natgillin/translations-raw huggingface dataset:
The culture showed that he was infected with a bacterium called Escherichia coli (E. coli), which produced an extended-spectrum beta-lactamase (ESBL) and was resistant to many antibiotics, including ciprofloxacin.
Mikrobiološka preiskava urina je pokazala, da je bil okužen z bakterijo Escherichia coli (E. coli), ki je proizvajala laktamaze beta razširjenega spektra (ESBL) in je bila odporna na številne antibiotike, vključno s ciprofloksacinom.
Important points to note in this case are that Paolo had developed an infection with a community-acquired highly resistant E. coli.
Pomembne posebnosti tega primera so, da se je Paolova okužba razvila zaradi visoko odporne bakterije E. coli, pridobljene v domačem okolju.
Since he was afraid to motor-boat back to Rome by himself in case he became very ill, his brother-in-law accompanied him.
Ker se ni upal sam vrniti s čolnom domov, saj bi se mu stanje med potjo lahko poslabšalo, ga je spremljal svak.
After a while, however, he developed a fever with shaking chills and the symptoms of his urinary tract infection intensified.
Čez čas se je pojavila še povišana telesna temperatura z mrzlico, simptomi okužbe sečil pa so postali izrazitejši.
Paolo's E. coli was found to be sensitive only to amoxicillin/clavulanic acid, trimethoprim-sulfamethoxazole, fosfomycin and to the carbapenems, a class of last-line antibiotics, which are the treatment of choice for bacteria that produce ESBLs.
Ugotovili so, da je Paolova bakterija E. coli občutljiva le za amoksicilin s klavulansko kislino, trimetoprim s sulfametoksazolom, fosfomicin in za karbapeneme, zadnjo obrambno vrsto antibiotikov, ki so zdravilo izbora za okužbe z bakterijami, ki tvorijo ESBL.
coli was resistant to the fluoroquinolones, a class of antibiotics that can also be taken by mouth to treat urinary tract infections, including complicated ones.
Odporna je bila proti fluorokinolonom, ki jih je mogoče jemati tudi peroralno za zdravljenje okužb sečil tudi za zapletene okužbe.
The laboratory results showed that the only antibiotics that Paolo's E. coli was sensitive to were amoxicillin/clavulanic acid, trimethoprim-sulfamethoxazole, fosfomycin and finally, a class of last line antibiotics called the carbapenems.
Laboratorijski rezultati so pokazali, da je bila bakterija, s katero je bil okužen Paolo, občutljiva le za amoksicilin s klavulansko kislino, trimetoprim s sulfametoksazolom, fosfomicin in še na antibiotike zadnje obrambne vrste, ki jih imenujemo karbapenemi.
While on holiday, Paolo developed a complicated urinary tract infection with an E. coli isolate that produced extended-spectrum-beta lactamases (ESBL).
Paolo je na dopustu zbolel za zapleteno okužbo sečil z bakterijo E. coli, ki izloča ESBL (laktamaze beta razširjenega spektra).
The antibiotic that Paolo ended up taking was amoxicillin-clavulanic acid, which he took by mouth.
Paolo je na koncu prejel amoksicilin s klavulansko kislino, ki ga je jemal peroralno.
Paolo could not take trimethoprim-sulfamethoxazole, which is an oral antibacterial agent, because he was allergic to it. Carbapenems can only be given intravenously, meaning spending some time at the hospital.
Paolo peroralnega antibiotika trimetoprima ssulfametoksazolom ni smel jemati, saj je bil alergičen nanj.
Antibiotic consumption varies widely between EU/EEA countries.
Uporaba antibiotikov se med državami EU/EGP zelo razlikuje.
infographic information material toolkit material
grafični prikaz informacij informativno gradivo komplet informativnega gradiva
In the countries with the highest consumption, people consume 3.4 times more antibiotics than in the countries with the lowest consumption.
V državah z največjo uporabo ljudje zaužijejo 3,4-krat več antibiotikov kot v državah z najmanjšo uporabo.
Only 70 years after the introduction of antibiotics, we are facing the possibility of a future without effective antibiotics for treating patients infected by several types of bacteria.
