Global and National
Response to AMR
Chatham House/Murdoch University
AMR Symposium
Chris Baggoley
8 December 2014
Drivers of AMR
Poor infection
prevention and
control
Collapse of
antibiotic research
and development
Poor and
unrestrained use
of antibiotics
Substandard
antibiotics
Antibiotic resistance
Globalisation and
international
travel
International AMR initiatives in 2014
Ministerial Conference
Antibiotic Resistance
“Joining Forces for Future Health”
The Hague – 25 to 26 June 2014
Antimicrobial resistance:
global report on surveillance.
ISBN 978 92 4 156474 8
© World Health Organization 2014
Global Health
Security Agenda
Meeting
Washington DC
26 September 2014
Total Outpatient antibiotic use in 26
European countries in 2002
35
AUS
Sulfonamides and
trimethoprim
J01E
30
DDD per 1000 inh. per day
Others
J01B+J01G+J01X
25
Quinolones
J01M
20
Macrolides, Lincosam.,
Streptogramins
J01F
15
Tetracyclines
J01A
10
Cephalosporins
J01D
5
Penicillins
J01C
0
FR GR LU PT IT BE SK HR PL IS IE ES FI BG CZ SI SE HU NO UK DK DE LV AT EE NL
Source: ESAC Website
What is already in place?
•
Strong regulatory systems to ensure safe, effective, high
quality medicines
•
Most antibiotics available by prescription only
•
National standards – Infection prevention and control,
antimicrobial stewardship in hospitals
•
Some surveillance of AMR, and antibiotic use in hospitals
•
BUT, some critical gaps, and no comprehensive national
strategy to guide action and ensure efforts are coordinated
Regulatory Controls
The NSQHS Standards
Standard 1
Governance for Safety and
Quality in Health
Service Organisations
Standard 2
Partnering with
Consumers
Standard 3
Healthcare
Associated
Infections
Standard 10
Preventing Falls and
Harm from Falls
Standard 4
Medication
Safety
Standard 9
Recognising and
Responding to Clinical
Deterioration in Acute
Health Care
Standard 5
Patient Identification
and Procedure
Matching
Standard 8
Preventing and
Managing Pressure
Injuries
Standard 7
Blood and Blood
Products
Standard 6
Clinical
Handover
www.health.gov.au/amr
© Commonwealth of Australia 2013
ISBN: 987-1-921983-47-4
June 2013
This publication is available at:
agriculture.gov.au/publications
Antimicrobial prescribing practice in Australia:
results of the 2013 National Antimicrobial
Prescribing Survey
www.safetyandquality.gov.au
National leadership to drive action
• Importance of strong leadership, commitment to
action, and funding to support development and
implementation of a national plan
• Australian AMR Prevention and Containment Steering Group
established February 2013
• $11.9 million allocated in 2013-14 Federal Budget
• Supported by an advisory group to provide expert
clinical and technical advice on AMR
National AMR Strategy
•
Proposed goal: To slow the development and spread of AMR
and conserve the effectiveness of antimicrobials
•
Objectives: To achieve this goal, we will focus our efforts on:
 improving surveillance
 preventing infections and the spread of resistant infections
and
 improving the appropriate use of antimicrobials
Developing a National Antimicrobial Resistance
Strategy for Australia – October 2014
ISBN: 978-1-74186-192-1
Online: ISBN: 978-1-74186-193-8
Publications approval number: 10917
Key elements
1. Infection prevention and control
2. Surveillance
3. Antimicrobial stewardship
4. Communication and Education
5. International engagement
6. Research and Development
7. Governance
Communication & Education
NPSMedicineWise
‘Resistance Fighter’ public
awareness campaign
•
Training modules for medical students and junior hospital medical staff
•
Some education activities available for GPs, but not compulsory
•
Gaps – very difficult to achieve sustained changes in consumer attitudes
and behaviours - continue with efforts to increase public awareness of
AMR, drivers, and appropriate use of antibiotics
Global Health
Security Agenda
Meeting
Washington DC
26 September 2014
Origin and Evolution of
Antibiotic Resistance
Source: Microbiol. Mol. Biol. Rev. 2010, 74(3):417. DOI: Julian Davies and Dorothy Davies
Resistance Origins and Evolution of Antibiotic
ACSQHC: Elements of HAI Standard
 Systems and governance
 Infection prevention policies and protocols
 Managing patients with infections
 Antimicrobial stewardship
 Cleaning, disinfection and sterilisation
 Consumer information
Infection Prevention & Control
National Safety and Quality Health Service (NSQHS) Standards
•
Standard 3: Preventing and Controlling Healthcare
Associated Infections
•
Australian Guidelines for the Prevention and Control of Infection in Healthcare
•
National Hand Hygiene Initiative
•
Gaps – general practice, aged care, veterinary practice, animal health
Surveillance
Resistance
• AGAR is a collaboration of 30 public and private laboratories around
Australia which collects, analyses and reports on trends in the level of AMR
in bacteria causing important and life threatening infections in humans.
Antibiotic Usage
• NAUSP collects data on antibiotic utilisation in Australian hospitals - 80%
national representation of principal referral hospital beds.
• DUSC collects and analyses data on medicines dispensed by community
pharmacies
Appropriateness
• NAPS – annual point prevalence survey on the appropriateness of
antimicrobial prescribing in hospitals
Surveillance
• Gaps - current initiatives not comprehensive/nationally representative.
Need data from general practice, aged care, as well as antibiotic use in
animals and agriculture
• New initiative to improve data on AMR and AU in human health,
including establishing passive and targeted surveillance systems for AMR
and AU across hospital, community and aged care settings and a national
alert system to inform clinicians and policy-makers about emerging AMR
trends.
• Agriculture – report on antimicrobial usage monitoring and resistance
surveillance activities in the animal and agriculture sector in Australia, and
overseas to inform future action
Surveillance of antibiotic usage
 Community
– PBS, Pharmacies – usage data
– Medicare – no. of prescriptions
 Animal - APVMA – antibiotic volumes
 Hospital
– National Antibiotic Usage Surveillance Program (NAUSP) -covers 70% of
acute referral beds – pharmacy dispensing data
 Appropriateness –
– National Antibiotic Prescribing Survey
 Import and supply data
– Therapeutic Goods Administration and the Australian Pesticides and
Veterinary Medicines Authority
Antimicrobial Stewardship
•
•
•
To date, efforts have focussed on hospital
settings
National Safety and Quality Health Service
Standard 3 requires AMS programs to be
implemented
Therapeutic Guidelines: Antibiotic
Gaps:
• No equivalent approach in general practice, aged
care or animal health
• Most antibiotics for humans are prescribed in
community settings, and evidence of increasing
AMR in the community
• Antibiotic use in animal health???
Key components of AMR Stewardship
Hospitals
Community / primary care
Leadership
Leadership
AMR team
Therapeutic guidelines
Local formulary
Practice clinical audit
Education and training
Education and training
Prescriber feedback
Liaison with local laboratory
Measure performance
Patient education
Clinical microbiology service
Prescriber feedback
Antimicrobial Resistance Global Action Plan
“Going Forward” Strategic Technical Advisory Group
14 April 2014 - Keiji Fukuda (Geneva)
Strategic and Technical Advisory Group
for Addressing AMR
Dr Marie-Paule Kieny: 14-16 April 2014
The Drugs Don’t Work
A Global Threat
Published 2013
Copyright © Professor Dame Sally C Davies,
Dr Jonathan Grant And Professor Mike Catchpole