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Presentations from NW Russian regions: Karelia (EN)

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Presentations from NW Russian regions – gaps and challenges, opportunities and strengths: Karelia

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Presentations from NW Russian regions: Karelia (EN)

  1. 1. REPUBLIC OF KARELIA Key objectives and challenges, potential and strengths Natalia Vezikova
  3. 3. REPUBLIC OF KARELIA Population of the Republic, according to the State Statistics Committee of Russia, is 622464 people.(2018). Population density - 3.5 people / km2 (2015). Urban population — 79,59 % (2015). 818 inhabited localities :  13 cities,  11 urban-type settlements,  794 — small towns, settlements and villagers.
  4. 4. Healthcare facilities in Karelia  Central Republican Hospital  Central Children Republican Hospital  Cancer Hospital  Central Infectious Disease Republican Hospital  Emergency Care Hospital  Prenatal Center  Central Maternity Hospital  Central City Children Hospital  STI Clinic  3 Medical facilities affiliated with various Public Agencies
  5. 5.  4 Outpatient clinics for adults  4 Outpatient clinics for children  Dental services (for children and adults)  Republican TB Clinic  Mental Clinic  Drug Abuse Clinic  Central district hospitals  Two bacteriological laboratories
  6. 6. WEAKNESSES  Non-existence of a unified central bacteriological laboratory in the Republic of Karelia:  Central Child Republican Hospital, Central Infectious Diseases Republican Hospital and Center for Hygiene and Epidemiology have own bacteriological laboratories.  Other healthcare facilities (including Central Republican Hospital) purchase services of bacteriological laboratories located in St.Petersburg (‘Citylab’, ‘Invitro’, ‘Liis’, etc., under Federal Law # 44)
  7. 7. WEAK POINTS Non-existence of a unified database of bacteriological culture results; Insufficient recording of nosocomial infections; Lack of properly trained clinical microbiologists and epidemiologists; A number of medical facilities (located in the districts of the Republic) have no formularies (logbooks) of antimicrobials and no protocols of perioperative antibiotic prophylaxis; Insufficient recording of inefficient antimicrobials use and adverse effects.
  8. 8. STRENGTHS  Clinical pharmacology service has been established (there are clinical pharmacologists available in almost all large inpatient healthcare facilities);  Antimicrobial therapy is carried out in consistency with the results of culturing;  Antimicrobial formularies (logbooks) generated in consistency with the results of culturing are in use in Petrozavodsk inpatient facilities;  In consistency with the National Vaccination Plan, Republic of Karelia has introduced Preventive Vaccination Calendar (in addition to that preventive vaccination with anti-pneumococcal vaccine is provided for patients with chronic lung diseases as part of the “Prevention of Disability in the Republic of Karelia” special programme)
  9. 9. Antimicrobial formulary (logbook)  Antimicrobial formulary (logbook) does not come down to a list of antimicrobials used by physicians in medical facilities  The formulary (logbook) contains empirical therapy programs  To provide more precise AB ‘stationing’ , Guidelines on Infections Treatment recommend to mark out the 1st, 2nd and 3rd line of therapeutic agents instead of breaking down agents into agents of primary choice and alternative ones - the latter would have allowed for more loose interpretation.
  10. 10. Draft program to combat the spread of antibiotic resistance Improving public awareness on antibiotic resistance:  promoting public awareness on AMA use and antimicrobial resistance  promotion of immunization, healthy lifestyle and personal hygiene  Involvement of medical prevention centers and “Medical Student Volunteers” movement  Cooperation with Petrozavodsk State University’s medical institute  Work with mass media and other non-commercial organizations
  11. 11. Draft program on containment of antibiotic resistance Training for specialists  Schools of efficient pharmacotherapy for primary care and hospital specialists  Conferences on vaccine prevention and treatment of infectious diseases that involve medical professionals participating in the continuous medical education program.  Training for clinical microbiologists-bacteriologists on the premises of the Antimicrobial Chemotherapy Scientific Research Institute at Smolensk Medical University or at other corresponding healthcare facilities
