RESUMEN
OBJECTIVES: Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences. METHODS: The data on outpatient antibiotic consumption were obtained from the Institute of Public Health and Health Insurance Institute of Slovenia and expressed in defined daily doses (DDD)/1000 inhabitant-days. The number of media publications on 'antibiotic drugs' and 'bacterial resistance' during the study period was obtained. In 2000, the prescription of co-amoxiclav and fluoroquinolones was restricted because of a constant increase in the consumption of these drugs. The data on incidence of acute mastoiditis and penicillin resistance among invasive pneumococci were obtained. RESULTS: The total outpatient consumption of antibacterials increased from 15.21 DDD/1000 inhabitant-days in 1996 to 20.08 in 1999, and decreased to 16.97 in 2003. The consumption of restricted antibiotics decreased from 7.29 in 1999 to 5.25 DDD/1000 inhabitant-days in 2003. There was a positive correlation between antibiotic consumption and the number of newspaper articles (r=0.92), and a negative correlation between the number of diagnostic tests and antibiotic consumption (r=-0.73 for the C-reactive protein test and -0.68 for the streptococcal antigen detection test). Reduced antibiotic consumption was paralleled by a decrease in penicillin resistance among invasive pneumococci. No increase in mastoiditis cases was observed in spite of reduced antibiotic consumption. CONCLUSION: Restriction of antibiotic prescription proved to be effective in reducing outpatient antibiotic consumption. The effect was prolonged and affected restricted antibiotics as well as non-restricted drugs.
Asunto(s)
Atención Ambulatoria , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Fluoroquinolonas/uso terapéutico , Farmacorresistencia Bacteriana , Mastoiditis/epidemiología , Resistencia a las Penicilinas , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Estudios Retrospectivos , Eslovenia/epidemiología , Streptococcus pneumoniae/efectos de los fármacosRESUMEN
The objective of the present study was to assess the economical impact of invasive Haemophilus influenzae type b infections in Slovenia, where the annual incidence of these infections is 16.4/100000 in children less than 5 years of age, and to compare it with the costs of a vaccination programme. The lifetime costs and benefits were estimated for the annual birth cohort of 18200 children. In the base-case model, the calculated benefit-to-cost ratios were 0.15, 0.98 and 1.38 taking into account 95% of savings in acute care costs, medical costs, and medical and non-medical costs, respectively. From the point of view of the Institute of Health Insurance of Slovenia, who pays all healthcare and vaccination costs, the vaccination programme per annual birth cohort of 18200 children would require an extra 7023 EUR or 0.40 EUR per cohort-child. The savings to society would represent 118410 EUR, indicating the rationale for inclusion of H. influenzae type b vaccination in the routine childhood immunisation programme in Slovenia.
Asunto(s)
Infecciones por Haemophilus/economía , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/economía , Haemophilus influenzae tipo b , Polisacáridos Bacterianos/economía , Cápsulas Bacterianas , Preescolar , Estudios de Cohortes , Análisis Costo-Beneficio , Árboles de Decisión , Infecciones por Haemophilus/epidemiología , Infecciones por Haemophilus/inmunología , Vacunas contra Haemophilus/farmacología , Haemophilus influenzae tipo b/inmunología , Humanos , Lactante , Recién Nacido , Modelos Económicos , Polisacáridos Bacterianos/farmacología , Eslovenia/epidemiologíaRESUMEN
The correlation between increased macrolide consumption and the resistance of Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis to macrolides in Slovenia from 1994 to 1999 was evaluated. The outpatient consumption of macrolides increased from 1.89 to 3.84 defined daily doses (DDD)/1000 inhabitants/day during the observation period. This increase in macrolide consumption was paralleled by a steady increase in macrolide resistance in S. pyogenes (from 0 to 7.4%, r = 0.90, P = 0.014) and upper respiratory S. pneumoniae isolates (from 0 to 9%, r = 0.82, P = 0.044). In other pathogens studied, no significant increase was detected.
