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If you would like to subscribe to the newsletter please click here.You can also view the previous issue(s) of this newsletter by clicking here. You can view WAAAR’s (World Alliance Against Antibiotic Resistance) /ACdeBMR yearly publication on AMR here: AMR Control 2015 /AMR Control 2016.
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In this issue
- A European One Health Action Plan against Antimicrobial Resistance (AMR)
- The Red Zone; Antimicrobial resistance: lessons from Romania
- G20 and AMR
- Italy: education of school youth on antibiotics
- The burden of C. difficile infections in terms of suffering, mortality, and cost in the national health system, France. A Da Volterra press release
- Bacteriophage therapy to treat colistin-only-sensitive Pseudomona
- AB Stewardship in the ICU (A. Dinh; C. Duran)
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News from India on AMR
- Dr Abdul Ghafur, Chennai Declaration: India publishes national IPC Guidelines
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A European One Health Action Plan against Antimicrobial Resistance (AMR)
As a follow up to the 2011 EU action plan on AMR, and in an effort by the EU commission to support the EU stand at the forefront for addressing AMR, a new action plan has been developed and recently published, based on the One Health Approach. This new action plan builds on the 2011 action plan, after its evaluation and receiving feedback on the road map and an open public consultation. The new One Health Action plan is motivated by the need for the EU to play a leading role in the fight against AMR and to add value to Member states actions. As stated in the report, the key objectives of this new plan are built on three main pillars:
- Making the EU a best practice region
- Boosting research, development, and innovation
- Intensifying the EU efforts worldwide to shape the global agenda on AMR
AMR-Times comments: Overall, the action plan was more comprehensive and detailed than the one published in 2011, however, the action plan did point out what to be done, without concrete suggestions on how it can be done, with this lack of clarity, it might be hard to measure the success of the action plan. In the animal health area, it is worth mentioning that the new regulatory framework, based on the recent animal health law, offers an improved basis to develop more detailed rules, as mentioned in the report for controlling resistant bacteria. On the area of awareness, and increasing understanding, the report highlights that the level of awareness of the relationship between the use of antimicrobials, and the development and spread of AMR is still low according to several Eurobarometer surveys, and it is thought that it’s a major cause for the inappropriate use of antimicrobials, but what wasn’t highlighted, was the notion that the level of awareness does not necessarily correspond to rational use, as the decisions and actions made by whether the public or professionals have a behavioural dimension as well. The action plan also discusses, better prevention and control strategies for AMR, including promoting the prudent use of antimicrobials, through guidelines, but the impact of pharmaceutical promotion on the irrational use of antimicrobials was not highlighted, however, the plan did underline the importance of cooperation with industry but in the context of finding alternatives and improving access. There was a whole section in the plan, discussing new therapeutics and alternatives, without specifically mentioning what kind of alternatives, whether herbal products, complementary medicine, and/or vaccinations. It is worth mentioning that, the report did focus on the strengthening bilateral partnerships, improving collaboration with developing countries, addressing the of the environment and animal health.
Report by: Mostafa El Yamany
Web=link: https://ec.europa.eu/health/amr/sites/amr/files/amr_action_plan_2017_en.pdf
Antimicrobial Resistance and causes of non-prudent use of antibiotics in human medicine in the EU
The EU commission produced a report, showcasing the results of ARNA (‘Antimicrobial resistance and the causes of non-prudent use of antibiotics’), a project which was carried out under a contract with the European Commission (Directorate-General for Health and Food Safety). Most of the data collection and work on the project took place from July 2014 to June 2016.
The ARNA project aimed to:
- identify key factors that drive the sales and non-prudent use of antibiotics in human medicine obtained without a prescription;
- assess the level of enforcement of the legislation regarding ‘prescription-only’ use of antimicrobial agents in the EU;
- document good practices aimed at strengthening the more prudent use of antibiotics;
- develop policy options for more prudent use of antibiotics.