Le 70 let od uvedbe antibiotikov se srečujemo z možnostjo, da v prihodnosti ne bomo imeli učinkovitih antibiotikov za zdravljenje bolnikov, okuženih z več vrstami bakterij.
Furthermore, the infographic shows the percentages of resistance against the most common groups of antibiotics.
Poleg tega grafični prikaz prikazuje deleže odpornosti proti najpogostejšim skupinam antibiotikov.
In hospital sector, the latest ECDC data show that consumption of carbapenems - a last-line group of antibiotics - significantly increased in six countries and none of the countries showed a decrease.
Najnovejši podatki centra ECDC kažejo, da se je v bolnišničnem sektorju uporaba karbapenemov, ki spadajo v skupino rezervnih antibiotikov, v šestih državah zelo povečala, v nobeni pa se ni zmanjšala.
What is the problem?
V čem je težava?
The ECDC directory (link) contains online resources for developing guidelines.
Portal ECDC (povezava) vsebuje spletne vire za pripravo smernic.
e) Higher direct and indirect hospital costs.
e) višjih neposrednih in posrednih stroškov bolnišničnega zdravljenja.
a) Leadership commitment: ensuring the necessary resources in terms of staff, technology and budget are available.
a) zavezanost vodstva (zagotavljanje razpoložljivosti potrebnih kadrovskih, tehnoloških in finančnih virov);
This resistance may be transferred to other bacteria [41].
Odpornost se lahko prenese na druge bakterije [41].
These improvements did not cause any increase in adverse patient outcomes [46].
Te izboljšave niso povzročile nobenega povečanja neželenih posledic za bolnike [46].
b) Appointing leaders that are responsible for the overall programme and for antibiotic use.
b) imenovanje vodij, ki so odgovorni za celoten program in rabo antibiotikov;
e) Training and education for medical, pharmacy, laboratory, nursing, and non-clinical staff, as well as patients and their families;
e) usposabljanje in izobraževanje za medicinsko, farmacevtsko, laboratorijsko, negovalno in drugo osebje, pa tudi za bolnike in njihove družine;
Antibiotics have long-term effects on the development and persistence of antibiotic resistance in the microbiota.
Antibiotiki imajo dolgotrajne učinke na razvoj in ohranjanje odpornosti proti antibiotikom v mikrobioti.
Up to a half of all antibiotic use in European hospitals is unnecessary or inappropriate [6,37,38].
V skoraj polovici primerov je raba antibiotikov v evropskih bolnišnicah nepotrebna in neprimerna [6,37,38].
In European hospitals, Clostridium difficile infections can lead to up to a 42% increase in mortality, 19 extra days of hospital stay, and more than EUR 14,000 of additional costs per patient [23,24].
V evropskih bolnišnicah lahko okužbe z bakterijo Clostridium difficile povzročijo do 42 % večjo umrljivost, 19 dodatnih dni bolnišničnega bivanja in več kot 14 000 EUR dodatnih stroškov na bolnika [23,24].
d) Preventing and reducing antibiotic resistance, together with infection prevention and control measures.
d) preprečevanju in zmanjšanju odpornosti proti antibiotikom, skupaj z ukrepi za preprečevanje in obvladovanje okužb.
Losing effective options for the treatment and prevention of infections is a global health security threat [31].
Izguba učinkovitih možnosti za zdravljenje in preprečevanje okužb predstavlja globalno grožnjo za zdravstveno varnost [31].
a) Delayed access to effective antibiotic therapy for individual patients, causing treatment failures, longer illnesses, prolonged stays in hospital and increased morbidity and mortality;
a) zapoznelega dostopa posameznih bolnikov do učinkovitega zdravljenja z antibiotiki, kar povzroča neuspešno zdravljenje, daljše trajanje bolezni, podaljšano bivanje v bolnišnici ter povečano obolevnost in smrtnost;
e) Antibiotic therapy is not reviewed after 48-72 hours, or the choice of antibiotic is not streamlined when microbiological culture data become available.
e) izbira antibiotičnega zdravljenja se ponovno ne oceni po 48-72 urah oziroma se izbira antibiotika ne prilagodi glede na rezultate o mikrobioloških preiskav.
How is our use of antibiotics contributing to the problem
Kako naša uporaba antibiotikov prispeva k tej problematiki?
