Abstract
During 1991-1999 a significant increase of consumption of macrolides and fluoroquinolones was observed in Slovenia,and this was associated with significant increase of resistance of Streptococcus pneumoniae and Streptococcus pyogenes to macrolides and Escherichia coli to fluoroquinolones, respectively.Between 1999 and 2007 the prevalence of S. pneumoniae resistant to erythromycin increased from 3.7% to 16.8% even though the use of macrolides in the same period decreased from 3.81 to 2.43 defined daily doses (DDD) per 1,000 inhabitants and per day. The co-resistance and the spread of resistant clones were the reason for constant increase in macrolide resistance. Slovenia is one of the few European countries with decreasing prevalence of methicillin resistant Staphylococcus aureus (MRSA) in hospital care during the last years. As a result of control measures introduced in 1999,the MRSA prevalence rates decreased from 21.4% in 2000 to 8.3% in 2007.
Highlights
Slovenia is a small central European country with over two million inhabitants [1]
In this paper we describe the experiences in prevention and control of antibiotic resistance in ambulatory care, focusing on methicillin-resistant Staphylococcus aureus (MRSA) in hospital care
A recent analysis showed that the prevalence of erythromycin resistance among invasive S. pneumoniae isolates increased from 3.7% in 1999 to 16.8% in 2007 in spite of a decrease of consumption of macrolides by 36.3% in the same period [7]
Summary
Slovenia is a small central European country with over two million inhabitants [1]. The country has a centralised compulsory Bismarck-style* health insurance system, which is administered by the Health Insurance Institute of Slovenia and includes almost all inhabitants (>99%). Ambulatory care In Slovenia the increased use of antibiotics in ambulatory care during the 1990s was associated with increased resistance of some respiratory infection pathogens. Between 1994 and 1999, the macrolide consumption increased twofold, from 1.89 to 3.84 defined daily doses (DDD) per 1,000 inhabitants and per day, and at the same time the macrolide resistance in S. pyogenes increased from 0 to 7.4% and of non-invasive strains of S. pneumoniae from 0 to 9% [3].
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