Download WHO`s Perspective and the Global Action Plan

Global Action Plan to combat
antimicrobial resistance
| Antimicrobial Resistance: Global Surveillance
Antimicrobial Resistance Global Report
on Surveillance 2014 (I)
•
Focuses on antibacterial resistance (ABR)
•
Information gathered include:
Surveillance of ABR
according to WHO
regions
National and published
data on 7 bacteria
| Antimicrobial Resistance: Global Surveillance
Systematic reviews of
evidence of health and
economic burden in
5 bacteria/ resistance
combinations
Identification of gaps
Bacteria Commonly Causing Infections
in Hospitals and Communities
Name of bacterium/
resistance
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
-vs 3rd gen. cephalosporins
84
5/6
0-82
-vs fluoroquinolones
90
5/6
3-96
-vs 3rd gen. cephalosporins
85
6/6
2-82
-vs carbapenems
69
2/6
0-68
83
5/6
0.3-90
Escherichia coli
Klebsiella pneumoniae
Staphylococcus aureus
Examples of typical
diseases
Urinary tract infections,
blood stream infections
Pneumonia,
blood stream infections,
urinary tract infections
Wound infections,
blood stream infections
-vs methicillin “MRSA”
| Antimicrobial Resistance: Global Surveillance
Available National Data* on Resistance for Nine
Selected Bacteria/Antibacterial Drug Combinations, 2013
*National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole
Risk of Death is Higher in Patients Infected
with Resistant Strains
Deaths (%)
Outcome (number of studies included)
Resistant
Not resistant
RR (95% CI)
2.02 (1.41 to 2.90)
Escherichia coli resistant to:
3rd gen. cephalosporins
Bacterium attributable mortality (n=4)
23.6
12.6
Fluoroquinolones
Bacterium attributable mortality (n=1)
0
0
Klebsiella pneumoniae resistant to:
3rd 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)
26.3
16.9
1.64 (1.43 to 1.87)
Staphylococcus aureus resistant to:
Methicillin (MRSA)
Bacterium attributable mortality (n=46)
| Antimicrobial Resistance: Global Surveillance
Estimates of Burden of Antibacterial Resistance
European Union
Thailand
United States
population 500m
population 70m
population 300m
25,000 deaths per year
>38,000 deaths
>23,000 deaths
2.5m extra hospital days
>3.2m hospital days
>2.0m illnesses
Overall societal costs
(€ 900 million, hosp. days)
Approx. €1.5 billion per year
Overall societal costs
US$ 84.6–202.8 mill. direct
>US$1.3 billion indirect
Overall societal costs
Up to $20 billion direct
Up to $35 billion indirect
Source: ECDC 2007
Source: Pumart et al 2012
Source: US CDC 2013
Global information is insufficient to show complete disease burden impact and costs
| Antimicrobial Resistance: Global Surveillance
Summary:
Antibacterial Resistance
1.
High proportions of resistance were reported in all regions to common
treatments for bacteria causing infections in both healthcare settings
and in the community
2.
Antibacterial resistance has a negative effect on patient outcomes and
health expenditures
3.
Treatment options for common infections are running out
4.
Despite limitations, the report demonstrates
worldwide magnitude of ABR and surveillance gaps
| Antimicrobial Resistance: Global Surveillance
Resolution on AMR
World 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 practice
– To apply a multisectoral approach by
consulting.....
Submit to 2015 Health Assembly through
the Executive Board January 2015
– November 2014
| Antimicrobial Resistance: Global Surveillance
Consultation on draft GAP (1)
Online consultation held between 4 July and 1
September 2014
– Open 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
| Antimicrobial Resistance: Global Surveillance
Consultation on draft GAP (2)
Strengthen tripartite collaboration
– FAO, OIE, WHO
– Worked together on development of global action plan
• Shared actions for the collaboration
16 October consultation with Member States
– http://www.who.int/drugresistance/memberstatemeeting/en/
17 October 3rd meeting of WHO Advisory Group
Additional Member State consultations scheduled
– Optimizing use of medicines (Oslo, November)
– Global surveillance (Stockholm, December)
– Research agenda (Brasilia, 1Q2015)
| Antimicrobial Resistance: Global Surveillance
Consultation on draft GAP (2)
• Technical consultations
• Infection prevention and control
• Innovation, R&D of new medicines
• Diagnostics
• Surveillance
• December 2012 – led to global report
• March 2014 – establishment of working groups
• September 2014 – working group meetings
| Antimicrobial Resistance: Global Surveillance
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 progress
| Antimicrobial Resistance: Global Surveillance
Implementing, monitoring and evaluation
Countries should develop and implement national action
plans
 “building blocks”
 National priorities, circumstances
WHO will develop a framework for monitoring and
evaluation
 WHO to report every 2 years
Others to develop own action plans and report within
normal reporting cycle
| Antimicrobial Resistance: Global Surveillance
Global Surveillance:
Resolution WHA67.25
• Urges Member States to:
• Monitor extent of antimicrobial resistance
• To develop AMR surveillance systems
• In patients in hospitals
• Outpatients in all other healthcare settings and the
community
• Animals and non-human usage of antimicrobials
| Antimicrobial Resistance: Global Surveillance
Global Surveillance:
Draft global action plan for WHA68
• Develop a national surveillance system for AMR that:
• Includes a national reference centre with the ability to
systematically collect and analyse data on a core set......
• Includes at least one reference laboratory capable
of......operating to agreed quality standards
• Shares information so that national, regional and global
trends can be detected and monitored
| Antimicrobial Resistance: Global Surveillance
Thank you
| Antimicrobial Resistance: Global Surveillance