Antibiotic Awareness Week 2018 - PowerPoint Presentation

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Antibiotic Awareness Week 2018

Insert your organisation’s name here

Insert presenter’s name here

#AAW2018

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Overview

Antibiotics are

vital life-saving medicines

Antimicrobial resistance is both a global and local problemThe link between antibiotic use and resistanceAddressing antimicrobial resistance in AustraliaAntimicrobial stewardship (AMS)

Antibiotic Awareness

Week

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12 – 18 November 2018

Aims

to encourage best

practice in relation to antibiotic use, among the general public, health workers and policy makers to prevent and contain the spread of antimicrobial resistance.

Antibiotic Awareness Week in Australia

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Antibiotics are a type of antimicrobial

Antimicrobials

Ref:1

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Narrow spectrum antibiotics work against a limited group of bacteria Broad spectrum antibiotics work against a larger group of bacteria

Overuse of unnecessarily broad spectrum antibiotics can drive antimicrobial resistance Broad vs Narrow Spectrum

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Antimicrobial resistance (AMR) occurs when bacteria, parasites, viruses or fungi change to protect themselves from the effects of antimicrobial drugs designed to destroy them.

This means previously effective antimicrobial drugs (e.g. antibiotics) used to treat or prevent infections may no longer work.The World Health Organization (WHO) has identified AMR as ‘one of the biggest threats to global health’.

Australia has in place a national AMR strategy. What is antimicrobial resistance (AMR)?

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Antibiotics treat infections caused by bacteria

Modern medicine, especially surgery and cancer treatments, depends on effective antibiotics to minimise the risk of infectionCurrently, antibiotics reduce post-operative infection rates to below 2.0%

Without effective antibiotics, this could increase to around 40% to 50%. Up to 30% of these patients could die from resistant bacterial infectionsThe risk of mortality without access to effective antibiotics may make some treatments and surgical procedures too risky to continue

Antimicrobial resistance results in substantial financial cost for patients and healthcare systems.Why are antibiotics and antimicrobial resistance important?

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In general, the impact of medications are limited to the patient taking themUse of antibiotics has an impact not just for the patient using them but the global community as well

Antibiotics are unique

Ref:2

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Antimicrobial resistance is a natural phenomenon Overuse, misuse and inappropriate use of antibiotics may accelerate this

The delivery of more complex health care which may require longer use of antibiotics Prolonged hospitalisation The potential impact of

surgical procedures undertaken overseas Resistant pathogens can now spread easilyduring hospitalisation if infection prevention is poor

potential for cross-border transmission through increased travel.How has antimicrobial resistance developed?

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Ref:3

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Resistance is not new

Ref:4

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Resistance is getting worse

2013

2015

Carbapenem-resistant

E

nterobacteriaceae

Ref:5

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Relationship between total antibiotic consumption and

Streptococcus pneumoniae resistance to penicillin in 20 industrialised countries.

Antibiotic use is related to antimicrobial resistance

Ref:6

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Antibiotic use in Australia

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Antibiotic use in Australia

Ref:8

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Very few antibiotics have been developed in the last 20 years

Most ‘new’ antibiotics are variations of existing antibioticsOnly 5 novel classes have been developed in the last 20 years.

Decline in antibiotic production

Ref:9

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Trends in sales of recently launched antibiotics discourage pharmaceutical companies to invest in their research and development

Decline in antibiotic production

Ref:10

Ref:11

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In May 2015, the World Health Assembly adopted a Global Action Plan on Antimicrobial Resistance, which outlines five key objectives to:

Improve awareness and understanding of antimicrobial resistance Strengthen

the knowledge and evidence base Reduce the incidence of infection

Optimise the use of antimicrobial medicines Develop the economic case for sustainable investment.Antimicrobial Resistance – Global ResponseRef:12

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In June 2015, the Australian Government released its first

National Antimicrobial Resistance Strategy 2015–2019 to guide the response to the threat of antimicrobial misuse and resistance. Objectives:

Communication, education and training Antimicrobial stewardship Surveillance

Infection prevention and control National research agenda Strengthen international partnerships Clear governance arrangements. Australia’s response to antimicrobial resistance

Ref:13

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The AURA Surveillance System: Coordinates the integration of data from a range of sources on antimicrobial use and antimicrobial resistance

Contributes significantly to the development and implementation of health strategies to respond to, monitor and prevent antimicrobial resistance in AustraliaAURA 2019 due in March 2019

Surveillance of Antimicrobial Use and Resistance in Australia (AURA)

Ref:14

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In Australia, antimicrobial resistance also affects aged care homes and the community. High levels of antibiotic use in the community (which includes primary and aged care) is a growing concern