The report describes the results of the ARNA (antimicrobial resistance and the causes of non-prudent use of antibiotics) project, found that the highest self-reported use of non-prescription oral antibiotics was in Romania (20% of all antibiotic users in 2013, and 16% in 2016) and Greece (16% of all antibiotic users in 2013, and 20% in 2016). High rates of non-prescription antibiotics use were also found in Latvia, Bulgaria, Croatia, and Hungary. The antibiotics were obtained from either a pharmacy or healthcare provider without a prescription, or were left over from a previous prescription.
Patient surveys in seven of the ARNA countries suggested lack of knowledge about antibiotics was a major determinant of non-prudent use, while surveys of pharmacists found that patient pressure played a role in the decision to sell antibiotics over-the-counter (OTC) without a prescription, with some pharmacists saying they feared customers might go to another pharmacy if they refused. A majority of pharmacists and general practitioners (GPs) reported being asked to prescribe an antibiotic even though there was no medical indication.
Web=links: https://ec.europa.eu/health/amr/sites/amr/files/amr_arna_report_20170717_en.pdf
http://www.cidrap.umn.edu/news-perspective/2017/07/news-scan-jul-17-2017
The Red Zone; Antimicrobial resistance: lessons from Romania
A study by EPHA (European Public Health Alliance)
This study that was reproduced by EPHA provides a case study in which the situation of AMR in Romania is analyzed. The study is the outcome of desk research and in-depth expert interviews. In the annual data collected by ECDC, it was highlighted that for:
- Klebsiella pneumoniae, Romania has the 3rd highest resistance rate among 30 countries surveyed: 49.8% combined resistance to fluoroquinolones, third generation cephalosporins, and aminoglycosides, compared to an EU/EAA average of 18.6%.
- Escherichia Coli: Resistance to third generation cephalosporins was twice as high in Romania (26.8%) as in Europe (13.1%); The combined resistance of the Bacteria to fluoroquinolones, third-generation cephalosporins and aminoglycosides is the third highest among the countries studied, 13.5% versus 5.3% for the EU/EEA
- Methicillin-resistant Staphylococcus aureus (MRSA): Romania is in a distant first place with a 57.2% resistance rate, compared to an EU/EEA average of just 16.8% in 2015
Among the other mentioned strains in the report were Acinetobacter species and Enterococcus feacium, where high levels of resistance were recorded in Romania. “It is clear that you are in the red zone”, said Dr Marc Sprenger, the former ECDC director and the current director of AMR in the WHO, in an interview during the European Antibiotic Awareness Day (EAAD) 2014. He made this statement referring to the 2013 ECDC map, showcasing the percentages of invasive Klebsiella pneumoniae isolates
with combined resistance to third generation cephalosporins, fluoroquinolones and aminoglycosides, where Romania's color on the map is red, which indicated very high levels of combined resistance.
Regarding Antibiotic consumption, Gabriel Popescu, Infections Diseases Professor and adviser to the Health Minister Voiculescu said “Antibiotic consumption in Romania has reached a very high level”, and data collected from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) shows that Romania had a total consumption in the community and the hospital sector of 33.3 defined daily doses per thousand inhabitants and per day, the second highest in Europe. On awareness, and the degree of knowledge about the appropriate use of antibiotics, the 2016 Eurobarometer on AMR, confirms that Romanian knowledge is below the European average; the second lowest in the EU, on par with Bulgaria, Greece, and Latvia. Professor Alexandru Rafila told EPHA that another reason for the increased AMR is the lack of screening procedures for patients who carry resistant bacteria and of capacities to isolate them from the rest of the hospital patients. Regarding antibiotic prescribing by physicians and their dispense in pharmacies, the vice president of the National Medicines Agency, Vlad Mixich told EPHA regarding regulation “You can pass laws, give sanctions, It’s useless-especially on this subject, because you’re interfering with the doctor’s independence and autonomy to practice, which is a delicate area legally and ethically.”—“This is a very difficult thing to understand in Western Europe: legally, on paper, things are the way they should be; but in practice, the law does not necessarily apply.”- It was stated in the study that Mixich believes that better results could be achieved through behavioral interventions to physicians and pharmacists. In the last pages of the study, there was a strong point made by Dr. Marius Geantă, on Europe’s role; he said that “There is the free movement of goods, capitals, people, and services – but there’s also (the free movement of) treatment resistant microorganisms. The first four are regulated through (European) directives, right? I think (the latter) should also be regulated on way or the other. I would not leave everything up to the member states”.