Why hospitals should be promoting antibiotic stewardship?
Zakaj bi morale bolnišnice spodbujati nadzor nad rabo antibiotikov?
Infections with multidrug-resistant bacteria can be severe, fatal and costly and can directly lead to [2-11] [expert consensus]:
Okužbe z bakterijami, odpornimi proti več antibiotikom, so lahko hude, usodne in drage ter lahko vodijo neposredno do [2-11] [strokovno usklajeno]:
c) Hospital-based teams, which include infectious disease specialists, clinical pharmacists and microbiologists, providing support to prescribers;
c) skupine sodelavcev v bolnišnicah, ki vključujejo infektologe, klinične farmacevte in klinične mikrobiologe, za nudenje podpore zdravnikom, ki predpisujejo zdravila;
Promoting prudent antibiotic use is both a patient safety and a public health priority [31,42].
Spodbujanje preudarne rabe antibiotikov je prednostna naloga tako z vidika varnosti bolnikov kot tudi javnega zdravja [31,42].
Antibiotics are given to many hospital inpatients [35,36].
Antibiotike prejemajo številni bolniki v bolnišnicah [35,36].
The programme included antibiotic stewardship measures targeting carbapenem use [62].
Program je zajemal ukrepe za nadzor nad rabo antibiotikov, ki so bili usmerjeni na uporabo karbapenemov [62].
Antibiotics are often prescribed to patients in hospitals without explaining the importance of prudent antibiotic use [expert consensus].
Antibiotiki se bolnikom v bolnišnicah pogosto predpisujejo brez pojasnila o pomenu njihove preudarne rabe [strokovno usklajeno].
b) More adverse events, because alternative antibiotic therapies, that are more toxic, must often be used;
b) več neželenih učinkov, saj je pogosto potrebno zdravljenje z nadomestnimi antibiotiki, ki so bolj toksični;
a) Delayed administration of antibiotics in critically ill patients;
a) zapoznelo zdravljenje z antibiotiki pri kritično bolnih;
Increasingly, many European countries have national guidance on antimicrobial stewardship programmes for hospital prescribers.
Vse več evropskih držav je za zdravnike, ki predpisujejo zdravila v bolnišnicah, pripravilo nacionalne smernice o programih za nadzor nad rabo protimikrobnih zdravil.
b) Increasing infection cure rates and reduce treatment failures;
b) povečanju števila ozdravljenja okužb in zmanjšanju števila neuspešnih zdravljenj;
Antimicrobial management initiatives that promote prudent antibiotic use are called antibiotic stewardship programmes [19,42-45].
Pobude za nadzor nad protimikrobnimi zdravili, ki spodbujajo preudarno rabo antibiotikov, se imenujejo programi za nadzor nad rabo antibiotikov [19,42-45].
Antibiotic stewardship programmes consist of multifaceted actions, such as [19,42,43,44,48-57]:
Programi za nadzor nad rabo antibiotikov vključujejo večstranske ukrepe, kot so [19,42,43,44,48-57]:
In a pooled analysis of antibiotic stewardship programmes, total consumption fell (by 19% hospital-wide and by 40% in intensive care units), overall antibiotic costs were reduced (by about one third), and the hospital length of stay shortened (by 9%).
V združeni analizi programov za nadzor nad rabo antibiotikov se je njihova celotna raba zmanjšala (za 19 % po bolnišnicah in za 40 % na oddelkih za intenzivno zdravljenje), zmanjšali so se skupni stroški antibiotikov (za približno tretjino), skrajšalo se je tudi trajanje hospitalizacije (za 9 %).
Availability of guidelines, consultation with infectious diseases specialist, and trainings represent the most helpful interventions to promote better use of antibiotics [25,27].
Razpoložljivost smernic, posvetovanje z infektologi in usposabljanja so najkoristnejši ukrepi za spodbujanje ustreznejše rabe antibiotikov [25,27].
d) Reduced quality of patient stay due to anxiety because of the need for rigorous infection control measures;
d) slabše kakovosti bivanja bolnika v bolnišnici zaradi zaskrbljenosti ob uvedbi strogih ukrepov za obvladovanje okužb;
• 80% reported reduced expenditures;
• 80 % poročalo o zmanjšanju stroškov;
How do antibiotic stewardship programmes work?