Australia is better placed than many countries to respond to antimicrobial resistance through having: The Antimicrobial Use and Resistance in Australia (AURA) Surveillance System

The National Alert System for Critical Antimicrobial Resistances – CARAlert (as part of AURA)

The Australian Government’s National Antimicrobial Resistance Strategy 2015-2019Initiatives developed and implemented by states and territories, and the private sector

Australia’s response to antimicrobial resistance

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Surveillance of Antimicrobial Use and Resistance in Australia (AURA)

N

ational

N

otifiable

D

iseases

S

urveillance

S

ystem

N

ational

N

eisseria

N

etwork

OrgTRx

The AURA National Coordination Unit is responsible for the AURA Surveillance System. Funding for AURA is provided by the Australian Government, and state and territory health departments. Multiple partners contribute data.

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Australia has very high usage of antibiotics in the community - 46% of individual Australians received an antibiotic in 2015

Antibiotics were most commonly dispensed for very young people and older people, with: 51% of those aged 0–4 years

60% of those aged 65 years or over, and 76% of those aged 85 years or over

being supplied at least one antibiotic in 201530% of MedicineInsight patients (just under 1 million people) were prescribed systemic antibiotics between 1 January and 31 December 2015AURA 2017 Key Findings – Antibiotic use in the Community

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Significant amount of antibiotics prescribed for respiratory tract infections (RTI)Seasonal variation is driven by viruses – which do not respond to antibiotics

Data shows that 60% of patients who present with RTI will be prescribed antibiotics.

Prescribing for Upper Respiratory Tract Infection (URTI)

Marked seasonal variation in agents used for RTI

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Treatment failures

Recurring infectionsLonger hospital stays

Longer recovery timesA higher risk of mortality or long term implications

Significant financial cost of treatmentPatient impact of antimicrobial resistant infections

Watch Glen’s Story

here

Ref:15

Preventing infections is everybody's

business

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Which infections are we seeing? [Insert surveillance

data, i.e. what is the most common cause of bacteraemia in your facility]What are our susceptibility and resistance patterns?

[Insert hospital data] [Numbers of cases]

[Examples of cases]Are there local antimicrobial resistance issues?What are local rates of MRSA, C diff?Do you have access to a local antibiogram?Antimicrobial resistance locally – What is happening in our health service?

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This is a placeholder for a local example of a patient who experienced a resistant bacterial infection at your healthcare facility

Insert a case study (optional) You may want to detail the:

diagnosis and the method of diagnosisbacterium that was resistant to the preferred antibiotic

medications used to treat the bacterial infectiontime, resources and people involved to treat the infection impact on the patient, the patient’s life and patient’s familyimmediate, medium or long-term health implications (if any).

Patient story

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Monitoring of Critical Antimicrobial Resistance (CARAlert)

Link to latest

CARAlert Report

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Organisms which are resistant to ‘last-line’ antibiotics653 results - October 2017 – March 2018

87% of all CARs were from the 3 most populous states: New South Wales (32%)

Victoria (34%) Queensland (21%)

Only 4 reports received from the Northern Territory and 5 from TasmaniaMost common CAR - Azithromycin non-susceptible Neisseria gonorrhoeae Followed by Carbapenemase-producing Enterobacterales (CPE)Critical Antimicrobial Resistances (CAR)

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The National Antimicrobial Utilisation Surveillance Program (NAUSP) is a partner in AURA and collects data on antimicrobial use.

Factors that are likely to have contributed to reduced use include: Increased capacity of local, state and territory, and national AMS programs Changes in clinical

practiceMore effective adoption of recommendations in Therapeutic Guidelines: Antibiotic.

Aggregate Hospital Antibiotic Use 2016 (NAUSP)

Ref:16

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Insert local antibiotic use data (if available)

Include information about your contributions to National Antimicrobial Usage Surveillance Program (NAUSP)

Insert NAUSP data.Local Antibiotic Use

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Whilst antimicrobial utilisation is a good measure for the success of antimicrobial prescribing interventions it does not assess why the antimicrobial was used.

Utilisation: how much we use?

Appropriateness: was it a good choice?

Utilisation vs Appropriateness

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National Antimicrobial Prescribing Survey (NAPS) - In 2017, 22.4% of all prescriptions from all participants were deemed “inappropriate” (n= 24 987 prescriptions)

Appropriateness of prescribing in Australia

Ref:17

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Does your healthcare facility audit appropriateness of prescribing?