Summary by Mostafa El Yamany
Web=link: https://epha.org/wp-content/uploads/2017/06/In-the-red-zone-EPHA.pdf
G20 and AMR
The G20 final declaration includes a large segment on AMR, meaning a commitment at the level of Heads of State.
However, the UN General Assembly of fall 2016 had already highlighted this engagement. The decrease in health system funding in the EU, to speak of that region, continuing over the past few years have cut back on personnel, on infrastructure, and have a deleterious effect on infection prevention and control, meaning more hospital-acquired-infections risks for patients and personnel alike, which will cost more than the ‘savings’ by budgetary restraints. Furthermore, the excellent national AMR Plans will not translate into action without investments to back them up...
The only positive news was the “Global AMR Collaboration Hub”. But, as is the case for Tuberculosis (increasingly drug-resistant) or for HIV (ARV resistance on the rise too), countries need strong well-funded health systems to face AMR and to prevent AMR infectious disease epidemics, then the ‘Hub’ will have the skeleton to support it. The tendency in AMR today is to concentrate on the muscle power and to let the backbone fall apart. Has anyone ever seen a mass of powerful muscles without a skeleton??
We happened to read Richard Horton in the Lancet on the G20. He’s right and restrained alright.
Much promises, but what’s concrete in the end? AMR-Times editor
The G20 “Global AMR Collaboration Hub”
The Wellcome Trust press release stressed that: “The Global Collaboration Hub will be open to all G20 countries, G20 guest countries and to non-government donors. Members will be expected to release additional investment in national and/or international research, but there will not be a set minimum for entry.”
The Hub is expected to fund R&D for new products, including vaccines and diagnostics.
“The scope of work will cover all stages of the antimicrobial development pipeline, as well as vaccines, alternative therapies, and new diagnostic tools.”
Of all comments, we liked Jim O'Neill's best: “O'Neill said: "in the Review on AMR, we recommended 27 interventions that could solve the AMR crisis for a generation. So far this decade, however, three US-based pharmaceutical manufacturers have already spent more money buying back their own shares than would be needed to see those interventions through. Pharmaceutical companies have essentially become balance-sheet managers first, and drug makers second. Someone needs to flip that model on its head.”
Web=link: https://wellcome.ac.uk/press-release/wellcome-and-gates-foundation-support-new-global-body-tackle-superbugs
AMR related News Items and Scientific Articles
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Italy: educating primary school students on AB use
A pool of public health experts from the University of Turin has developed a hands-on educational program called Microbiological@mind project, aimed not only to increase practical knowledge of prudent antibiotic use among the general public as well as the prescribers but also to stimulate scientific interest on the topic.
The objective of the project, started in September 2011 and concluded in 2015, was to foster comprehension of AMR to a selection of more than 1,200 primary school students from Turin, Italy, aged 9 to 11. Through the implementation of workshops, consisting of hands-on experiments in the laboratory, team competitions, and interactive activities, the experts attempted to educate children about microbiology, reinforcing awareness of positive behaviors that may ensure a safer lifestyle and prevent the unnecessary or inappropriate use of antibiotics. Furthermore, to analyze the effectiveness of the project, students have been subjected to a pre and post activity test consisting in a closed-answers questionnaire, based on the contents of the workshops - namely the introduction to microbes, infection spread, the immune system, infection treatment, and infection prevention. The results of the analysis showed that, due to the implementation of the teaching activity, students were able to significantly increase their understanding of the topic despite the consistent lack of basic knowledge regarding antibiotics. In fact, the percentage of correct answers in the pre-test was 2.0% and 12.1 % for antibiotic action and use, respectively. In the post-test, knowledge of the correct use of antibiotics rose from 5.0% to 77.2% in the post-test, and knowledge of risk of bacterial resistance to antibiotics due to their incorrect increased from 12.2% to 73.6%. As the authors pointed out, although it is difficult to determine the effectiveness of the project, due to the lack data on a long-term basis and alternative variables that might have affected the results of the post-test, it is accurate to believe that early childhood microbial literacy through the attendance of workshops based on hand-on approach should raise awareness on proper use of antibiotics and health-related issues.
