1 |

Antibiotic Guardian Workshop

Improving awareness and AMR in Europe

Marc Sprenger, MD PhD , Director AMR

27 June 2018

2 |

What is the scene?

3 |

Klebsiella pneumoniae

Bloodstream infection, urinary tract infection, surgical-site

infection and pneumonia

Carbapenem-resistant KP mortality rate +/- 50% 1

4 |

Carbapenem-resistant K.pneumoniae

2010 EARS-net 2016 CAESAR

5 |

Acinetobacter spp.

Urinary tract infections, skin/soft tissue infections, blood stream

infections, pneumonia and meningitis

30% mortality in hospitalized patients3

6 |

Multidrug-resistant Acinetobacter spp.

2014 EARS-net 2016 CAESAR

7 |

Methicillin-resistant Staphylococcus aureus

(MRSA)

2009 EARS-net 2016 CAESAR

8 |

AMR is the Greatest Threat to Modern Medicine

Profound health consequences

– Individuals, health systems, food systems, and practice of medicine

Economic and other intersectoral implications

– Development, agriculture, food, business, etc.

Long-term threat with no end in sight unless fundamental changes

are made

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Factors Contributing to AMR

Holmes at al., 2016

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Use of Antibiotics Is On The Rise

Van Boeckel et al. The Lancet Infectious Diseases 2014 14, 742-750DOI: (10.1016/S1473-

3099(14)70780-7)

Total global antibiotics

consumption increased

30%

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AMR and the SDGs

Untreatable infections in

animals threaten food prod

AMR hardest on the poor Antibiotic residues (hosp,

pharma & agri contaminate

water

AM core components

health systemsBalance access, innovation

and conservation of AM

*Cumulative costs AMR $120

trillion by 2050

Require multi-stakeholder

partnerships*World Bank Group Report on Drug-Resistant Infections (March 2017)

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Global Action Plan Antimicrobial Resistance

Adopted by World Health Assembly in 2015

Recognized & supported by FAO (Resolution

4/2015) and OIE (Resolution 26) governing

bodies in 2015

Bring AMR to UNGA!

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Global Action Plan's 5 Strategic Objectives

1. Improve awareness and understanding

2. Strengthen knowledge through surveillance & research

3. Reduce the incidence of infection

4. Optimize the use of antimicrobial medicines

5. Ensure sustainable investment

Develop National Action Plan

14 |

Antibiotics Consumption (JIACRA ECDC/EFSA/EMA, 2017)

0

20

40

60

80

100

120

140

160

180

200

In humans mg/kg biomass 2014

15 |

Antibiotics Consumption

0

50

100

150

200

250

300

350

400

450

Human (mg/kg)

In food prod animals & humans mg/kg biomass

(JIACRA ECDC/EFSA/EMA, 2017)

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Patient Pressure to Prescribe Antibiotics

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World Antibiotic Awareness Week

(13 – 19 November 2017)

Antibiotic resistance is a global

health crisis that should be

addressed with the utmost

urgency.

-Dr. Tedros Adhanom Ghebreyesus,

Director General

World Health Organization

18 |

Awareness: 2017 WAAW: 131 countries

15K+ views

9.2 M impressions

175K+ engagements

Global Social Channel Performance Total Countries Participating

Global video

views

21M+ 75.5K+ 850K+Global social channel

impressions

Campaign website page

views

29K+ engagements

Global pieces of

coverage

94

22 11

Region of the Americas Eastern Mediterranean RegionAfrica Region

26 \

European Region

37South East Asia Region

10Western Pacific

Region

25

As there was no hard news

story, a press advisory was

released, and there were a

total of:

The web and social

media were very

successful with:

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Behaviour Change Activities: Focus on Thailand

Antibiotic Smart Use campaign: Awareness, Education and Policy

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Behaviour Change Activities: Focus on Thailand

Antibiotic Smart Use campaign: Awareness, Education and Policy

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Cumulative number of countries enrolling to

GLASS

2

10

19

2732 32

35 37 38 3841 43 43

4649 51

56 56 56 56 57 59 6063 64

68

5

1318 20 20

23 2427

30 30 31 3136

38 4047 47 47 47 48 49

52 53 5458

01020304050607080

Total Enrolment completed

Enrolment call

21.03.2016

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Enrolment completed (n=58)

Enrolment in progress (n=10)

Status of countries enrolled in GLASSAs of 30 April 2018*

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Global Action Plan's 5 Strategic Objectives