What tools are used (e.g.. National Antimicrobial Prescribing Survey [NAPS], jurisdictional audit tools)

If participating in NAPS, insert your healthcare facilities results here:

Consider results compared to national results Time series data how the your facility’s NAPS results have contributed to your AMS program.

Appropriateness of prescribing at our hospital

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May increase risk of adverse effects, including: AMR (current and future patients)

Antimicrobial allergyTreatment failure Toxicity (e.g. ototoxicity)Clostridium difficile Increased health care costs (i.e. length of stay)

Why is inappropriate use important?

ReasonYes (%)

No (%)

Not specified (%)

Spectrum too broad

21.9%

46.3%

31.8%

Incorrect dose or frequency

20.1%

50.9%

29.0%

Antimicrobial not required

17.5%

49.8%

32.7%

Incorrect duration

16.5%

51.0%

32.5%

Spectrum too narrow

6.6%

58.8%

34.6%

Incorrect route

5.2%

60.6%

34.3%

n = 5,864

Reasons for a reported prescription being assessed as inappropriate, Hospital NAPS contributors, 2017

Ref:17

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In 2015, around half of the Australian population had at least one antimicrobial dispensed under the PBS (44.7% n = 10,701,804)

Antibiotics in primary care – Pharmaceutical Benefit Scheme (PBS)

Ref:18

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In 2015, only 23.5% of patients prescribed antimicrobials had an indication recorded Of these people, 60% who were reported to have colds/upper respiratory tract infections were prescribed an antimicrobial

But antimicrobials are not generally recommended for these conditions Antibiotics in primary care –

NPS MedicineWise Medicine Insight

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Variation raises concerns about equity and safety and appropriateness of careThere

is marked variation in use of antibioticsbetween statesbetween hospitalsdifferent sizes

within the same sizeThe reasons for this are not well understoodAlso marked variation in community dispensing of antibiotics

The first Australian Atlas of Healthcare Variation (2015) included information on community antibiotic useThe third Atlas will be released later this year containing antibiotic data at a national levelFurther data will be available at state and territory level in 2019Understanding Variation

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Number of PBS prescriptions dispensed for amoxicillin-clavulanate

per 100,000 people, agestandardised, by local area, 2013–14

Ref:19

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Antimicrobial Stewardship isn’t about “not using antimicrobials” but rather “identify that small group of patients who really need antibiotic treatment and then explain, reassure and educate the large group of patients who don’t”

Stewardship means to protect somethingAMS is a systematic approach to

optimising the use of antimicrobialsGoals of AMS are to:

improve patient outcomes / patient safetyreduce antimicrobial resistancereduce costs.AMS works hand-in-hand with infection prevention and control strategies

Antimicrobial Stewardship (AMS)

Ref:20

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Safety

– bring up to the minimum acceptable and sustainable standard

Quality – aspiring to the best possible quality and effectiveness of care

Equity – ensuring every patient regardless of their cultural or linguistic background has the same experience of care

Has the right patient received the right antibiotic, at the right time, at the right dose, via the right route for the right duration?

Is there a systematic approach to ensure each patient using antimicrobials is managed with the principles of AMS?

Does your organisation keep up to date with the latest evidence and strive to innovate and implement that standard of care?

Antimicrobial Stewardship (AMS) – Safety, Quality and Equity dimensions

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Ref:21

A Critical Balance

Risk of toxicity and adverse drug reactions

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Antimicrobial Stewardship

= least harm to current/future patients

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Clear organisational structure and governance

Executive and clinical leadership AMS advisory committee

Multidisciplinary clinical AMS team Expert advice from

infectious diseases experts microbiologists pharmacistsEducation and training prescribers, pharmacists, nursesconsumers

Information technology resources.

Enablers for effective for AMS Programs

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Essential strategies for AMS Programs

Pre-prescription

Post-prescription

Formulary managementDirect patient input eg AMS Round

Restriction System

Audit

and Feedback

Guidelines

Monitor appropriateness

– National Antimicrobial Prescribing Survey (NAPS)

Education

Monitor utilisation – National Antimicrobial Utilisation Surveillance Program

(NAUSP)

Antibiograms (susceptibility

of microogranisms to antimicrobials)

Education

Selective reporting of susceptibility testing

Electronic solutions - eMeds

– automatic stops

Confirming patient’s allergy status

IV to Oral switch

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Insert information on your AMS service:

Structure, governance – who is responsible?Who leads AMS activities?Who is on your local AMS team?What AMS activities are undertaken?

What AMS activities are you / your department involved in?

