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

10

00 i

nh

. p

er

day

Others

J01B+J01G+J01X

Sulfonamides and

trimethoprim

J01E

Quinolones

J01M

Macrolides, Lincosam.,

Streptogramins

J01F

Tetracyclines

J01A

Cephalosporins

J01D

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 7

Blood and Blood

Products

Standard 10

Preventing Falls and

Harm from Falls

The NSQHS Standards

Standard 1

Governance for Safety and

Quality in Health

Service Organisations

Standard 2

Partnering with

Consumers

Standard 4

Medication

Safety

Standard 3Healthcare

AssociatedInfections

Standard 8

Preventing and

Managing Pressure

Injuries

Standard 9

Recognising and

Responding to Clinical

Deterioration in Acute

Health Care

Standard 5

Patient Identification

and Procedure

Matching

Standard 6

Clinical

Handover

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 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

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 AMR

Dr 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