Global and national response to AMR

1. Global and National
Response to AMR
Chatham House/Murdoch
University
AMR Symposium
Chris Baggoley
8 December 2014

2. Drivers of AMR
Globalisation and
international
travel
Poor infection
prevention and
control
Collapse of
antibiotic research
and development
Poor and
unrestrained use
of antibiotics
Substandard
antibiotics
Antibiotic resistance

3. International AMR initiatives in 2014

7. Ministerial Conference
Antibiotic Resistance
“Joining Forces for Future Health”
The Hague – 25 to 26 June 2014

8. Antimicrobial resistance:
global report on surveillance.
ISBN 978 92 4 156474 8
©World Health Organization 2014

9. Global Health
Security Agenda
Meeting
Washington DC
26 September 2014

10. Total Outpatient antibiotic use in 26
European countries in 2002
35
30
25
20
15
10
5
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
DDD per 1000 inh. per 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

12. 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

13. Regulatory Controls

14. 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 3
Healthcare
Associated
Infections
Standard 4
Medication
Safety
Standard 9
Recognising and
Responding to Clinical
Deterioration in Acute
Health Care
Standard 8
Preventing and
Managing Pressure
Injuries
Standard 5
Patient Identification
and Procedure
Matching
Standard 6
Clinical
Handover

15. www.health.gov.au/amr

16. © Commonwealth of Australia 2013
ISBN: 987-1-921983-47-4
June 2013

17. This publication is available at:
agriculture.gov.au/publications

18. Antimicrobial prescribing practice in
Australia: results of the 2013 National
Antimicrobial Prescribing Survey
www.safetyandquality.gov.au

19. 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

20. 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

21. 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

22. 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

23. 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

25. Global Health
Security Agenda
Meeting
Washington DC
26 September 2014

28. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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???

36. 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

37. Antimicrobial Resistance Global Action Plan
“Going Forward” Strategic Technical Advisory Group
14 April 2014 - Keiji Fukuda (Geneva)

39. Strategic and Technical Advisory Group
for Addressing AMR
Dr Marie-Paule Kieny: 14-16 April 2014

42. The Drugs Don’t Work
A Global Threat
Published 2013
Copyright © Professor Dame Sally C Davies,
Dr Jonathan Grant And Professor Mike Catchpole