Effective Surveillance of AMR

Susan Hopkins Healthcare Epidemiologist, Public Health England Consultant Infectious Diseases & Microbiology, Royal Free London Honorary Senior Lecturer, University College London

Objectives •  To outline key surveillance in relation to AMR

•  To outline the importance of data sharing

•  To share experiences

English Surveillance Programme for Antibiotic Use and Resistance (ESPAUR) Established by PHE in 2013 in response to the strategy Terms of reference updated in 2015, at year 2 review Focuses on bringing together NHS, PHE, Private sector across all prescribers and clinicians to improve

Surveillance data on AMR and prescribing Antimicrobial stewardship activities Education and training for healthcare professionals Work with Comms/ Marketing for the Public

3 ESPAUR 2014: Year 2 Report

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Population 56million Four regions, 15 PH centres, 27 NHS area teams Eight Knowledge and Intelligence Teams

–  London –  South West –  South East –  West Midlands –  East Midlands –  North West –  Northern and Yorkshire –  East

Other local presence –  ten microbiology laboratories –  field epidemiology teams

Additional support –  Local teams can also draw on national

scientific expertise based at Colindale, Porton Down and Chilton

Local presence

Prevention of AMR

infections

Environment

Surveillance & epidemiology

Healthcare workers

Antimicrobials Administrative procedures

Know about infection control

Delivery

Symptomatic patients isolated

Sufficient isolation rooms

Systems in place to respond to ↑ in cases

Systems in place to detect & trigger response ↑ in cases

Lab SOPs reliably identify cases

Systems in place to recognise epidemic/ virulent strains

Systems in place to monitor & benchmark

prescribing

Policy available – hospital/GPs

Reduce use of broad spectrums

Antibiotic pharmacist

Can recognise cases early

Know how to monitor & treat cases

Can identify high risk patients

Systems in place to identify & manage cases

Stop unnecessary Rx

High frequency of hand hygiene

Prudent prescribing

Patient equipment cleaned after each use

Systems in place to assure high standard of cleaning

Chlorine used for cleaning in outbreaks

Research to understand causes and risk factors

Research to evaluate prevention measures

AMR: role of surveillance & epidemiology

Surveillance Data Flows

HIV MRSA/MSSA C difficile E coli SSI ICU PPS

Influenza VTEC

Data Sources

Data mgmt systems

Analysis & output

ESPAUR, One Health EARS, ESAC, HAI-net ECDC

HPUs GPs Laboratories: Ref & clinical

IHR & EWRS Outbreaks

& Incidents

NOIDS ePACT IMS

RCGP & Q-Research NHSD FWE HAI SGSS

Clinicians 1° & 2° N H S

Direct AMU ONS WHO/ ECDC

Deaths H I V & STI

A&E

EDSS

Surveys

B P S U , Serology PPS

Aetiological Reporting

Syndromic Reporting

Event Reporting

Other Reporting

SGSS: Second Generation Surveillance System

CSC March 2014 7

Laboratory text files(preferred method)

SGSS LaboratoryData Import

Legacy CoSurv/Amsurv files

Bespoke Excel format (CDR and

AMR)

sFTP

Web Upload

Email

Web Data Entry

Laboratory Person

SGSS Data

Warehouse

ReportingWeb

Business Intelligence Layer (BI)

Mining and Analysis

APIHPZone

External networks PHE network

BI Security layerRole based model based

on requirement / permission to view patient

level or aggregate data

SGSS Operational Database

SGSS – Report Menu

8 AMR Surveillance - WM Antibiotic Pharmacy Group

Resistance in Escherichia coli •  Proportion resistance stable •  Increased rate of bacteraemias & antibiotic resistant bacteraemias •  Regional variation across the country

E. coli isolates non-susceptible to ciprofloxacin, 3rd gen cephalosporins and gentamicin, England 2010-2013

Proportions of E. coli bloodstream infection isolates non-susceptible to indicated antibiotics, NHS Area Team, 2013

Grey areas represent ATs where <70% of isolates had susceptibility data available ESPAUR - BSAC Roundtable Series

Carbapenems ~0.3% of total use 31% increase from 2010 to 2013 99% hospital use Majority of regions increased Huge variability across AT

Consumption of most commonly used carbapenems, DID, 2010-2013

Consumption of carbapenems by General Practice and Hospitals, DID, 2010-13

Map of carbapenem consumption by ATs, DID, 2013

Support and contribute to EU surveillance

Visit from Thai MoH, R Pebody 2013

Proportion of Carbapenems Resistant K. pneumoniae Isolates in Participating Countries 2006-2012

Data source: ECDC (EARS-Net))

2006 2010

2012 2014

Conclusions •  Antimicrobial resistance a significant threat

•  crosses hospital and community •  crosses organisations, borders, regions etc

•  Need effective information for action •  antimicrobial use and resistance •  voluntary and mandatory surveillance •  sentinel and routine surveillance •  geographical and organisation specific

•  Laboratory and Surveillance Strategy goes hand in hand •  early interaction and development key •  decide on outputs (i.e. key needs and information for action/ policy etc) •  develop feedback systems