Kako delujejo programi za nadzor nad rabo antibiotikov?
Many prescribers do not know antibiotic resistance prevalence rates in their local setting [25,26], and recognise lacks in their training regarding antibiotic use [27].
Številni zdravniki, ki predpisujejo zdravila, ne poznajo, kako so razširjene odpornosti proti antibiotikom v njihovem lokalnem okolju, [25,26] in se zavedajo pomanjkanja usposabljanja na področju rabe antibiotikov [27].
Misuse of antibiotics accelerates the emergence and dissemination of antibiotic resistance [8,31-34].
Neustrezna raba antibiotikov pospešuje pojav in širjenje odpornosti proti antibiotikom [8,31-34].
In a recent survey of hospitals that had implemented an antibiotic stewardship programme [47]:
V nedavni raziskavi bolnišnic, ki so izvajale program za nadzor nad rabo antibiotikov, jih je [47]:
Such multidrug-resistant bacteria are a real and constant threat to clinical practice in all healthcare settings in Europe [1].
Te bakterije, ki so odporne proti več antibiotikom, predstavljajo resnično in nenehno grožnjo za klinično prakso v vseh zdravstvenih ustanovah v Evropi [1].
Antibiotic resistance threatens the health and safety of patients in all healthcare settings in Europe [1].
Pojav odpornosti proti antibiotikom ogroža zdravje in varnost bolnikov v vseh evropskih zdravstvenih ustanovah [1].
f) Using evidence-based antibiotic guidelines and policies;
f) uporaba z dokazi podprtih smernic in politik glede rabe antibiotikov;
h) Monitoring antibiotic resistance and use, and making this information available to prescribers.
h) spremljanje odpornosti proti antibiotikom in njihove rabe ter posredovanje teh informacijzdravnikom, ki predpisujejo zdravila.
Antibiotic resistance is more likely to develop and spread when [39] [expert consensus]:
Razvoj in širjenje odpornosti proti antibiotikom sta verjetnejša v primeru [39] [strokovno usklajeno]:
Examples of antibiotic stewardship strategies, actions and outcomes in European countries include:
Primeri strategij, ukrepov in rezultatov nadzora nad rabo antibiotikov v evropskih državah
• 58% reported reductions in antibiotic resistance.
• 58 % poročalo o zmanjšanju odpornosti proti antibiotikom.
d) Proactive auditing of antibiotic prescriptions with feedback to team members;
d) proaktivne revizije izdanih receptov za antibiotike s pošiljanjem povratnih informacij sodelavcem v skupini;
Gram-negative bacteria, such as Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter spp., are becoming resistant to most available antibiotics [16,17].
Po Gramu negativne bakterije, kot so Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa in Acinetobacter spp., postajajo odporne proti večini razpoložljivih antibiotikov [16, 17].
c) Fewer effective antibiotic treatments for immunosuppressed patients and those undergoing surgical operations;
c) manj učinkovitih antibiotikov za zdravljenje bolnikov z oslabljenim imunskim sistemom in tistih, ki so imeli kirurški poseg;
Netherlands - Implementing rapid processing of microbiology tests increased the proportion of patients receiving appropriate treatment within the first 48 hours in a teaching hospital [63].
Nizozemska - z uvedbo hitre obdelave mikrobioloških testov v učni bolnišnici se je povečal delež bolnikov, ki so prejeli ustrezno zdravljenje v prvih 48 urah [63].
Antibiotic stewardship programmes, can contribute to [42,45,46] [expert consensus]:
Programi za nadzor nad rabo antibiotikov lahko prispevajo k [42,45,46] [strokovno usklajeno]:
Only a few antibiotics in the research and development pipeline may be effective against existing multidrug-resistant bacteria [28-30].
Le nekaj antibiotikov, ki so trenutno v fazi raziskav in razvoja, bi lahko učinkovalo na obstoječe bakterije, ki so odporne proti več antibiotikom [28-30].
Italy - A four-year infection control programme decreased the incidence of infections and colonisation caused by carbapenem-resistant bacteria in a teaching hospital.