Asunto(s)
Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Farmacorresistencia Microbiana , Atención Ambulatoria , Antibacterianos/uso terapéutico , Haemophilus influenzae/efectos de los fármacos , Humanos , Modelos Lineales , Macrólidos , Pruebas de Sensibilidad Microbiana , Moraxella catarrhalis/efectos de los fármacos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Eslovenia/epidemiología , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pyogenes/efectos de los fármacos , Factores de TiempoRESUMEN
BACKGROUND: Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same in children. METHODS: One hundred and forty-three healthy children and young adults (6-24 years of age, male to female ratio, 1:1) were assessed for the presence of antibodies to the agents of human granulocytic ehrlichiosis (HGE), human monocytic ehrlichiosis (HME), Borrelia burgdorferi sensu stricto (BB), and tick-borne encephalitis (TBE) virus in Slovenia, where tick-related infections are endemic. Antibodies to HGE and HME agents were assayed by indirect immunofluorescence, and antibodies to BB and TBE by enzyme-linked immunosorbent assay. A questionnaire about tick exposure was answered by all subjects. In the event of a positive result, a detailed interview was conducted. RESULTS: Of 143 study subjects, 22 (15.4%) had detectable antibodies to HGE agent, 22 (15.4%) were positive to BB, 18 (12.6%) were positive to TBE virus (12 of these were vaccinated) and 4 (2.8%) were positive to the HME agent. The history of persons seropositive to an HGE agent had been uneventful. CONCLUSIONS: Our study documents a high seroprevalence of HGE in children and young adults in Slovenia, similar to the seroprevalence of LB and higher than that of TBE and HME. Although the majority of these infections are probably asymptomatic or mild, active surveillance for acute HGE infections in children in areas endemic for tick-related infections is necessary.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Anticuerpos Antivirales/sangre , Mordeduras y Picaduras , Ehrlichiosis/epidemiología , Encefalitis Transmitida por Garrapatas/epidemiología , Enfermedades Endémicas , Enfermedad de Lyme/epidemiología , Garrapatas , Adulto , Animales , Grupo Borrelia Burgdorferi/inmunología , Niño , Ehrlichia chaffeensis/inmunología , Ehrlichiosis/diagnóstico , Encefalitis Transmitida por Garrapatas/diagnóstico , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Enfermedad de Lyme/diagnóstico , Masculino , Estudios Seroepidemiológicos , Eslovenia/epidemiología , Encuestas y CuestionariosRESUMEN
The impact of increased macrolide consumption on the resistance of common respiratory pathogens to erythromycin and azithromycin was evaluated. The study focused mainly on azithromycin. During the period from 1991 to 1996, a 3.5-fold increase in macrolide prescriptions for outpatients was observed in Slovenia. Compared to 1994, when no macrolide resistance was evident in Streptococcus pyogenes and noninvasive Streptococcus pneumoniae, a significant increase in macrolide resistance was observed in these two pathogens in 1997. Moraxella catarrhalis remained uniformly susceptible to macrolides. Close monitoring of macrolide resistance of common respiratory pathogens is thus necessary.
Asunto(s)
Antibacterianos/farmacología , Infecciones del Sistema Respiratorio/microbiología , Antibacterianos/uso terapéutico , Azitromicina/farmacología , Azitromicina/uso terapéutico , Prescripciones de Medicamentos , Farmacorresistencia Microbiana , Utilización de Medicamentos , Eritromicina/farmacología , Eritromicina/uso terapéutico , Humanos , Moraxella/efectos de los fármacos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Streptococcus/efectos de los fármacosRESUMEN
Records of patients aged 0 to 15 years, hospitalised between 1993 and 1998 at the intensive care unit (ICU) of the Department of Infectious Diseases, Ljubljana, Slovenia, suffering from a severe attack of tick-borne encephalitis (TBE), were reviewed. Of 133 children hospitalised due to TBE virus infection during the observation period, 7 (5.2%) were treated in the ICU. All patients were male, aged 6 to 14 (mean, 11.1) years. In six cases, focal encephalitis was diagnosed, and in one case it was suspected. All patients survived. After a mean follow-up period of 7.9 (range, 1.5 to 17) months, one patient was found to have severe neurologic sequelae and two patients had moderate sequelae. In conclusion, the results of our retrospective study of severe forms of TBE in children demonstrate that this disease can run a severe course and may lead to permanent sequelae, most often in boys of school-going age who present with focal encephalitis. Therefore, immunisation of school children against TBE in endemic areas is strongly recommended.
Asunto(s)
Encefalitis Transmitida por Garrapatas/clasificación , Adolescente , Niño , Sordera/etiología , Encefalitis Transmitida por Garrapatas/complicaciones , Encefalitis Transmitida por Garrapatas/prevención & control , Humanos , Masculino , Meningoencefalitis , Paresia/etiología , Estudios Retrospectivos , Convulsiones/etiología , Vacunas Virales/uso terapéuticoRESUMEN
The susceptibility of 108 Streptococcus pneumoniae strains isolated from normally sterile body sites during 1993-1995 in Slovenia has been studied. Overall resistance to penicillin, erythromycin, trimethoprim-sulfamethoxazole, cefuroxime, cefaclor and chloramphenicol was 16.6, 0.9, 26.8, 0, 4.5 and 4.6%, respectively. All penicillin-resistant isolates (intermediate resistance) were susceptible to cefotaxime, ceftriaxone and vancomycin. Isolates less susceptible to penicillin were also significantly less sensitive to chloramphenicol, cefaclor and trimethoprim-sulfamethoxazole than penicillin-sensitive strains. Pneumococci isolated in children were significantly (p < 0.05) more resistant to trimethoprim-sulfamethoxazole than those isolated in adults. The study demonstrated moderate resistance rate of S. pneumoniae to penicillin and trimethoprim-sulfamethoxazole and a low-level resistance rate to erythromycin, cefaclor and chloramphenicol. No straightforward correlation between overall consumption of antibiotics and antimicrobial resistance was found.