Report by Caterina Floriani Mussolini for AMR-Times
AMR-Times Chief Editor’s comment: this study is tremendous and should be considered a model to be adopted in all countries.
The Microbiological@mind project: a public engagement initiative of Turin University bringing microbiology and health education into primary schools
Web=link: http://www.ijaaonline.com/article/S0924-8579(17)30199-1/fulltext
The Burden of C. difficile Infections in Terms of Suffering, Mortality, and Costs in France's Hospital System
Data were extracted from the French national hospitalization database for patients covered by the national health insurance scheme in 2014. Hospitalizations were selected using the International Classification of Diseases, 10 th revision (ICD-10) code for CDI. Hospital stays with CDI as the primary diagnosis or the secondary diagnosis (comorbidity) were studied for the following parameters: patient sociodemographic characteristics, mortality, length of stay (LOS), and related costs. A retrospective case-control analysis was performed on stays with CDI as the secondary diagnosis to assess the impact of CDI on the LOS and costs.
Overall, 5,834 hospital stays with CDI as the primary diagnosis were included in this study. The total national insurance costs were €30.7 million (US $33,677,439), and the mean cost per hospital stay was €5,267±€3,645 (US $5,777±$3,998). In total, 10,265 stays were reported with CDI as the secondary diagnosis. The total national insurance additional costs attributable to CDI were estimated to be €85 million (US $93,243,725), and the mean additional cost attributable to CDI per hospital stay was €8,295±€17,163, median, €4,797 (US $9,099±$8,827; median, $5,262).
CDI has a high clinical and economic burden in the hospital, and it represents a major cost for national health insurance. When detected as a comorbidity, CDI was significantly associated with increased LOS and economic burden. Preventive approaches should be implemented to avoid CDIs.
"To describe the hospital stays of patients with Clostridium difficile infection (CDI) and to measure the hospitalization costs of CDI (as primary and secondary diagnoses) from the French national health insurance perspective"
Infect Control Hosp Epidemiol 2017;38:906–911
Da Volterra press release:
Clostridium difficile infections in hospitalized patients have a high clinical and economic burden and represent a major cost for national health insurance (in France).
- Clostridium difficile Infections (CDI) acquired during hospitalization significantly increased the length of stay and the economic burden
- The total cost of CDIs in French hospitals was 115.7M€ in 2014 for the national health insurance
Paris (France) – 18 July 2017 – Da Volterra, a leading biotechnology company developing a portfolio of unique products in the antibacterial field, with a specific focus on antibiotic resistance, reports today results from a retrospective study on the epidemiology and costs of Clostridium difficile infections in French hospitals published under the title “Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective” in the journal “Infection Control and Hospital Epidemiology”. The study shows that the total costs attributable to Clostridium difficile infections (CDI) in hospitalized patients were estimated at 115.7M€ for the French national health insurance (Assurance Maladie) in 2014. (In Europe, the cost of this pathology is estimated to reach more than 3 billion euros a year) Researchers conducted a large retrospective study on all hospital discharges that occurred in France in 2014 to understand the clinical and economic burden of Clostridium difficile infections in hospitalized patients, analyzing 16,099 hospital stays. There were 4,968 patients who were admitted with a CDI as the primary diagnosis and 9,156 who were admitted to the hospital for a different health condition and acquired the infection during their hospital stay. The study indicated that the mean age of CDI patients was 69 years. The hospital mortality of patients with a primary diagnosis of CDI was 7.4%, while it was 17.3% in patients where the CDI was a secondary diagnosis.