1. Improve awareness and understanding

2. Strengthen knowledge through surveillance & research

3. Reduce the incidence of infection

4. Optimize the use of antimicrobial medicines

5. Ensure sustainable investment

Develop National Action Plan

24 |

Methicillin-resistant Staphylococcus aureus

(MRSA)

2009 EARS-net 2016 CAESAR

25 |

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Prof. Celine Pulcini

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Antibiotic Use in Dentistry

In the UK, dentists accounted for 7% of all

community prescriptions of antimicrobials

Antibiotic Guardian has created a pledge

specifically for dentists

1Dar-Odeh, Najla Saeed et al. “Antibiotic Prescribing Practices by

Dentists: A Review.” Therapeutics and Clinical Risk

Management 6 (2010): 301–306. Print.

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National (not including the territories) and regional rates of health care–associated Clostridium difficile infection in adults per 10 000 patientdays from 2009 to 2015.

Kevin C. Katz et al. CMAJ 2018;190:E758-E765

©2018 by Canadian Medical Association

31 |

Antibacterial agents in clinical development

• 51 new antibiotics in the clinical pipeline

• 33 against priority pathogens

• ~9 are innovative

Pipeline is insufficient to treat priority

pathogens & TB

• Of 10 phase-I antibiotics to tackle

gram-negative bacteria only 1-2 will

make it to market in 7 yearsSource: http://apps.who.int/iris/bitstream/10665/258965/1/WHO-EMP-IAU-2017.11-

eng.pdf?ua=1

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"One Health" Approach

AMR affects humans, animals, and the environment

Partnering with FAO and OIE on a comprehensive approach

WHO is collaborating with UNEP to develop evidence base on

AMR’s impact on the environment

33 |

Recommendations

1. Overall use

2. Growth promotion use

3. Prevention use (without disease)

4a. Control use (with disease)

4b. Treatment use (with disease)

Best practice statements

1. About new class of antibiotics

2. About antibiotics currently not being

used in food production

34 |

British Poultry Council

BPC reduced antibiotic use by

weight by 71%

Poultry meat production

increased by 11%

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Increasing Consumer Demand…

Public Interest Research Group, 2016 Public Interest Research Group, 2015

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Global Action Plan's 5 Strategic Objectives

1. Improve awareness and understanding

2. Strengthen knowledge through surveillance & research

3. Reduce the incidence of infection

4. Optimize the use of antimicrobial medicines

5. Ensure sustainable investment

Develop National Action Plan

39 |

National Action Plans AMR (030518)

1. 100 countries have approved NAP*

2. 67 countries in progress

3. 154 countries submitted Tri-partite survey (June)

4. 88 countries involved in community of practice

5. 470 implementers in community of practice

*Small island states, West and Central Africa, Fragile states

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The other part of the world

41 |

Escalating number of deaths in developing

countries

Source: Review

on Antimicrobial

Resistance :

Tackling drug-

resistant infections

globally. O’Neill

report 2016.

42 |

Highest burden of infectious disease

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Burden of infectious disease is in low income

countries Burden of Infectious Disease Progress in developing an AMR

National Action Plans

44 |

Water and Sanitation

40% of health facilities in LMICs have no source of water

– Impossible to prevent infection

Source: Emory

University

45 | Dr Kamini Walia (Paris 20/3/18)c

Cephalosporines

46 | Dr Kamini Walia (Paris 20/3/18)

47 |

Reality of medical practice (Rachel Glogowski)

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Limited staff, 10 fte 3000 beds

57 |

Antibiotics as a substitute for decent

infrastructure

58 |

Antibiotics as a substitute for decent hygiene

59 |

Antibiotics as a substitute for decent care

60 |

For animals as well as humans

61 |

Can you make a difference?...Yes!

1. Prescribe antimicrobials only when necessary

2. Educate patients on AMR & resist pressure to prescribe

3. Vaccinate patients

4. Follow diagnostic procedures

5. Political commitment is essential!: reach out to your government

officials

62 |

Making a difference!

Dame Sally Davies & Lord Jim O’Neill

Wellcome Trust

Fleming Fund

Many more (Wateraid)

63 |

Conclusion

1. You are needed

2. No silver bullet, multiple actions required

3. Substantial progress made, countries involved

4. Political attention is pivotal (WHA)

5. Resources needed, all levels

Its is all about implementation in health system!

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For More Information

Please visit: http://www.who.int/antimicrobial-resistance/en/

On Twitter: @Marcsprenger4PH