Worldwide initiative to control AMR and role of antimicrobial stewardship

Transcription

1 GCCMID Dubai, May 2016 Wrldwide initiative t cntrl AMR and rle f antimicrbial stewardship U. Theuretzbacher Center fr Anti-Infective Agents, Vienna, Austria Extensively resistant Gram-negatives Percentage f carbapenem-resistant Klebsiella, CDDEP 2015, WHO 2014, PAHO 1

2 Frm discussin t actin 2

3 Cnvergence f principles Better use f existing antibitics Preventin, infectin cntrl Surveillance Educatin, training Stimulate R&D f new antibitics: innvatin + sustainable use and equitable access prvisins Glbal cllabratin and crdinatin 5 New ecnmic mdels Innvatin Priritisatin 3

4 WHO Glbal Actin Plan AMR Imprve awareness and understanding Strengthen knwledge thrugh surveillance and research Reduce incidence f infectin Optimize the use f antimicrbial medicines Ensure sustainable investment in R&D Eurpean Cmmissin Actin Plan Apprpiate use f antimicrbials identify the key factrs that drive the sales and nn prudent use f antibitics in human medicine, enfrce f the legal prescriptin nly requirement in the EU, dcument best practices EMA: enfrcing f a prescriptin nly plicy fr antibacterials, update prduct infrmatin Strengthen the regulatry framewrk n veterinary medicines and n medicated feed Strengthen infectin preventin and cntrl in healthcare settings Develp and/r strengthen multilateral and bilateral cmmitments fr the preventin and cntrl f AMR in all sectrs Strengthen surveillance systems n AMR and antimicrbial cnsumptin in human medicine Cmmunicatin, educatin and training: Survey and cmparative effectiveness research 4

5 Twards EU guidelines Preparatin f EU guidelines n prudent use f antimicrbials in human health One Health Apprach Brad supprt fr an EU One Health apprach Setting targets in the EU and in Natinal Actin Plans are imprtant Ban n the preventive use f antibitics in animals and firm restrictins n antibitics that are f critical imprtance t human health Framing f AMR as a health security issue Ecnmic benefits and csts f AMR shuld be addressed 5

6 Natinal Actin Plan, USA Centers fr Medicare and Medicaid Services FDA Will require antibitic stewardship aligned with CDC s cre and new infectin cntrl standards in inpatient settings and lng term care facilities Remve all grwth prmtin uses f medically imprtant antibitics by the end f 2016 Use f medically imprtant antimicrbial drugs under veterinary supervisin CDC Antimicrbial Use Measure: risk adjusted summary measure f antibitic use in hspitals, benchmark fr hspitals and health systems t use in antimicrbial stewardship prgrams Departments f Defense Multidrug resistant rganism Repsitry and Surveillance Netwrk CDC: Cre elements f a stewardship prgram Leadership Cmmitment: Dedicating necessary human, financial and infrmatin technlgy resurces. Accuntability: Appinting a single leader respnsible fr prgram utcmes. Experience with successful prgrams shw that a physician leader is effective. Drug Expertise: Appinting a single pharmacist leader respnsible fr wrking t imprve antibitic use. Actin: Implementing at least ne recmmended actin, such as systemic evaluatin f nging treatment need after a set perid f initial treatment (i.e. antibitic time ut after 48 hurs). Tracking: Mnitring antibitic prescribing and resistance patterns. Reprting: Regular reprting infrmatin n antibitic use and resistance t dctrs, nurses and relevant staff. Educatin: Educating clinicians abut resistance and ptimal prescribing. 6

7 CDC: Cre elements f a stewardship prgram Plicies that supprt ptimal antibitic use Dcument dse, duratin, and indicatin Develp and implement facility specific treatment recmmendatins Antibitic Time uts Prir authrizatin Prspective audit and feedback CDC: Cre Elements f Hspital Antibitic Stewardship Prgrams Natinal Actin Plan UK Reward excellence and quality imprvement in the NHS NHS will ffer hspitals incentive funding t supprt expert pharmacists and clinicians review and reduce inapprpriate prescribing Clinical cmmissining grups are being supprted t reduce the number f antibitics prescribed in primary care Hspital trusts will receive payments fr gathering and sharing evidence f antibitic cnsumptin and review within 72 hurs f the beginning f treatment. Reducing the use f specific types f drug 7

8 Natinal Actin Plan Nrway A multisectrial and cmprehensive strategy Surveillance and Mnitring Human Health demand supply Respnsible use Infectin preventin Universal Access need Innvatin and R&D (Knwledge Base) One Health Animal Health Nrwegian Institute f Public Health, Jhn-Arne Rttingen Natinal Actin Plan Suth Africa Precius Matss 8

9 Antibitic resistance is highest pririty G7 Summit, May, Japan Wrld Health Assembly, May, Geneva G 20 Summit, September, China G7 Health Ministers Meeting, September, Japan UN General Assembly Meeting, September, New Yrk Why respnsible and sustainable use? Rate f XDR and PDR Gram negative pathgens increases N new antibitics in develpment against XDR, PDR Reduced therapeutic ptins t treat infectins Higher risk in ther medical fields (cancer treatments, surgery,...) Ecnmic lss 9