Antibiotic Guardian Workshop · Global Action Plan's 5 Strategic Objectives 1. Improve awareness...
Transcript of Antibiotic Guardian Workshop · Global Action Plan's 5 Strategic Objectives 1. Improve awareness...
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Antibiotic Guardian Workshop
Improving awareness and AMR in Europe
Marc Sprenger, MD PhD , Director AMR
27 June 2018
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What is the scene?
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Klebsiella pneumoniae
Bloodstream infection, urinary tract infection, surgical-site
infection and pneumonia
Carbapenem-resistant KP mortality rate +/- 50% 1
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Carbapenem-resistant K.pneumoniae
2010 EARS-net 2016 CAESAR
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Acinetobacter spp.
Urinary tract infections, skin/soft tissue infections, blood stream
infections, pneumonia and meningitis
30% mortality in hospitalized patients3
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Multidrug-resistant Acinetobacter spp.
2014 EARS-net 2016 CAESAR
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Methicillin-resistant Staphylococcus aureus
(MRSA)
2009 EARS-net 2016 CAESAR
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AMR is the Greatest Threat to Modern Medicine
Profound health consequences
– Individuals, health systems, food systems, and practice of medicine
Economic and other intersectoral implications
– Development, agriculture, food, business, etc.
Long-term threat with no end in sight unless fundamental changes
are made
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Factors Contributing to AMR
Holmes at al., 2016
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Use of Antibiotics Is On The Rise
Van Boeckel et al. The Lancet Infectious Diseases 2014 14, 742-750DOI: (10.1016/S1473-
3099(14)70780-7)
Total global antibiotics
consumption increased
30%
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AMR and the SDGs
Untreatable infections in
animals threaten food prod
AMR hardest on the poor Antibiotic residues (hosp,
pharma & agri contaminate
water
AM core components
health systemsBalance access, innovation
and conservation of AM
*Cumulative costs AMR $120
trillion by 2050
Require multi-stakeholder
partnerships*World Bank Group Report on Drug-Resistant Infections (March 2017)
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Global Action Plan Antimicrobial Resistance
Adopted by World Health Assembly in 2015
Recognized & supported by FAO (Resolution
4/2015) and OIE (Resolution 26) governing
bodies in 2015
Bring AMR to UNGA!
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Global Action Plan's 5 Strategic Objectives
1. Improve awareness and understanding
2. Strengthen knowledge through surveillance & research
3. Reduce the incidence of infection
4. Optimize the use of antimicrobial medicines
5. Ensure sustainable investment
Develop National Action Plan
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Antibiotics Consumption (JIACRA ECDC/EFSA/EMA, 2017)
0
20
40
60
80
100
120
140
160
180
200
In humans mg/kg biomass 2014
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Antibiotics Consumption
0
50
100
150
200
250
300
350
400
450
Human (mg/kg)
In food prod animals & humans mg/kg biomass
(JIACRA ECDC/EFSA/EMA, 2017)
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Patient Pressure to Prescribe Antibiotics
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World Antibiotic Awareness Week
(13 – 19 November 2017)
Antibiotic resistance is a global
health crisis that should be
addressed with the utmost
urgency.
-Dr. Tedros Adhanom Ghebreyesus,
Director General
World Health Organization
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Awareness: 2017 WAAW: 131 countries
15K+ views
9.2 M impressions
175K+ engagements
Global Social Channel Performance Total Countries Participating
Global video
views
21M+ 75.5K+ 850K+Global social channel
impressions
Campaign website page
views
29K+ engagements
Global pieces of
coverage
94
22 11
Region of the Americas Eastern Mediterranean RegionAfrica Region
26 \
European Region
37South East Asia Region
10Western Pacific
Region
25
As there was no hard news
story, a press advisory was
released, and there were a
total of:
The web and social
media were very
successful with:
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Behaviour Change Activities: Focus on Thailand
Antibiotic Smart Use campaign: Awareness, Education and Policy
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Behaviour Change Activities: Focus on Thailand
Antibiotic Smart Use campaign: Awareness, Education and Policy
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Cumulative number of countries enrolling to
GLASS
2
10
19
2732 32
35 37 38 3841 43 43
4649 51
56 56 56 56 57 59 6063 64
68
5
1318 20 20
23 2427
30 30 31 3136
38 4047 47 47 47 48 49
52 53 5458
01020304050607080
Total Enrolment completed
Enrolment call
21.03.2016
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Enrolment completed (n=58)
Enrolment in progress (n=10)
Status of countries enrolled in GLASSAs of 30 April 2018*
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Global Action Plan's 5 Strategic Objectives
1. Improve awareness and understanding
2. Strengthen knowledge through surveillance & research
3. Reduce the incidence of infection
4. Optimize the use of antimicrobial medicines
5. Ensure sustainable investment
Develop National Action Plan
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Methicillin-resistant Staphylococcus aureus
(MRSA)
2009 EARS-net 2016 CAESAR
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Prof. Celine Pulcini
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Antibiotic Use in Dentistry
In the UK, dentists accounted for 7% of all
community prescriptions of antimicrobials
Antibiotic Guardian has created a pledge
specifically for dentists
1Dar-Odeh, Najla Saeed et al. “Antibiotic Prescribing Practices by
Dentists: A Review.” Therapeutics and Clinical Risk
Management 6 (2010): 301–306. Print.
