobial use and reduce the development of antimicrobial resistance. The Dutch Working Party on Antibiotic Policy (SWAB) offers evidence-based guidelines and makes yearly reports on the use of antibiotics and trends in antimicrobial resistance in general practice and in hospitals (see here). Furthermore, in each hospital clinical microbiologists have played a very pro-active role in advising physicians on recognizing the appropriate indication of antibiotic prescribing, the choice of antibiotics including tailoring treatment as soon as possible and the optimal duration of treatment.

In 2012 the SWAB had published a vision document stating that in 2014 each hospital was required to have a multidisciplinary antibiotics team (A-team) and should have implementedan antibiotic stewardship program that includes a description of specific tasks and responsibilities (see here). ThisA-team should at least include a clinical microbiologist, an infectious diseases specialist and a (hospital)pharmacist. Moreover, this team should closely work with colleagues from hospital hygiene and infection control.

At my own institution residents in clinical microbiology and infectious diseases are stimulated to actively contribute to antimicrobial stewardship projects, e.g. start smart then focus, intravenous-oral switch, antibiotic de-escalation based on microbiological results, and restrictive use of reserve antibiotics. These projects target both improving activities of CM/ID doctors as well as endorsing prudent use of antibiotics among all prescribing physicians in the hospital and increase general awareness of antimicrobial resistance.


Thea Christin Zapf (Germany)

In Germany we have an organisation called antibiotic stewardship -ABS- (see here). This organization offers further education courses for trainees, resident doctors, and specialists in various medical fields. Furthermore participants of ABS-courses shall be involved into a network on the basis of a virtual platform, that shall be shaped by ABS members/participants. Participants can become members of several ABS-study groups (SG) (e.g. SG for antibiotic treatment and bact. resistance / SG for Quality control / SG for ABS-interventions …etc) that meet once a year (on the European antibiotic awareness day) for the ABS-network-meeting to exchange ideas and to expedite projects.

Next to this there is a law about prevention of infection (§23 Infektionsschutzgestz) that is executed in the hospitals by monitoring of nosocomial infections. The monitoring commissioner collects data about nosocomial infections (e.g. catheter-associated urinary tract infections, central venous catheter-associated infections, etc…) and sends the collected data to the local health office.

In Marburg there is a monitoring commissioner, who is responsible for the surveillance of nosocomial infections. Furthermore there a delegates for hygiene factors (doctors and nurses) who are responsible for the surveillance of infections and hygiene on their wards. In addition there is an infection-board where doctors from several medical fields meet. They present and discuss about selected patient-cases that have something to do with infection, antibiotic treatment and hygiene.


Zaira Palacios (Spain)

In Spain there is significant awareness of infection control due to the high level of resistance mainly in Enterobacteriaceae group.

At national level we are trying to promote a general plan working joined with the Ministery of Health to fight against antimicrobial resistance. So far this plan has no financial resources but national societies of both ID and CM are raising awareness and improving education among the population while the government is working in this plan. Many national experts of antimicrobial stewardship are contributing to this project. Until this moment is not mandatory but most of the hospital have a antibiotic policy (is the set of strategies and activities undertaken to organize the antimicrobial treatment in the hospital, and achieve health outcomes for patients) and Infection committee (is responsible for the antibiotics policy in hospitals. Its functions as an advisory body to the medical directorate are the analysis of the epidemiology of the infections in the center, measures for its prevention and control, improving the appropriate use of antimicrobials, training, and knowledge production). They are in charge of antimicrobial stewardship at each hospital.


At my hospital we have a daily meeting with pharmacist to comment and discuss about restricted antibiotics or prolonged use of it. Then a clinician visit the patient and offers a non-tax advice to the clinician in charge. Yearly we also have a point prevalence survey on which pharmacist, microbiologist and clinicians participate. Also we have 3 nurses devoted exclusively to monitor each surgery at the centre and each transfer or admission to ICU. We do surveillance swabs routinely and decolonize people who needs. At a time we have a external rotation we promote antimicrobial stewardship program. In 2013 we developed our first local guideline of treatment, it has been updated yearly and many participants of different specialties has contribute to this work. Moreover, we have a twitter account to promote our antimicrobial stewardship program.


Italy (Alberto E. Maraolo)

Italy is one of the European countries most affected by the plague of antimicrobial resistance (AMR) but only recently (2 November 2017) the Ministry of Health has approved a national plan to specifically fight AMR in the wake of WHO resolution WHA68.7, dating back to May 2015, and of  European One Health Action Plan against Antimicrobial Resistance adopted by the EU.

  • Earlier, the control of AMR in Italy was included in more general “plan for prevention”, a guide for implementing measure addressing a broad range of medical problems, such as drug use or the disease burden related to non-communicable diseases.
  • The new Italian plan has pinpointed 6 settings of intervention in the field of infectious diseases: surveillance, prevention, appropriate use of antimicrobials, education, communication and information, research and innovation.
  • A wide range of actions is considered by the plan in order to accomplish a series of goals; in the next months more compelling directives will be released in order to get the plan implemented in the whole national territory, hopefully in an harmonious way.


Naples (Napoli) is the third most populous city in Italy, the most important in the Southern part of the country, as well as the capital of the region Campania. Unfortunately, in Campania the rate of AMR (affecting at once Gram-negative and Gram-positive bacteria) is worrisome, with percentages of MDR strains higher than the national average (in turn higher than EU average). This is the consequence of several years of antibiotic misuse, driven by inappropriate prescription both at GPs’ level and at hospital level, lacking the position of ID consultant in most non-tertiary care centers. The center where I work has been implementing an antimicrobial stewardship mixed program (both restrictive and persuasive measure) since the beginning of 2017, focused on selected wards, in order to create a model easily to validate in other similar realities in the region.

1 Comment

  • cesare bolla says:

    Italy, as you know, is one of the European Countries with the most worrying incidence of antimicrobial resistance. After many years, finally, a written national action plan against this plague is available and We are waiting for specific directives from the local governments.

    I’m ID specialist at Alessandria public Hospital, in Piemonte region (north-west of Italy). I have been working overthere since last january, both as MD in the Infectious diseases unit and as member of the local Infection control Committee.

    With my colleagues (IDs, microbiologist, pharmacist and infection control MD), within december, We are planning to start an antimicrobial stewardship program focused on surgical prophylaxis and UTI monitoring. After collecting local epidemiological data on antimicrobial resistance and data on antibiotic consumption, We noticed that these 2 fields were the weakest sectors at all as antibiotic prescription.

    It’s just a first step but We hope to increase our program in the next future!

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