Sunday, February 22, 2015 1 Abdullah M Assiri ANTIMICROBIAL RESISTANCE Local perspectives Abdullah M. Assiri, MD Assistant Deputy Minister for Preventive Medicine MOH, KSA
Global threat The WHO Global Strategy for Containment of Antimicrobial Resistance: establish infection control programmes with responsibility for effective management of antimicrobial resistance in hospitals and ensure that all hospitals have access to such a programme
Impact of MDRo on ICP HCF, particularly acute HCF, are important sites for the both the emergence and transmission of antimicrobial resistance. The intensity of antimicrobial use together with Populations highly susceptible to infection create an environment
Impact of MDRo on ICP Some MDRO may be restricted to specific risk groups with little impact on community: Drug resistant fungi in neutropenia patients Burkholderia spp Others have more impact on other patient groups and community: ESBL, MRSA, VRE.
Impact of MDRo on ICP ICPs act primarily through limiting transmission of resistant organisms among patients Some infection control activity may actually promote antimicrobial resistance e.g. prophylactic antimicrobial use Overall, infection control programs have some efficacy in containing antimicrobial resistance, particularly when an outbreak with a resistant strain is identified
Effectiveness of infection control programs Effective ICP decreased the frequency of endemic HCI by 30% to 50% *The SENIC study The specific role of such programs in containing antimicrobial resistance has not been reported An assumption would be that such a program would decrease antimicrobial-resistant infections proportional to the overall decrease HAIs
Effectiveness of infection control programs NOT NECESSARILY STRAIGHTFORWARD Good ICP-----less MDRO infections------less antibiotic use-----less pressure----reduce MDRO BUT Highly immunocompromised patients (who are more likely to get MDRO infections) are those with infections least likely to be preventable
Effectiveness of infection control programs AND Effect on the total burden of colonization of MDRO has also not been adequately evaluated
Prophylactic use of antimicrobials The use of prophylactic antimicrobials to prevent infection is an important infection control intervention Surgical prophylaxis SDD in ICU Decreased requirement for antimicrobial s because infections have been prevented Increased resistance because of antibiotic pressure
LOCAL DATA ON ANTIMICROBIAL RESISTANCE
Selected MRSA metrics from the studies of MRSA colonization and/or infection among patients in Saudi Arabia
Aly and Balkhy Antimicrobial Resistance and Infection Control 2012 1:26 doi:10.1186/2047-2994-1-26
Antibiotic susceptibility for Acintobacter baumanii isolates tested between 2004 and 2009 Ann Saudi Med. 2010 Sep-Oct; 30(5): 364 369.
Zowawi et al, Clinical Microbiology Reviews p. 361 380, Jul 2013
MICROBIOLOGY INFRASTRUCTURE SURVEY
Sunday, February 22, 2015 17 Abdullah M Assiri Voluntary survey Online survey Based on: CDC Patient Safety Component Annual Hospital Survey tool (http://www.cdc.gov/nhsn/forms/57.103_pshos psurv_blank.pdf) 14 hospital responded Survey period was one week ( during March 2014)
Sunday, February 22, 2015 18 Abdullah M Assiri Blood cultures Total no. of blood cultures set (aerobic & anaerobic) processed per year (approx. avrgs) = 4188 Average of 83 blood cultures 83 per week 2418 2965 Blood cultures Urine cultures Chart Title 4676 5453 2598 2712
Antibiogarm of a referral hospital-ksa, 2014 Gram positive bacteria 19
Antibiogarm of a referral hospital-ksa, 2014 Gram negative bacteria 20
INFECTION CONTROL PROGRAMS
ICP Baseline survey 2013 Full time Human resources 100. 75. 50. 39.6 42.1 46.7 46. 45. 43.7 25. 0. North region East region Central region West region South region National
ICP Baseline survey 2013 Surveillance of HAI 100. 75. 50. 43.9 44.6 55.5 52.8 52.3 49.5 25. 0. North region East region Central region West region South region National
ICP Baseline survey 2013 Microbiology lab support 100. 75. 50. 49.3 52.8 63.7 60.5 57.8 56.2 25. 0. North region East region Central region West region South region National
ICP Baseline survey 2013 Knowledge and availability Technical guidelines 100. 75. 53.6 53.1 64.9 60.8 57.3 57.8 50. 25. 0. North region East region Central region West region South region National
Survey of 25 MoH hospitals
Survey of 25 MoH hospitals
Survey of 25 MoH hospitals
Survey of 25 MoH hospitals