Global Action Plan to combat
antimicrobial resistance
| Antimicrobial Resistance
Global Report on Surveillance 2014
Patients with
pneumonia
and bacteria
in the blood
Penicillin increased
the chance of survi
val from 10% to 90
%
Adapted from Austrian et al. Ann
Int. Med 1964;
60, 759
| .Antimicrobial
Resistance
Global Report on Surveillance 2014
% survivors
Penicillin
Untreated
Days
The more we use them, the more we lose them
From Albrich et al EID 2004
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Global Report on Surveillance 2014
Diseases that should be treatable now
more likely to kill
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Global Report on Surveillance 2014
Impact on mutliple sectors of health care
Infectious disease
Medical Procedures
 Pneumonia
 Neonatal care
 Gonorrhea
 Transplantation
 Enteric infections
 Cancer treatment
 Blood infections
 Surgery
 etc.
 etc.
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Global Report on Surveillance 2014
Why now?
Increasingly serious global public health
threat
– New evidence and information
– Desperation over "dry pipeline"
Economic impact
– World Economic Forum 2013 Global Risk
Report
Growing awareness and commitment
– Political, professional, public
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Global Report on Surveillance 2014
| Antimicrobial Resistance
Global Report on Surveillance 2014
Antimicrobial Resistance Global Report
on Surveillance 2014 (I)
•
Focuses on antibacterial resistance (ABR)
•
Information gathered include:
Surveillance of ABR
according to WHO
regions
National and published
data on 7 bacteria
| Antimicrobial Resistance
Global Report on Surveillance 2014
Systematic reviews of
evidence of health and
economic burden in
5 bacteria/ resistance
combinations
Identification of gaps
Selected Bacteria/Resistance Combinations
Bacterium
Resistance/ decreased
susceptibility to:
Escherichia coli
3rd generation cephalosporins,
fluoroquinolones
Klebsiella pneumoniae
3rd generation cephalosporins,
carbapenems
Staphylococcus aureus
Methicillin (beta-lactam antibiotics) i.e. MRSA
Streptococcus pneumoniae
Penicillin
Nontyphoidal Salmonella (NTS)
Fluoroquinolones
Shigella species
Fluoroquinolones
Neisseria gonorrhoeae
3rd generation cephalosporins
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Global Report on Surveillance 2014
Available National Data* on Resistance for Nine
Selected Bacteria/Antibacterial Drug Combinations, 2013
*National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole
Bacteria Commonly Causing Infections
in Hospitals and Communities
Name of bacterium/
resistance
No. of 194 MS
providing
national data
No. of WHO regions with
national reports of 50 %
resistance or more
Range of reported
proportion of
resistance
-vs 3rd gen. cephalosporins
84
5/6
0-82
-vs fluoroquinolones
90
5/6
3-96
-vs 3rd gen. cephalosporins
85
6/6
2-82
-vs carbapenems
69
2/6
0-68
83
5/6
0.3-90
Escherichia coli
Klebsiella pneumoniae
Staphylococcus aureus
Examples of typical
diseases
Urinary tract infections,
blood stream infections
Pneumonia,
blood stream infections,
urinary tract infections
Wound infections,
blood stream infections
-vs methicillin “MRSA”
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Global Report on Surveillance 2014
Bacteria Mainly Causing Infections
in the Community
Name of bacterium/
resistance
Streptococcus
pneumoniae
Examples of typical
diseases
66
6/6
0-73
66
3/6
0-96
34
2/6
0-47
42
3/6
0-36
Diarrhoea
(“bacillary dysenteria”)
- vs fluoroquinolones
Neisseria gonorrhoeae
Range of reported
proportion of
resistance
Foodborne diarrhoea,
blood stream infections
-vs fluoroquinolones
Shigella species
No. of WHO regions
with national reports of
25 % resistance or more
Pneumonia, meningitis,
otitis
-non-susceptible to
penicillin
Nontyphoidal Salmonella
No. of 194
MS providing
national data
Gonorrhoea
-vs 3rd gen. cephalosporins
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Global Report on Surveillance 2014
Systemic Reviews: Evidence of the Burden
of Antibacterial Resistance
Is there any difference in outcome from infections
caused by resistant vs sensitive bacteria?