  12. 12. Draft program on containment of antibiotic resistance Control of antimicrobial resistance and antimicrobials use:  To establish a unified microbiological laboratory (service) in the Republic of Karelia (on the premises of the Child Republican Hospital);  To set up a unified database of nosocomial pathogens;  To introduce and validate antimicrobial formularies (logbooks) for non-nosocomial and nosocomial infections; protocols for perioperative antibiotic prophylaxis (to be introduced in the healthcare facilities);  To improve infection control of nosocomial infections in the healthcare facilities;  To introduce evaluation of antibacterial agents effectiveness in real clinical practice.
  13. 13. Draft program on containment of antibiotic resistance Controlling the spread of multi-drug resistant bacteria:  Collaboration between clinical pharmacologist, clinical microbiologist and clinical epidemiologist in the medical facility;  Introduction of protocols for the prevention of nosocomial infections in every medical facility;  Introduction and validation of the disinfectants formularies (logbooks) in the medical facilities.
  14. 14. Central Republican Hospital  The hospital comprises: 16 specialized clinical units, 2 intensive care units, 15 paraclinic units, 12 diagnostic units.  Hospital bed capacity: 822 beds in the round-the clock inpatient department, 18 beds in the day-patient hospital, and 25 beds in the outpatient day-care ward.
  15. 15. Central Republican Hospital Department of Clinical Pharmacology and Drug Supply 2,700 to 3,000 consultations are provided annually. Main goals of the consultations:  AM therapy correction;  prescription of reserve antibiotics;  nosocomial flora analysis (ICU, surgical units, ACE units)
  16. 16. Central Republican Hospital Department of Clinical Pharmacology and Drug Supply Starting from 2001, in order to streamline the use of antimicrobial drugs and provide control of nosocomial infections, the following measures have been introduced in the Hospital:  Hospital formulary (logbook) of antimicrobials including recommendations on diagnosis and treatment of infections,  Chief physician order on antibiotic prophylaxis of surgical infections,  Protocol for sepsis diagnostics and treatment.
  17. 17. Central Republican Hospital Department of Clinical Pharmacology and Drug Supply  The formulary of antimicrobial drugs is being reputedly reviewed in consistency with new data on local antibiotic resistance, introduction of new antimicrobial agents, and changes in infections treatment guidelines
  18. 18. RESULTS FROM 2014  Total number of biological samples sent to the laboratory for microbiological testing - 2561  In 2014, according to the laboratories, 4520 various infectious pathogens were identified as a result of culturing.  Positive samples accounted for 70% of the total number of clinical samples.
  19. 19. Microbial landscape Microorganisms Number of strains Frequency of isolation, % Gramm-negative bacteria 3339 73,8 Gram-positive bacteria 1150 25,4 Fungi (Candida spp) 31 0,8 Total 4520 100
  20. 20. Gramm-negative bacteria Microorganisms Number of strains Frequency of isolation, % K.pneumoniae 839 25,1 Acinetobacter spp. 606 18,1 Escherichia coli 521 15,6 P.aeruginosa 442 13,2 Proteus spp. 332 9,9 Enterobacter spp. 212 6,3 Serratia spp. 93 2,8 S.maltophilia 79 2,4 Others 215 6,6 Total 3339 100
  21. 21. Gram-positive bacteria Microorganisms Number of strains Frequency of isolation, % S. aureus 405 35,2 Enterococcus spp. 378 32,9 Coagulase negative staphylococci 158 13,7 Others 209 18,2 Total 1150 100
  22. 22. Acinetobacter sensitivity
  23. 23. P. Aeruginosa sensitivity
  24. 24. Klebsiella pneumoniae sensitivity, ESBL producents
  25. 25. Escherichia coli sensitivity
  26. 26. Tests and studies results:  Gram-negative microflora takes the lead in the etiological structure of infections identified in the Central Republican Hospital(73.8%)  K.pneumoniae (18,6%), Acinetobacter spp. (13,4%), Escherichia coli (11,5%), P.aeruginosa (9,7%), S. aureus (8,9%), Enterococcus spp. (8,4%) predominate among all pathogens
  27. 27. Спасибо за внимание! Thank you for your attention!