Italija - z izvajanjem štiriletnega programa za obvladovanje okužb v učni bolnišnici se je zmanjšala incidenca okužb in kolonizacij, ki so jih povzročile bakterije, odporne proti karbapenemom.
Cephalosporins, carbapenems, fluoroquinolones and anti-anaerobe antibiotics have a high risk of selecting for multidrug-resistant Gram-negative bacteria [40].
Cefalosporini, karbapenemi, fluorokinoloni in protianaerobni antibiotiki predstavljajo visoko tveganje za pojav večkratno odpornih po Gramu negativnih bakterij [40].
c) Reducing adverse events from antibiotic use; and
c) zmanjšanju neželenih učinkov zaradi rabe antibiotikov ter
• 86% reported reduced use of broad-spectrum antibiotics;
• 86 % poročalo o zmanjšanju rabe antibiotikov širokega spektra;
France - Using information technology support for antibiotic prescriptions decreased antibiotic consumption in many hospitals [59].
Francija - z uporabo podpore informacijske tehnologije za predpisovanje antibiotikov se je v številnih bolnišnicah zmanjšala raba antibiotikov [59].
The emergence of bacteria resistant to multiple classes of antibiotics is particularly concerning.
Še posebej zaskrbljujoč je pojav bakterij, ki so odporne proti več različnim razredom antibiotikov.
Sweden - Twice weekly audit and feedback in an internal medicine department led to an absolute 27% reduction of antibiotic use , especially of broad-spectrum antibiotics (cephalosporins and fluoroquinolones), as well as shorter antibiotic treatment durations and earlier switching to oral therapy [68].
Švedska - revizije, ki so se izvajale dvakrat tedensko, in zagotavljanje povratnih informacij so na oddelku za interno medicino privedli do absolutnega 27 odstotnega zmanjšanja rabe antibiotikov, zlasti antibiotikov širokega spektra (cefalosporinov in fluorokinolonov), kot tudi do krajšega trajanja zdravljenja z antibiotiki in hitrejšega prehoda na peroralno zdravljenje [68].
d) The duration of antibiotic therapy is either too short or too long;
d) trajanje antibiotičnega zdravljenja je prekratko ali predolgo;
Antibiotic stewardship programmes can reduce patient care costs [42,45,46].
S programi za nadzor nad rabo antibiotikov se lahko zmanjša stroške oskrbe bolnika [42,45,46].
Misusing antibiotics increases the risk of infections with multidrug-resistant bacteria [15].
Neustrezna raba antibiotikov povečuje tveganje okužbe z bakterijami, odpornimi proti več antibiotikom [15].
• 71% reported reduced healthcare-associated infections;
• 71 % poročalo o zmanjšanju števila okužb, povezanih z zdravljenjem;
• 65% reported reduced length of stay or mortality;
• 65 % poročalo o skrajšanju bolnišničnega bivanja oziroma zmanjšanju umrljivosti;
Misusing antibiotics increases the incidence of Clostridium difficile infections [19-22].
Zloraba antibiotikov povečuje pojav okužb z bakterijo Clostridium difficile [19-22].
Spain - After only one year, education on guidelines combined with regular feedback led to a 26% improvement in the rate of appropriate treatments, and a 42% reduction of antibiotic consumption at a tertiary teaching hospital [67].
Španija - v učni terciarni bolnišnici je izobraževanje o smernicah skupaj z rednimi povratnimi informacijami v samo enem letu privedlo do 26 odstotnega povečanja števila ustreznih zdravljenj in 42 odstotnega zmanjšanja rabe antibiotikov [67].
Hungary - Infectious disease specialist consultation in a surgical intensive care unit, together with a restricted prescribing policy, led to lower use of all antibiotics and a marked reduction in use of broad-spectrum antibiotics [61].
Madžarska - posvetovanja z infektologi na oddelku za intenzivno zdravljenje so skupaj z omejevalno politiko predpisovanja antibiotikov privedla do manjše rabe vseh antibiotikov in izrazitega zmanjšanja rabe antibiotikov širokega spektra [61].
Netherlands - Case audits for the reassessment of antibiotic use after 48 hours reduced antibiotic consumption and length of stay in a urology ward of an academic hospital, and also had a positive direct return on investment [64,65].