“This study shows in a new light the importance of the medical impact of Clostridium difficile, and it deserves to be recognized by French hospital practitioners in order to avoid these infections.” said Antoine Andremont, MD, PHD, a leading microbiologist expert from INSERM, University Paris Diderot and Hospital Bichat who participated in the study.
The median length of stay (LOS) of community onset CDI as a primary diagnosis was 9 days, whereas hospital-acquired CDIs added 11 days in the hospital over patients without a CDI.
This finding suggests that hospital-acquired CDIs place a high burden on the national health insurance system by causing patients to stay longer in the hospital, decreasing the bed turnover and leading to higher healthcare costs.
This hypothesis was confirmed upon examination of the additional study results: the total cost of CDI was 115.7M€, where 30.7M€ were attributable to when the reason for admission was CDI, and 85M€ were attributable to hospital-acquired CDIs. Clostridium difficile infections are extremely costly, especially when onset occurs during hospitalization.
Florence Séjourné, CEO of Da Volterra, stated: “This study clearly demonstrates that innovative preventive approaches should be implemented to diminish both the suffering of patients and the economic burden of CDIs on our healthcare system. Da Volterra is committed to the prevention of CDIs and has been actively engaged in this fight for several years. We are now positioned as one of the rare companies in the world to have a new therapeutic agent in clinical development for the prevention of these life-threatening infections.”
About Da Volterra: Da Volterra is a biopharmaceutical company based in Paris (France) and develops new strategies for the prevention and the treatment of multi-resistant and life-threatening bacterial infections for which the medical need is increasing and remains largely unmet. While antibiotic resistance and healthcare associated infections threaten current medical practice, Da Volterra’s innovative approaches promise substantial medical progress while fitting the expectations of healthcare professionals. Its most advanced product, DAV132, is developed to prevent Clostridium difficile infections in at high-risk patients by protecting the intestinal microbiota from antibiotic induced disruptions.
Web=link: http://dx.doi.org/10.1017/ice.2017.114 http://www.davolterra.com
Bacteriophage therapy to treat colistin-only-sensitive Pseudomonas aeruginosa septicemia
A case study conducted on a patient affected by acute kidney injury showed how bacteriophage therapy was effective Ito treat colistin-only-sensitive Pseudomonas aeruginosa septicemia. Bacteriophages are increasingly adopted as safe alternatives or additions to antibiotic therapy. In particular cases, bacteriophage cocktails are a good alternative or support to treat potential fatal sepsis from bacteremia caused by bacterias such as Pseudomonas aeruginosa.
In the case presented, the patient was initially treated with antibiotic therapy and, in a later stage, with purified bacteriophage cocktail BFC1. In 2016, a 61-year-old man was diagnosed with Enterobacter cloacae peritonitis and severe abdominal sepsis with disseminated intravascular coagulation, secondary to a diaphragmatic hernia with bowel strangulation. Some complications emerged causing a gangrene of the peripheral extremities, which led to the amputation of the lower limbs and the development of large necrotic pressure sores. After three months, a wound culture conducted during the surgical management of the pressure sores revealed colonization with multidrug-resistant P. Aeruginosa, which caused the development of septicemia with colistin-only-sensitive P. Aeruginosa. Further, ten days after the start of an intravenous colistin therapy, the patient developed acute kidney injury with rising serum creatinine and urea levels, presumably induced by sepsis and drug. To prevent further kidney damage, the antibiotic therapy was discontinued. Only after the re-emerge of the P. Aeruginosa septicemia and subsequent coma, the doctors decided to put forward a bacteriophage therapy. In fact, to avoid intensive therapy interventions - such as hemofiltration - to address the risk of colistin nephrotoxicity, fifty microlitres of purified bacteriophage cocktail BFC1 were administrated to the patient as a 6-h intravenous infusion for 10 days. The cocktail contained two bacteriophages that showed in vitro activity against the patient’s P. Aeruginosa isolates. Immediately, the overall condition of the patient significantly improved, hemofiltration was avoided, and no complications related to the bacteriophages therapy were observed.
