Antimicrobial Use and Resistance in Australia

Transcription

1 Antimicrobial Use and Resistance in Australia John Turnidge Senior Medical Advisor, ACSQHC

2 Funding from July 2013 to June 2016 to establish antimicrobial resistance surveillance in Australia

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5 The National Strategy Objectives 1. Increase awareness and understanding of antimicrobial resistance, its implications, and actions to combat it through effective communication, education and training. 2. Implement effective antimicrobial stewardship practices across human health and animal care settings to ensure the appropriate and judicious prescribing, dispensing and administering of antimicrobials. 3. Develop nationally coordinated One Health surveillance of antimicrobial resistance and antimicrobial usage. 4. Improve infection prevention and control measures across human health and animal care settings to help prevent infections and the spread of antimicrobial resistance. 5. Agree a national research agenda and promote investment in the discovery and development of new products and approaches to prevent, detect and contain antimicrobial resistance. 6. Strengthen international partnerships and collaboration on regional and global efforts to respond to antimicrobial resistance. 7. Establish and support clear governance arrangements at the local, jurisdictional, national and international levels to ensure leadership, engagement and accountability for actions to combat antimicrobial resistance.

6 Resistance Surveillance Passive Hospital OrgTRx expansion Community OrgTRx expansion Targeted Hospital AGAR expansion and enhancement Community AGAR expansion and enhancement NNN: Neisseria gonorrhoeae and meningitidis AMRLN: Mycobacterium tuberculosis Salmonella, Shigella

7 Usage Surveillance Passive Hospital NAUSP Community PBS Targeted Hospital NAPS Community MedicineInsight

8 Resistance Rates 2014 and trends Data sources: OrgTRx, Sullivan Nicolaides Pathology, AGAR, AGSP, AMSP, AMRLN

9 Percent Resistant E. coli Blood (n=5,936) Urine (n=82,430) Other (n=2,684) AMP AMC CZL CTR PTZ TMP SXT GEN CIP NOR MER

10 E. coli ESBLs ESBL pampc ESBL + pampc ESBL + pampc + Carb - 100% 90% 80% 70% 60% % 40% 6 30% 20% 10% 0% ACT NSW NT QLD SA TAS VIC WA

11 Percent Resistant K. pneumoniae 60 Blood (n=1,465) 50 Urine (n=10,648) Other (n=1,102) CZL AMC CTR PTZ TMP SXT GEN CIP NOR MER

12 K. pneumoniae ESBLs ESBL ESBL + pampc pampc ESBL + Carb Carb ESBL + pampc + Carb - 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ACT NSW NT QLD SA TAS VIC WA

13 Percent Resistant E. cloacae Blood (n=574) Other (n=4,039) CTR CPM PTZ TMP SXT GEN CIP NOR MER

14 Percent Resistant S. aureus Blood (n=3,705) 70 Other (n=64,785) Penicillin Oxacillin Erythromycin Clindamycin Tetracycline

15 Percent Resistant S. aureus - MRSA 80 Public Hospitals (n=406) AGAR Public Hospitals & Health Services (n=6,135) 63.8 Private Hospitals (n=241) Community (n=415) Residential Aged Care Facility (n=259) CIP ERY CLN SXT GEN RIF FUS LNZ DAP

16 Percent Resistant S. aureus HA-MRSA CIP ERY CLN SXT GEN RIF FUS LIN DAP

17 Percent Resistant S. aureus CA-MRSA CIP ERY CLN SXT RIF FUS LNZ

18 Percent Resistant Percent Resistant E. faecalis and E. faecium Blood (n = 828) Urine (n = 4,258) Other (n = 1,027) Ampicillin Vancomycin Linezolid Ampicillin Vancomycin Linezolid Blood (n = 470) Urine (n = 518) Other (n = 237)

19 Percent E. faecium 70 ND (n=3) 60 not vana or vanb (n=4) vana (n=31) vanb (n=137) ACT NSW NT QLD SA TAS VIC WA AUS

20 Pharmaceutical Benefits Scheme Data from million scripts dispensed for systemic antimicrobials (J01) 22.8 DDD/1000/day 2.7 million scripts dispensed for topical antimicrobials 10.7 million unique patients (46% of population) Captured Public hospital outpatients (except NSW) Repeats Not captured Private scripts?5% Aboriginal medical services and similar

21 Prescriptions (millions) DDD/1000/day Pharmaceutical Benefits Scheme What happened in 2003 and 2006? Year of supply Total Antibiotic Prescriptions J01 Prescriptions J01 DDDs/1000 population/day

22 Preferred Spectra

23 NPS MedicineWise MEDICINEINSIGHT Program

24 NPS MedicineWise MEDICINEINSIGHT Program

25 National Antimicrobial Utilisation Surveillance Program

26 National Antimicrobial Utilisation Surveillance Program

27 National Antimicrobial Utilisation Surveillance Program

28 National Antimicrobial Utilisation Surveillance Program

29 National Antimicrobial Utilisation Surveillance Program

30 National Antimicrobial Prescribing Survey

31 National Antimicrobial Prescribing Survey

32 National Antimicrobial Prescribing Survey

33 National Antimicrobial Prescribing Survey

34 Aged Care NAPS Pilot Table 1: Participating RACFs, by state State Number (%) NSW 17 (9.1) QLD 7 (3.8) SA 8 (4.3) TAS 6 (3.2) VIC 130 (69.9) WA 18 (9.7) Total 186 Table 1: Registered auditors for participating facilities, by profession category Profession category n (%) ICP 56 (47.5) Nurse 42 (35.6) Nurse Practitioner 1 (0.8) Pharmacist 13 (11.0) Quality manager 2 (1.7) Other 4 (3.4) TOTAL 118 Note: In this table, individual auditors are only counted once however several auditors were registered for multiple facilities. Table 2: Participating RACFs, by remoteness Remoteness Number (%) Major Cities of Australia 51 (27.4) Inner Regional Australia 81 (43.5) Outer Regional Australia 45 (24.2) Remote Australia 8 (4.3) Very Remote Australia 1 (0.5) Total 186

35 Aged Care NAPS Pilot Quality Indicator Indication documented (Best practice >95%) Review or stop date documented (Best practice > 95%) % of total antimicrobial prescriptions (n = 975)

36 Aged Care NAPS Pilot Figure 1: The most common indications, by prophylaxis vs treatment prescriptions Treatment 77.1% Prophylaxis 22.9%

37 Just the beginning