survivors Penicillin Untreated Days Penicillin increased the chance of survival from 10 to 90 Patients with pneumonia and bacteria in the blood Adapted from Austrian et al Ann Int Med 1964 ID: 660247
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Slide1
Global Action Plan to combat antimicrobial resistanceSlide2
%
survivors
Penicillin
Untreated
Days
Penicillin increased the chance of survival from 10% to 90%
Patients with
pneumonia
and bacteria
in the blood
Adapted from Austrian
et al.
Ann. Int. Med 1964;
60
, 759Slide3
The more we use them, the more we lose them
From
Albrich
et al EID 2004Slide4
Diseases that should be treatable now more likely to killSlide5
Impact on mutliple sectors of health careInfectious disease
PneumoniaGonorrheaEnteric infectionsBlood infectionsetc.Medical Procedures
Neonatal care
Transplantation
Cancer treatment
Surgery
etc.Slide6
Why now? Increasingly serious global public health threatNew evidence and informationDesperation over "dry pipeline"Economic impact
World Economic Forum 2013 Global Risk Report Growing awareness and commitmentPolitical, professional, publicSlide7Slide8
Focuses on antibacterial resistance (ABR)
Information gathered include:
Surveillance of ABR
according to WHO
regions
National and published data on
7 bacteria
Systematic reviews of evidence of health and economic burden
in
5
bacteria/ resistance combinations
Identification of gaps
Antimicrobial Resistance Global Report
on Surveillance 2014 (I)Slide9
Bacterium
Resistance/ decreased susceptibility to:
Escherichia coli
3
rd
generation cephalosporins,
fluoroquinolones
Klebsiella
pneumoniae
3rd generation cephalosporins, carbapenems
Staphylococcus
aureus
Methicillin (beta-lactam antibiotics) i.e. MRSA
Streptococcus
pneumoniae
Penicillin
Nontyphoidal
Salmonella
(
NTS
)
Fluoroquinolones
Shigella
species
Fluoroquinolones
Neisseria
gonorrhoeae
3
rd
generation
cephalosporins
Selected Bacteria/Resistance CombinationsSlide10
*National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole
Available National Data* on Resistance for Nine
Selected Bacteria/Antibacterial Drug
C
ombinations, 2013Slide11
Name of bacterium/ resistance
Examples of typical diseases
No. of 194 MS providing national data
No.
of WHO regions with national reports of 50 % resistance or more
Range of reported proportion of resistance
Escherichia coli
Urinary tract infections,
blood stream infections
vs
3
rd
gen.
cephalosporins
84
5/6
0-82
vs
fluoroquinolones
90
5/6
3-96
Klebsiella
pneumoniae
Pneumonia,
blood stream infections,
urinary tract infections
-
vs
3
rd
gen.
cephalosporins
85
6/6
2-82
-vs carbapenems
69
2/60-68Staphylococcus aureusWound infections,blood stream infections-vs methicillin “MRSA” 835/60.3-90
Bacteria Commonly Causing Infections in Hospitals and CommunitiesSlide12
Name of bacterium/ resistance
Examples of typical diseases
No. of 194 MS providing national data
No.
of WHO regions with national reports of
25
% resistance or more
Range of reported proportion of resistance
Streptococcus
pneumoniae
Pneumonia, meningitis, otitis
-non-susceptible to penicillin
66
6/6
0-73
Nontyphoidal
Salmonella
Foodborne diarrhoea,
blood stream infections
-
vs
fluoroquinolones
66
3/6
0-96
Shigella
species
Diarrhoea
(“bacillary
dysenteria
”)
-
vs
fluoroquinolones
34
2/6
0-47
Neisseria
gonorrhoeae
Gonorrhoea
-
vs
3
rd gen. cephalosporins 423/60-36
Bacteria Mainly Causing Infections in the CommunitySlide13
Is there any difference in outcome from infections
caused
by
resistant
vs sensitive
bacteria?
