Antibiotic resistance and policy in Belgium.
Antibiotic resistance is increasing worldwide, also in Belgium. A few examples to illustrate this problem: S. pneumoniae are becoming increasingly resistant to penicillin and erythromycin; resistance of S. pyogenes to erythromycin is increasing year-by-year; Salmonella and Campylobacter are becoming more and more resistant to the fluoroquinolones. In hospitals, the problem of methicillin-resistant Staphylococcus aureus appears to be decreasing, but two clones of ceftazidime-resistant Enterobacter aerogenes are spreading throughout the Belgian hospitals. Antibiotic resistance has become a serious health care issue both in hospitals and in the community. The popular press has termed some of the multiresistant organisms "killer bugs" or "superbugs". Infection with such organisms has been associated with treatment failures, higher morbidity and mortality and increased costs. In this paper, we will review the problems of antibiotic resistance in the community setting. We will briefly discuss those pathogens with important consequences of morbidity and mortality in the community, such as: Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis, the enteric pathogens Salmonella and Campylobacter, and the urinary tract pathogen E. coli. This resistance has in response to various conditions and opportunities, such as: clustering and overcrowding, increased number of immunodeficient patients, increased elderly population, population mobility, increased use of (broad-spectrum) antibiotics, over-the-counter sale and self-dosing with antibiotics, inappropriate antibiotic prescriptions and lack of compliance, fewer resources for education and infection control, decreased funding for public health surveillance. In Belgium, we should be able to develop, implement and evaluate a good antibiotic policy. Our country has a wealth of information on antibiotic consumption in hospitals and the community. This information has been used for benchmarking of antibiotic consumption in hospitals. A unique system for reimbursement of prophylactic use of antibiotics in surgery was developed which resulted in a more adequate use of antibiotics. However, a policy should not be limited to the human ecosystem. Therefore, a Coordination Commission for Antibiotic Policy was installed recently by the Ministers of Social Affairs, Public Health and Agriculture.
Goossens
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Laboratory for Microbiology, University Hospital Antwerp, University of Antwerp, Universiteitsplein 1-B 2610 Wilrijk-Antwerpen.
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000187:drug effects*; D001530:Belgium; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D015995:Prevalence
D000900:Anti-Bacterial Agents