The Directorate of Health
Well-attended symposium on antimicrobial resistance
25th November 2024
On Monday, November 18th, the Chief Epidemilogist hosted a symposium at Landspítali Unversity Hospital in Fossvogur and on Teams, as part of the annual awareness campaign on antimicrobial resistance (AMR).
The symposium was recorded to allow as many people as possible to watch and listen to the presentations.
Antibiotic use
Over the past ten years, the total sales of antibiotics in Iceland have decreased somewhat, with a significant reduction during the COVID-19 pandemic when the frequency of common infections in the community decreased. About 90% of all antibiotic use is community-based (outside hospitals). Recently, the Directorate of Health launched an interactive dashboard that displays antibiotic use in the community.
The largest share of antibiotic sales to health care institutions in Iceland, approximately 80%, is to Landspítali University Hospital. In recent years, cephalosporin use in hospitals has increased, especially ceftriaxone. The ratio of broad-spectrum antibiotics of total antibiotic use in hospitals in Iceland has nearly doubled in the last five years, reaching 30% in 2023. The use of narrow-spectrum antibiotics is encouraged to prevent further development of AMR.
Antimicrobial resistance
According to nation regulations, three types of AMR must be reported to the Chief Epidemiologist: Broad-spectrum beta-lactamases (BBL), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). A significant increase in BBL-producing organisms has been reported in recent years, and unusually high numbers of MRSA and VRE cases were detected in 2023.
Currently, the largest threat is presented by carbapenemase-producing bacteria, that are resistant to many classes of important antibiotics. Previously, most cases of carbapenemase-producing bacteria were related to hospital stay abroad, but in recent years more cases present without travel or hospitalization abroad. Carbapenemase-producing bacteria have been detected in various food items, and in 2023 infections were traced to consumption of contaminated antibiotic capsules (Dicillin/Staklox) in Denmark and Iceland. The use of proton-pump inhibitors (PPIs) is one of the risk factors for AMR-related infections.
Infection control and antimicrobial stewardship
It is essential to strengthen infection prevention and control (IPC) both in the hospital and community sectors. The transmission routes of resistant bacteria are numerous, including direct contact between individuals, surface contamination, water, food, and airborne transmission. Hand hygiene is the cornerstone of IPC in hospitals, and isolation rooms and targeted use of protective equipment can help prevent the spread of resistant bacteria between patients.
Strengthening antimicrobial stewardship is essential, and recently, a working group was established at Landspítali to enhance and define it´s strategic approach. Antimicrobial stewardship is a team effort that requires the involvement of many professional groups. The goal of antimicrobial stewardship is to optimize antibiotic treatment to achieve the best outcomes while minimizing negative consequences. Effective antimicrobial stewardship can reduce AMR, side effects, mortality and costs.
Access to antibiotics and antibiotic shortages
Antibiotic shortages are a widespread problem, particularly so in Iceland due to the small size of the market and its geographical location. Ensuring minimum drug supplies in the country is crucial, and therefore national regulations on inventory requirements need to be strengthened. Various reasons can contribute to antibiotic shortages, including issues related to production and distribution. To ensure adequate access to antibiotics, the Icelandic Medicines Agency has participated in Nordic tenders that have been successful.
Goal of the awareness campaign
It is important to remind the general public, government officials, healthcare professionals, and other stakeholders of the threat posed by the spread of antimicrobial resistant bacteria and this is the primary goal of the annual awareness campaign.
The Chief Epidemiologist
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