Keeping Antibiotics Working: Nursing Leadership in Action Pat McLaine, DrPH, MPH, RN Robyn Gilden, PhD, RN Department of Family and Community Health Maryland Nurses Association October 2016
US 2 million infections/year 23,000 deaths/year $53-70 billion lost: Excess hospital stays Lost work days Impact of Antibiotic Resistant Infections Maryland 37,500 infections/year 431 deaths/year $1.0-1.3 billion lost Excess hospital stays Lost work days CDC, Antibiotic Resistance Threats in the United States, 2013. p.6, http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf Maryland estimate based on proportion of US population
Global Impact of Antibiotic Resistance No antibiotics kills more people than resistance By 2015, 10 million deaths/year if no action 214,000 neonatal sepsis deaths annually 480,000 new cases of multi-drug resistant TB annually only 25% detected and reported resistance to first line malaria treatment confirmed in 5 countries, likely to spread resistance: HIV/AIDS anti-retrovirals http://www.who.int/mediacentre/factsheets/fs194/en/
Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.
Short Introduction https://youtu.be/zzy-wp9vwwo
Biology in Brief
Antibiotics Do Not Work on Viruses
2011 TOTAL US USE OF ANTIBIOTICS (in millions of pounds) 29,855,066 7,251,390 Human Use Animal Use Source: Center for Science in the Public Interest, Antibiotic Resistance In Foodborne Pathogens, a CSPI White Paper, 2013 p. 11.
ANTIBIOTICS USED ON LIVESTOCK ANTIBIOTICS USE ON LIVESTOCK Therapeutic Humans 20% (sick animals) approx. 14% Livestock 80% Nontherapeutic (animals are not sick) approx. 86% 80% OF ANTIBIOTICS ARE SOLD FOR USE ON LIVESTOCK 83-90% OF LIVESTOCK ANTIBIOTICS ARE FED TO ANIMALS THAT ARE NOT SICK Source: FDA letter to Rep. Slaughter, April 19, 2011; FDA, Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals, 2010; Union of Concerned Scientists, Hogging It!, 2000
Multiple Pathways Animal meat production Spread to food supply via contaminated environments Human exposure through contaminated food and environments Exposure to sick humans, some at higher risk
FEW NEW ANTIBIOTICS ARE BEING DEVELOPED Source: Infectious Diseases Society of America, Clin Infect Dis. 2011;52:S397-S428.
Deadliest Threats in US Health Care Organism Methicillin-resistant Staphlococcus aureus (MRSA) Annual Illnesses Annual Deaths 80,000 11,000 Streptococcus pneumoniae 1,200,000 7,000 Extended spectrum B-lactamase producing Enterobacteriaceae (ESBLs) Vancomycin-resistant Enterococcus (VRE) 26,000 1,700 20,000 1,300 ALL Antibiotic resistance 2,049,442 23,000 Clostridium difficile 250,000 14,000 http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf
Threat Level URGENT! Clostridium difficile 250,000 infections, 14,000 deaths annually 90% of deaths in persons 65+ $1 billion in excess medical costs annually Carbapenem-resistant Enterobacteriaceae 9,000 infections, 600 deaths annually Resistant to nearly all available antibiotics Drug-resistant Neisseria Gonorrhoeae 246,000 infections, <5 deaths annually 30% of all Gonorrhea infections multi-drug resistance will cripple control efforts http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf
WE RISK LOSING MAJOR MEDICAL ADVANCEMENTS Populations at Risk: Chemotherapy patients Surgical patients C-sections Joint replacements People on Dialysis Organ/bone marrow transplant recipients People w/compromised immune systems Very old, very young Source: Centers for Disease Control, Antibiotic Resistance Threats, 2013
The Facts are Clear Hundreds of scientific studies conducted over four decades have shown that feeding low doses of antibiotics to healthy food animals leads to drug-resistant infections in people. In fact, America s leading medical, scientific and public health organizations have been warning of the danger for years.
Options for Action
(CDC, 2013) Health Care Provider Stewardship
Health Care Actions Preventing Infections Immunization Safe food preparation Hand washing Tracking Join hospital committee Follow institution s plan Improving ABX Stewardship Use only if appropriate Right antibiotic Right dose Right way Complete full dosage Developing new drugs, tests
National Progress Report Tracks US & State Progress Tracks health-care associated Infections (HAIs) Central line associated bloodstream infections Catheter-associated UTIs MRSA Bacteremia Surgical Site Infections Abdominal hysterectomy Colon Surgery C. difficle infections Maryland s Report 2014 Lower central line associated blood stream infections Slightly lower surgical site infections colon surgery All other measures higher than national baseline National and State Healthcare Associated Infections Progress Report www.cdc.gov/hai/surveillance/progress-report/index.html
Strategies: 1. Leadership Commitment 2. Accountability 3. Drug Expertise 4. Action 5. Tracking 6. Reporting 7. Education nationalqualitypartners@qualityforum.org Antibiotic Stewardship in Acute Care
Denmark Antibiotics Phased-out Aarestrup, Seyfarth, et al. 2001; http://wwwnc.cdc.gov/eid/article/13/11/pdfs/07-0421.pdf. Final Phase Out
Policy: Germany/EU Ban of Avoparcin from Animal Feeds Result: Decreased vancomycin-resistant enterococci (VRE) in humans
The New No Antibiotics Standard
Individual/Policy Actions Practice Use sustainable, antibiotic-free products Policy/Advocacy Form purchasing committees Advocate for policies to better regulate antibiotic use Support state and national policies to restrict antibiotic use in animal feeding operations
Maryland Legislation MNA supported 2015 and 2016 efforts to restrict antibiotic use in animal feeding operations in Maryland Senator Shirley Nathan Pulliam sponsor & advocate How did your legislators vote? Legislation anticipated in 2017 Involve colleagues, family, friends Your legislators need to hear from YOU!
Global Action September 21, 2016 UN commits to take broad coordinated approach to address root causes across multiple sectors: Human health Animal health Agriculture Development of new antibiotics Need to establish clear goals and targets
Research Opportunities Development of new antibiotics and tests Development of improved global tracking Evaluation of effectiveness of control efforts Tracking: global, national, state, local Change in care/outcomes at health care facilities Change in animal feeding operations Animal and human health outcomes Change in policies Antibiotic use in humans & agriculture
Antimicrobial resistance poses a fundamental threat to human health, development, and security. The commitments made today must now be translated into swift, effective, lifesaving actions across the human, animal, and environmental health sectors. We are running out of time. Dr. Margaret Chan, Director-General of WHO 9/21/2016
Thank You.