Global and National Response to AMR

Chatham House/Murdoch University

AMR Symposium

Chris Baggoley8 December 2014

Drivers of AMR

Globalisation and

international travel

Poor infection prevention and

control

Collapse of antibiotic

research and development

Antibiotic resistance

Poor and unrestrained

use of antibiotics

Substandard

antibiotics

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

0

5

10

15

20

25

30

35

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

DD

D p

er 1

000

inh.

per

day

OthersJ01B+J01G+J01X

Sulfonamides andtrimethoprim J01E

Quinolones J01M

Macrolides, Lincosam.,Streptogramins J01F

Tetracyclines J01A

CephalosporinsJ01D

Penicillins J01C

Source: ESAC Website

AUS

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

Standard 7Blood and Blood

Products

Standard 10Preventing Falls and

Harm from Falls

The NSQHS Standards

Standard 1Governance for Safety and

Quality in Health Service Organisations

Standard 2Partnering withConsumers

Standard 4Medication Safety

Standard 3Healthcare AssociatedInfections

Standard 8Preventing and

Managing Pressure Injuries

Standard 9Recognising and

Responding to ClinicalDeterioration in Acute

Health Care

Standard 5Patient Identificationand ProcedureMatching

Standard 6ClinicalHandover

www.health.gov.au/amr

© Commonwealth of Australia 2013ISBN: 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 elements1. 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

Source: Microbiol. Mol. Biol. Rev. 2010, 74(3):417. DOI: Julian Davies and Dorothy Davies Resistance Origins and Evolution of Antibiotic

Origin and Evolution of Antibiotic Resistance

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

SurveillanceResistance• 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

Leadership

AMR team

Local formulary

Education and training

Prescriber feedback

Measure performance

Clinical microbiology service

Community / primary care

Leadership

Therapeutic guidelines

Practice clinical audit

Education and training

Liaison with local laboratory

Patient education

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 AMRDr Marie-Paule Kieny: 14-16

April 2014

The Drugs Don’t WorkA Global Threat

Published 2013Copyright © Professor Dame Sally C Davies, Dr Jonathan Grant And Professor Mike Catchpole