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Global Report on Surveillance 2014
Risk of Death is Higher in Patients Infected
with Resistant Strains
Deaths (%)
Outcome (number of studies included)
Resistant
Not resistant
RR (95% CI)
2.02 (1.41 to 2.90)
Escherichia coli resistant to:
3rd gen. cephalosporins
Bacterium attributable mortality (n=4)
23.6
12.6
Fluoroquinolones
Bacterium attributable mortality (n=1)
0
0
Klebsiella pneumoniae resistant to:
3rd gen. cephalosporins
Bacterium attributable mortality (n=4)
20
10.1
1.93 (1.13 to 3.31)
Carbapenems
Bacterium attributable mortality (n=1)
27
13.6
1.98 (0.61 to 6.43)
26.3
16.9
1.64 (1.43 to 1.87)
Staphylococcus aureus resistant to:
Methicillin (MRSA)
Bacterium attributable mortality (n=46)
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Global Report on Surveillance 2014
Estimates of Burden of Antibacterial Resistance
European Union
Thailand
United States
population 500m
population 70m
population 300m
25,000 deaths per year
>38,000 deaths
>23,000 deaths
2.5m extra hospital days
>3.2m hospital days
>2.0m illnesses
Overall societal costs
(€ 900 million, hosp. days)
Approx. €1.5 billion per year
Overall societal costs
US$ 84.6–202.8 mill. direct
>US$1.3 billion indirect
Overall societal costs
Up to $20 billion direct
Up to $35 billion indirect
Source: ECDC 2007
Source: Pumart et al 2012
Source: US CDC 2013
Global information is insufficient to show complete disease burden impact and costs
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Global Report on Surveillance 2014
Summary:
Antibacterial Resistance
1.
High proportions of resistance were reported in all regions to common
treatments for bacteria causing infections in both healthcare settings
and in the community
2.
Antibacterial resistance has a negative effect on patient outcomes and
health expenditures
3.
Treatment options for common infections are running out
4.
Despite limitations, the report demonstrates
worldwide magnitude of ABR and surveillance gaps
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Global Report on Surveillance 2014
Resolution on AMR
World health Assembly May 2014 ... To develop a
draft global action plan to combat AMR ... to ensure
that all countries ... have the capacity to combat
AMR.
– Takes into account existing action plans and
all available evidence and best practice
– To apply a multisectoral approach by
consulting.....
Submit to 2015 Health Assembly through
the Executive Board January 2015
– November 2014
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Global Report on Surveillance 2014
Consultation on draft GAP (1)
Online consultation held between 4 July and 1
September 2014
– Open to Member States, organizations
– 130 contributions received from all relevant sectors
• Member States, Government agencies and organizations: 54
• NGOs and civil society: 40
• Private sector: 16
• Academia: 16
• Other (International organizations): 4
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Global Report on Surveillance 2014
Consultation on draft GAP (2)
Strengthen tripartite collaboration
– FAO, OIE, WHO
– Worked together on development of global action plan
• Shared actions for the collaboration
16 October consultation with Member States
– http://www.who.int/drugresistance/memberstatemeeting/en/
17 October 3rd meeting of WHO Advisory Group
Additional Member State consultations scheduled
– Optimizing use of medicines (Oslo, November)
– Global surveillance (Stockholm, December)
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Global Report on Surveillance 2014
Draft global action plan will be based on…
5 Guiding principles
– Whole of society engagement
– Prevention first
– Access, not excess
– Sustainability
– Incremental targets for implementation
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Global Report on Surveillance 2014
Five strategic objectives:
Improve awareness and understanding
Strengthen the knowledge and evidence base
Reduce the incidence of infection
Optimize the use of antimicrobial medicines
Develop the economic case for sustainable
investment
Commitments to report progress
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Global Report on Surveillance 2014
Communication, Awareness, Training
Public communication programmes
Professional education, training, certification
Schools curricula
Public information and media
Role for all stakeholders in promoting public
understanding of infection prevention and use of
antimicrobial medicines
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Global Report on Surveillance 2014
Strengthen the knowledge and evidence base
Capacity to collect, analyse and report data
 Global surveillance based on national capacity
Integration of data between human and animal sectors
Develop global public health research agenda
 Implement (research funders to support)
Repository of information
 Global health R&D observatory
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Global Report on Surveillance 2014
Reduce the incidence of infection
Hygiene, infection prevention and control
 Healthcare settings (hospitals)
Sanitation, water and food safety
Control of STI, vector borne diseases
 HIV, gonorrhoea, malaria
Role of vaccines and immunization
 Expand use of existing vaccines (e.g. pneumococcal)
 Reduce prevalence of infection inappropriately treated with
antibiotics (e.g. influenza, rotavirus)
 New priority vaccines to prevent difficult-to-treat or untreatable
infections
Animal husbandry
 High density livestock (terrestrial and aquatic)
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Global Report on Surveillance 2014
Optimize use
Regulatory mechanisms for new antibiotics
Effective low-cost tools for diagnosis and susceptibility
testing
Access to medicines accompanied by measures to
protect continued efficacy
Code of practice
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Global Report on Surveillance 2014
Sustainable investment
Economic case for investment
Realizing the global investment needs
 Developing countries
Coordinating initiatives aimed at renewing investment in
new antibiotics, diagnostics & other tools
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Global Report on Surveillance 2014
Implementing, monitoring and evaluation
Countries should develop and implement national action
plans
 “building blocks”
 National priorities, circumstances
WHO will develop a framework for monitoring and
evaluation
 WHO to report every 2 years
Others to develop own action plans and report within
normal reporting cycle
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Global Report on Surveillance 2014
Thank you
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Global Report on Surveillance 2014