Nizozemska - z revizijo primerov za ponovno presojo o rabi antibiotikov po 48 urah se je na urološkem oddelku univerzitetne bolnišnice zmanjšala raba antibiotikov in skrajšalo trajanje hospitalizacije, ukrep pa je imel tudi neposreden pozitiven finančni učinek [64,65].
The incidence of Clostridium difficile infections decreased in the medical and surgical wards of an acute general hospital in the United Kingdom in response to revised empirical antibiotic treatment guidelines for common infections and restrictive measures for fluoroquinolone and cephalosporin usage [48].
Na internih in kirurških oddelkih splošne bolnišnice za akutna stanja v Združenem kraljestvu se je incidenca okužb z bakterijo Clostridium difficile zmanjšala po uvedbi revizije smernic za empirično zdravljenje pogostih ih okužb z antibiotiki ter omejevalnih ukrepov za rabo florokinolonov in cefalosporinov [48].
- Patients with bloodstream infections have a threefold higher mortality rate, prolonged hospital stays, and higher costs if their infection is due to third-generation cephalosporin-resistant Escherichia coli, compared with third-generation cephalosporin-susceptible isolates [12].
- Za bolnike z okužbami krvi so značilni trikrat večja umrljivost, daljša hospitalizacija in višji stroški, če so se okužili z bakterijo Escherichia coli, ki je odporna proti cefalosporinom tretje generacije, v primerjavi z izolati, ki so občutljivi za cefalosporine tretje generacije [12].
Poland - Developing guidelines for antibiotic prescriptions and pre-authorisation approval for restricted antibiotics decreased total antibiotic consumption in a general paediatric ward [66].
Poljska - s pripravo smernic za predpisovanje antibiotikov in dovoljenj za predhodno odobritev antibiotikov za omejeno rabo se je zmanjšala skupna raba antibiotikov na splošnem pediatričnem oddelku [66].
France - Restricting use of fluoroquinolones reduced consumption of this class of antibiotics and decreased the rate of meticillin-resistant Staphylococcus aureus in a teaching hospital [58].
Francija - v učni bolnišnici z omejevanjem uporabe fluorokinolonov se je zmanjšala raba antibiotikov te vrste in zmanjšala stopnja prevalence bakterije Staphylococcus aureus, ki je odporna proti meticilinu [58].
- Patients are up to three times more likely to die if their infections is caused by carbapenem-resistant Klebsiella pneumoniae, compared with carbapenem-susceptible isolates [14].
- Pri bolnikih je umrljivost trikrat večja, če je njihovo okužbo povzročila bakterija Klebsiella pneumoniae, ki je odporna proti karbapenemom, v primerjavi z izolati, ki so občutljivi za karbapeneme [14].
• Broad-spectrum antibiotics are used;
• rabe antibiotikov širokega spektra;
Germany - Implementing a computerised decision support system led to higher adherence to locally adapted guidelines, increased antibiotic-free days and reduced mortality over a five-year period in five intensive care units [60].
Nemčija - z uvedbo računalniškega podpornega sistema za sprejemanje odločitev je na petih oddelkih za intenzivno zdravljenje prišlo v petletnem obdobju do večjega upoštevanja lokalno prilagojenih smernic, večjega števila dni brez antibiotikov in zmanjšanja umrljivosti [60].
g) Using restrictive measures for antibiotic prescriptions (e.g., pre-approval and post-authorization requirements for specific antibiotics);
zahteve za pridobitev predhodnega dovoljenja in naknadno odobritev za določene antibiotike);
c) The dose of antibiotic is either too low or too high;
c) odmerek antibiotika je prenizek ali previsok;
• 96% hospitals reported reduced inappropriate prescribing;
• 96 % poročalo o zmanjšanju neprimernega predpisovanja antibiotikov;
• Too low doses of antibiotics are used.
• prenizkih odmerkov antibiotikov.
b) The spectrum of antibiotic therapy is either too narrow or too broad;
b) spekter antibiotičnega zdravljenja je preozek ali preširok;
Antibiotics are misused when they are prescribed unnecessarily (i.e. antibiotic treatment is not clinically needed) or when they are prescribed inappropriately, i.e. one of the following [18]:
zdravljenje z antibiotiki ni klinično potrebno) ali neustrezno, npr.