Antimicrobial Stewardship in our healthcare facility

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In the community General PracticeNot prescribing antibiotics for colds and flu

Delayed prescribingShared decision makingPublic declarations in the practice about conserving antibioticsPharmacies Offering symptomatic support for cold and flu

In the home Not taking antibiotics that haven’t been prescribed for youIn industry Investing in research and development for antimicrobials

Antimicrobial Stewardship – not just for hospitals

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Commission Resources for AMS

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Partnering with consumers

Link

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National Safety and Quality Health Service Standards

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Describes best-practice in antibiotic prescribing:

Urgent treatment of severe infectionAppropriate investigations collected (preferably before antibiotics)Information given to patient about diagnosis

Prescribing as per Therapeutic Guidelines: Antibiotic (or other local guidelines)

Information given to patient about treatmentDocumentation of treatment plan in the recordNarrowing of broad-spectrum empiric treatment when appropriateInvestigations reviewed in a timely waySurgical prophylaxis in accordance with guidelinesAMS Clinical Care Standard

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Always use the most current version Currently version 15, 2014

)New version due March 2019Check hospital intranetA ‘go to’ reference, especially where there are limited local guidelinesLearn more

www.tg.org.au click ‘Products’, then ‘Antibiotic’

Therapeutic Guidelines: Antibiotic

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Use this slide to highlight any AMS initiatives your organisation has completed recently

This may be A new guidelineA new audit

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Insert information on AAW in your health service:

Join the conversation on social media:Hashtags

#AAW2018

#WAAW#AntibioticResistance #AMR@

ACSQHC

and @NPSMedicineWise

Local activities and contact people

Include information about local activities

Local Antibiotic Awareness Week Activities

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Antimicrobial resistance:

occurs when an organism evolves and develops resistance to an antimicrobial that should inhibit or destroy it is reducing the effectiveness of antimicrobials to treat infections

is happening nowFew new antimicrobials are being developed

The misuse, overuse, and inappropriate use of antimicrobials contributes to antimicrobial resistanceAntimicrobial stewardship works hand in hand with prevention and control strategies to help address antimicrobial resistance.

Key messages

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NPS MedicineWise/ACSQHC Antimicrobial Prescribing Modules - https://

learn.nps.org.au/mod/page/view.php?id=4282 Future Learn - https://www.futurelearn.com/courses/antimicrobial-stewardship

Stanford AMS Course - http://errolozdalga.com/medicine/pages/OtherPages/AntibioticReview.ChanuRhee.html MAD-ID Course - http://mad-idtraining.org/certification/

  Infections in Surgery Course - https://infectionsinsurgery.org/management-of-intra-abdomianl-infections-free-online-course/ WHO Course - https://openwho.org/courses/AMR-competency Online Resources for AMS

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https://www.reactgroup.org/toolbox/understand/antibiotics/

http://blog.nus.edu.sg/singaporesling/2016/11/16/the-resistible-rise-of-antibiotic-resistance/Image courtesy of CDC / Melissa Brower

Centers for Disease Control and Prevention Public Health Image Library http://phil.cdc.gov/phil/home.asp

https://www.businessinsider.com.au/alexander-fleming-predicted-post-antibiotic-era-70-years-ago-2015-7 https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/carbapenem-resistant-enterobacteriaceae-risk-assessment-april-2016.pdf Source: The Antimicrobial Resistance Standing Committee (2013)

National Surveillance and Reporting of Antimicrobial Resistance and Antibiotic Usage for Human Health in Australia.

AURA 2017 Report -

https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/2017-report/

AURA 2017 Report -

https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/2017-report/

Butler M,

Blaskovich

M, Cooper M. Antibiotics in the clinical pipeline in 2013. J.

Antibiot

2013;66: 571-591

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/

https://www.sciencedirect.com/science/article/pii/S0006295216303082

http://www.who.int/drugresistance/documents/surveillancereport/en/

https://www.amr.gov.au/resources/national-amr-strategy

AURA 2017 Report -

https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/2017-report/

Youtube

- Glen’s Story -

https://www.youtube.com/watch?v=RIsBB6TmZvA

NAUSP 2016 Report -

https://www.safetyandquality.gov.au/publications/antimicrobial-use-in-australian-hospitals-results-of-the-2016-national-antimicrobial-utilisation-surveillance-program/

NAPS 2017 Report -

https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/naps-2/?

section=4

AURA 2017 Report -

https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/2017-report

/

Australian Atlas of Healthcare Variation -

https://www.safetyandquality.gov.au/atlas/atlas-2015/

British Journal of General Practice 2009, 59: 567

https://c.ymcdn.com/sites/www.ohioshp.org/resource/resmgr/AM_2016_Slides/4BoyleCraftetal-MeettheAntim.pdf

References

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