Antimicrobial resistance

Dr. Moustapha A. Ramadan

Introduction

• Antibiotics are used to prevent infection (chemoprophylaxis) and to treat patients (chemotherapy) with suspected or proven infection.

• Antibiotics are widely used, contributing to 35% of all prescriptions in health care facilities.

Introduction

• Normal microbial flora is protective.

• The administration of antibiotics kills off susceptible

strains of normal bacteria and these are replaced with resistant strains, which are often resistant to many different classes of antibiotics

Introduction

• About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths.

• Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries.

Global Burden

• A high percentage of healthcare associated infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).

Global Burden

• In the EU, Iceland and Norway,

400 000 resistant hospital‐acquired bacterial infections every year

25 000 people die from these infections every year

2.5 million extra hospital days annually,

costing more than 900 million euros.

Global Burden

Global Burden

What is ANTIMICROBIAL RESISTANCE?

• Antimicrobial resistance (AMR) is resistance of a microorganism (bacteria, viruses and some parasites) to an antimicrobial medicine to which it was previously sensitive

• Microorganisms are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others

Why is AMR a global concern ?

• Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness and greater risk of death.

• AMR reduces the effectiveness of treatment because patients remain infectious for longer, thus potentially spreading resistant microorganisms to others.

Why is AMR a global concern ?

• AMR threatens a return to the pre‐antibiotic era as many infectious diseases risk becoming uncontrollable

• Without effective antimicrobials for care and prevention of infections, the success of treatments such as organ transplantation, cancer chemotherapy and major surgery would be compromised.

Why is AMR a global concern ?

• AMR increases the costs of health care

• AMR compromises health security, and damages trade and economies allows resistant microorganisms to be spread rapidly to distant countries and continents.

WHAT DRIVES AMR?

WHAT DRIVES AMR?

• Inappropriate and irrational use of medicines ( not taking) the full course of a prescribed antimicrobial or when poor quality antimicrobials are used; including in animal husbandry

• Inadequate national commitment to a comprehensive and coordinated response

• Weak or absent surveillance and monitoring systems

WHAT DRIVES AMR?

• Inadequate systems to ensure quality and uninterrupted supply of medicines

• Poor infection prevention and control practices.

• Depleted arsenals of diagnostics, medicines and vaccines as well as insufficient research and development on new products

COMBAT DRUG RESISTANCE

• The emergence of AMR is a complex problem driven by many interconnected factors; single, isolated interventions have little impact.

• A global and national multi-sectoral response is urgently needed to combat the growing threat of AMR.

International Efforts

• WHO calls on all key stakeholders, including policy-makers and planners, the public and patients, practitioners and prescribers, pharmacists and dispensers, and the pharmaceutical industry, to act and take responsibility for combating antimicrobial resistance.

• No action today, no cure tomorrow

International EffortsWHO is engaged in guiding the response to AMR through:

• policy guidance

• support for surveillance

• technical assistance

• knowledge generation and partnerships, including through disease prevention and control programmes

International EffortsWHO is engaged in guiding the response to AMR

through:

• essential medicines quality, supply and rational use

• infection prevention and control

• patient safety

• laboratory quality assurance.

Strategies for reducing transmission of antimicrobial resistant organisms in Health care facilities

• Establishing an Antimicrobial use committee and formulating an antibiotic policy

• Formulation an infection control policy that is simple and effective, that emphasizes good hygiene.

• Knowledge of the infection control policy by all personnel.

Strategies for reducing transmission of antimicrobial resistant organisms in Health care facilities

• Repeated emphasis on hand hygiene.

• Appropriate use of personal protective equipment (PPE).

• Development of lab capacity to correctly identify antibiotic sensitivity patterns.

Strategies for reducing transmission of antimicrobial resistant organisms in Health care facilities

• Use of surveillance data to target specific areas at high risk for antimicrobial resistant organisms.

• Use of spatial separation between patients known to be infected or colonized with MRSA or VRE and patients who are not known to be infected or colonized.

Considerations in formulating antibiotics policies

• Each health care facility should have its own antimicrobial use programme/policies

• All policies should be reviewed after 12- 18 months

• Write down antibiotic prophylactic or therapeutic policies

• Enter the policy in the hospital formulary and display the policy on the walls of the wards

Considerations in formulating antibiotics policies

• Antibiotic use must be justifiable on the basis of the clinical diagnosis and known or expected infecting micro-organisms.

• Appropriate specimens for bacteriological examination must be obtained before initiating antibiotic treatment, in order to confirm the treatment is appropriate

• The selection of an antibiotic must be based not only on the nature of the disease and that of the pathogenic agent(s), but on the sensitivity patterns, patient tolerance, and cost

Considerations in formulating antibiotics policies

• The physician should receive timely, relevant information of the prevalence of resistance in the facility

• An agent with as narrow a spectrum as possible should be used

• Antibiotic combinations should be avoided, if possible

• Selected antibiotics may be restricted in use

Considerations in formulating antibiotics policies

• The correct dose must be used (low dosages may be ineffective for treating infections, and encourage the development of resistant strains, while excessive doses may have adverse effects, and may not prevent resistance).

• The antibiotics chosen for the policy should be rotated after a set period of time in order to reduce selective pressure

Considerations in formulating antibiotics policies

• Limit use of topical antibiotics

• Review the policy periodically. Policies should change if there are changes in the antibiotic resistance patterns, a change in the functions of a unit, a change in staff, a price increase in a certain antibiotic, , or if there are new antibiotics on the market.