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National (not including the territories) and regional rates of health care–associated Clostridium difficile infection in adults per 10 000 patientdays from 2009 to 2015.
Kevin C. Katz et al. CMAJ 2018;190:E758-E765
©2018 by Canadian Medical Association
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Antibacterial agents in clinical development
• 51 new antibiotics in the clinical pipeline
• 33 against priority pathogens
• ~9 are innovative
Pipeline is insufficient to treat priority
pathogens & TB
• Of 10 phase-I antibiotics to tackle
gram-negative bacteria only 1-2 will
make it to market in 7 yearsSource: http://apps.who.int/iris/bitstream/10665/258965/1/WHO-EMP-IAU-2017.11-
eng.pdf?ua=1
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"One Health" Approach
AMR affects humans, animals, and the environment
Partnering with FAO and OIE on a comprehensive approach
WHO is collaborating with UNEP to develop evidence base on
AMR’s impact on the environment
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Recommendations
1. Overall use
2. Growth promotion use
3. Prevention use (without disease)
4a. Control use (with disease)
4b. Treatment use (with disease)
Best practice statements
1. About new class of antibiotics
2. About antibiotics currently not being
used in food production
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British Poultry Council
BPC reduced antibiotic use by
weight by 71%
Poultry meat production
increased by 11%
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Increasing Consumer Demand…
Public Interest Research Group, 2016 Public Interest Research Group, 2015
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Global Action Plan's 5 Strategic Objectives
1. Improve awareness and understanding
2. Strengthen knowledge through surveillance & research
3. Reduce the incidence of infection
4. Optimize the use of antimicrobial medicines
5. Ensure sustainable investment
Develop National Action Plan
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National Action Plans AMR (030518)
1. 100 countries have approved NAP*
2. 67 countries in progress
3. 154 countries submitted Tri-partite survey (June)
4. 88 countries involved in community of practice
5. 470 implementers in community of practice
*Small island states, West and Central Africa, Fragile states
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The other part of the world
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Escalating number of deaths in developing
countries
Source: Review
on Antimicrobial
Resistance :
Tackling drug-
resistant infections
globally. O’Neill
report 2016.
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Highest burden of infectious disease
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Burden of infectious disease is in low income
countries Burden of Infectious Disease Progress in developing an AMR
National Action Plans
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Water and Sanitation
40% of health facilities in LMICs have no source of water
– Impossible to prevent infection
Source: Emory
University
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45 | Dr Kamini Walia (Paris 20/3/18)c
Cephalosporines
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46 | Dr Kamini Walia (Paris 20/3/18)
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Reality of medical practice (Rachel Glogowski)
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Limited staff, 10 fte 3000 beds
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Antibiotics as a substitute for decent
infrastructure
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Antibiotics as a substitute for decent hygiene
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Antibiotics as a substitute for decent care
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For animals as well as humans
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Can you make a difference?...Yes!
1. Prescribe antimicrobials only when necessary
2. Educate patients on AMR & resist pressure to prescribe
3. Vaccinate patients
4. Follow diagnostic procedures
5. Political commitment is essential!: reach out to your government
officials
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Making a difference!
Dame Sally Davies & Lord Jim O’Neill
Wellcome Trust
Fleming Fund
Many more (Wateraid)
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Conclusion
1. You are needed
2. No silver bullet, multiple actions required
3. Substantial progress made, countries involved
4. Political attention is pivotal (WHA)
5. Resources needed, all levels
Its is all about implementation in health system!
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For More Information
Please visit: http://www.who.int/antimicrobial-resistance/en/
On Twitter: @Marcsprenger4PH