Antibiotic resistance in Croatia in 2017

According to the European Center for Disease Prevention and Control (ECDC) estimates antimicrobial resistance (AMR) has more dangerous effect on human health than influenza, tuberculosis and AIDS together. And yet, not even after 10 years of public campaign on raising antibiotic resistance awarenes general public and large part of health care professionals still do not recognize AMR as one of the major issues worth renouncing convenineces that the use of broad spectrum antibiotics in any indication provide. Unfortunatelly, bacteria are not waiting for the slow response from the human side but are easily adapting to the enviroment full of antibiotics and we are recently witnessing successful spread of principally gram negative bacteria resistant to almost all antibiotics. Croatia has data on national and regional AMR rates for the period of more than 20 years ever since 1996 when the Croatian Committee for Antibiotic Resistance Surveillance (CARS) was founded at the Croatian Academy of Medical Sciences. The Croatian CARS microbiology laboratory network readily joined the European Antimicrobial Resistance Surveillance System (EARSS) at the very beginning of its functioning in 1998. When the European Surveillance of Antimicrobial Consumption (ESAC) project started in 2001 the Croatian CARS initiated collection of antibiotic consumption data using standardized ESAC methodology. These projects evolved into continuous ECDC programs in 2010 and 2011 in which Croatia as an EU Member State was invited to take part. In 2003 the Croatian Chapter of The Alliance for the Prudent Use of Antibiotics (APUA) was established within the Croatian CARS to further promote international collaboration. Since the early 2000s the World Health Organization emphasize that the AMR problem exceeds the problem of one profession only and that governments should get strongly involved at solving this problem at national and international level. The Croatian Ministry of Health (MoH) has its representative in the CARS ever since this Committee was founded and collaboration with MoH was further enhanced in 2003 when the Reference Centre (RC) for Antibiotic Resistance Surveillance was established at the University Hospital for Infectious Diseases. The RC provides technical support for AMR surveillance activities. MoH also founded the Croatian Intersectoral Coordination Mechanism (ICM), the Interdisciplinary Section for Antimicrobial Resistance Control (ISKRA) in 2006 which strengthened the national AMR and antimicrobial consumption surveillance networks and results reported in this publication are official national data integrated in the national AMR control program which was first issued in 2009 and updated in 2017. Laboratory standardization was recognized as a priority since the beginning of the national surveillance network and Croatian laboratories readily adopted the European Committee for Antimicrobial Sensitivity Testing (EUCAST) standards the same year when they were first issued. To ensure compliance with updates of the EUCAST standards the National Antibiotic Committee (NAC) was founded within CARS in 2011. Thanks to the good collaboration among the microbiology laboratories we are able to timely note emergence of strains with novel resistance mechanisms and to collaborate well with the network of infection control teams. However, in spite of many good initiatives national AMR rates as the indicators of rational antimicrobial prescribing and effective infection control are generally not decreasing. To preserve the efficacy of antibiotics a more rational approach to antibiotic therapy and interpretation of microbiology findings is needed. We hope that this will be achieved through establishing antimicrobial stewardship teams, the A-teams, who will help physicians in rational diagnosing and treating of infections in patients who are increasingly burdened with multiple comorbidities.

Arjana Tambić Andrašević
President of the Committee for Antibiotic Resistance Surveillance in Croatia 

Report on Antibiotic Resistance in Croatia in 2017.pdf

Report on Antibiotic Resistance in Croatia in 2016.pdf

Report on Antibiotic Resistance in Croatia in 2015.pdf

Report on Antibiotic Resistance in Croatia in 2014.pdf

Report on Antibiotic Resistance in Croatia in 2013.pdf

Report on Antibiotic Resistance in Croatia in 2012.pdf

Report on Antibiotic Resistance in Croatia in 2011.pdf

Report on Antibiotic Resistance in Croatia in 2010.pdf

Report on Antibiotic Resistance in Croatia in 2009.pdf

Report on Antibiotic Resistance in Croatia in 2008.pdf

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