Systemic
Reviews: Evidence of the Burden
of Antibacterial
Resistance Slide14
Deaths (%)
Outcome
(number of studies included)
Resistant
Not resistant
RR (95% CI)
Escherichia
coli
resistant to:
3
rd
gen.
cephalosporins
Bacterium attributable mortality (n=4)
23.6
12.6
2.02 (1.41 to 2.90)
Fluoroquinolones
Bacterium attributable mortality (n=1)
0
0
Klebsiella
pneumoniae
resistant to:
3
rd
gen.
cephalosporins
Bacterium attributable mortality (n=4)
20
10.1
1.93 (1.13 to 3.31)
Carbapenems
Bacterium attributable mortality (n=1)
27
13.6
1.98 (0.61 to 6.43)
Staphylococcus
aureus
resistant to:
Methicillin
(MRSA)
Bacterium attributable mortality (n=46)
26.3
16.9
1.64 (1.43 to 1.87)
Risk of Death is Higher in Patients Infected with Resistant StrainsSlide15
Estimates of Burden of Antibacterial Resistance
European
Union
population 500m
25,000
deaths per
year
2.5m extra
hospital daysOverall
societal costs (€ 900 million, hosp. days)
Approx. €1.5 billion per year
United
States
population 300m
>23,000 deaths
>
2.0m illnesses
Overall
societal
costs
Up
to $20 billion direct
Up
to $35
billion
indirect
Source
: ECDC
2007
Source
: US CDC
2013
Thailand
population 70m
>
38,000
deaths
>3.2m hospital days
Overall
societal
costs
US$ 84.6–202.8 mill. direct
>US$1.3 billion indirect
Source:
Pumart et al 2012Global information is insufficient to show complete disease burden impact and costs Slide16
High proportions of resistance were reported in all regions to common treatments for bacteria causing infections in both healthcare settings
and in the community
Antibacterial
resistance has a negative effect on
patient outcomes and
health
expenditures
Treatment options for common infections are running
out
Despite limitations, the report demonstrates
worldwide magnitude of ABR and surveillance gaps
Summary: Antibacterial ResistanceSlide17
Resolution on AMRWorld health Assembly May 2014 ... To develop a draft global action plan to combat AMR ... to ensure that all countries ... have the capacity to combat AMR.
Takes into account existing action plans and all available evidence and best practiceTo apply a multisectoral approach by consulting.....
Submit to 2015 Health Assembly through
the Executive Board January 2015
November 2014Slide18
Consultation on draft GAP (1)Online consultation held between 4 July and 1 September 2014Open to Member States, organizations
130 contributions received from all relevant sectors Member States, Government agencies and organizations: 54 NGOs and civil society: 40
Private sector
: 16
Academia: 16
Other
(International organizations
): 4 Slide19
Consultation on draft GAP (2)
Strengthen tripartite collaborationFAO, OIE, WHOWorked together on development of global action planShared actions for the collaboration
16 October consultation with Member States
http://www.who.int/drugresistance/memberstatemeeting/en
/
17 October 3
rd meeting of WHO Advisory GroupAdditional Member State consultations scheduledOptimizing use of medicines (Oslo, November)Global surveillance (Stockholm, December)Slide20
Draft global action plan will be based on… 5 Guiding principlesWhole of society engagement
Prevention firstAccess, not excessSustainabilityIncremental targets for implementation Slide21
Five strategic objectives: Improve awareness and understanding Strengthen the knowledge and evidence base
Reduce the incidence of infection Optimize the use of antimicrobial medicines Develop the economic case for sustainable investment
Commitments to report
progressSlide22
Communication, Awareness, TrainingPublic communication programmesProfessional education, training, certificationSchools curricula
Public information and mediaRole for all stakeholders in promoting public understanding of infection prevention and use of antimicrobial medicinesSlide23
Strengthen the knowledge and evidence baseCapacity to collect, analyse and report dataGlobal surveillance based on national capacity
Integration of data between human and animal sectorsDevelop global public health research agendaImplement (research funders to support)
Repository of information
Global health R&D observatorySlide24
Reduce the incidence of infectionHygiene, infection prevention and controlHealthcare settings (hospitals)Sanitation, water and food safety
Control of STI, vector borne diseasesHIV, gonorrhoea, malariaRole of vaccines and immunizationExpand use of existing vaccines (e.g. pneumococcal)
Reduce prevalence of infection inappropriately treated with antibiotics (e.g. influenza, rotavirus)
New priority vaccines to prevent difficult-to-treat or untreatable infections
Animal husbandry
H
igh density livestock (terrestrial and aquatic)Slide25
Optimize useRegulatory mechanisms for new antibioticsEffective low-cost tools for diagnosis and susceptibility testing
Access to medicines accompanied by measures to protect continued efficacyCode of practiceSlide26
Sustainable investmentEconomic case for investmentRealizing the global investment needs
Developing countriesCoordinating initiatives aimed at renewing investment in new antibiotics, diagnostics & other toolsSlide27
Implementing, monitoring and evaluationCountries should develop and implement national action plans“building blocks”
National priorities, circumstancesWHO will develop a framework for monitoring and evaluationWHO to report every 2 years
Others to develop own action plans and report within normal reporting cycleSlide28
Thank you