The pressure sores remained infected with several bacterial species, including P. Aeruginosa, causing multiple episodes of sepsis treated with empirical antibiotic therapy. Unfortunately, the patient died four months after the administration of bacteriophages therapy by a refractory cardiac arrest due to blood culture-confirmed Klebsiella pneumoniae sepsis. Susceptibility testing conducted in vitro disclosed that K. pneumoniae strain was sensible to the antibiotics administered to the patient. As far as the authors know, this is the first contemporary case of intravenous bacteriophage mono-therapy to fight P. Aeruginosa septicemia in humans.
Resumé by Caterina Floriani Mussolini
Use of bacteriophages in the treatment of colistin-only-sensitive Pseudomonas
aeruginosa septicaemia in a patient with acute kidney injury—a case report
Serge Jennes et al. Critical Care (2017) 21:129. Co-authors Daniel de Vos and Jean-Paul Pirnay informed AMR-Times of this publication- DOI 10.1186/s13054-017-1709-y
Web=link: https://www.ncbi.nlm.nih.gov/pubmed/28583189
AB Stewardship in the ICU (A. Dinh & C. Duran)
Aurélien DINH, Clara DURAN
Service des maladies infectieuses et tropicales, CHU Raymond Poincaré, GH Paris–Île-de-France-Ouest, AP-HP, UVSQ, Garches, France
Emergency departments are important prescribers of antibiotics. Putting in place a policy of good use in these services is a real challenge since the large flow of patients does not always allow a thorough reflection on antibiotic therapy. Another significant constraint is the large number of prescribing doctors and their shifts.
However, it is the first phase of diagnosis and management of patients and often conditions the continuation of the therapy. Despite these obstacles, it is possible to carry out a policy of good use of these services leading to better antibiotic prescription.
In our work we have succeeded in improving the antibiotic prescriptions of outgoing patients through a better use program involving: a part-time infectiologist antibiotic advisor available for any advice on antibiotic therapy; an emergency specialist, advisor for the permanent good practice which is a relay to his colleagues and attends daily staff meetings; and the involvement of the laboratory of microbiology which signals to the antibiotic advisor any positive blood culture. It also involves the training of internal young people for better use, distribution of referral support for the main infectious pathologies, and a return of previous audits.
This policy reduced the total antibiotic prescription by 26.7%, and the inappropriate antibiotic prescription by 25.8%, particularly in situations without indication (- 32.0%).
This experience demonstrates that the improvement of better use is feasible even in hard-to-reach services. Finally, it is the business of all and the involvement of several actors, including the appointment of a correspondent in the official service and the training of young colleagues, are probably the most beneficial.
References: Impact of an antimicrobial stewardship program to optimize antimicrobial use for outpatients at emergency department. Work previously presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases in 2017.
Web=link: http://www.sciencedirect.com/science/article/pii/S0195670117303870
Dinh and Duran In upcoming book AMR Control 2017
Potential Impact of Telemonitoring by Connected Devices on the Evaluation of Antibiotic Therapy's Duration in the Ambulatory Treatment of Pulmonary Infections.
By A. Dinh, C. Duran and F. Teboul.
And also:
Intensive Care Units as Epicentres for AMR Development
By Pr Jean de Waele ( Ghent Univ. Hosp., Belgium) and Dr Jean Carlet (President ACdeBMR/WAAAR and Chair of 2015 French Ministerial Task Force: Plan for the Preservation of Antibiotics.
« ICU as Epicentres for AMR Development »
To order AMR Control 2017 book (exclusive articles from the World Bank, the Min of Health of Germany, Lebanon, Senegal, the USA’s USAID initiatives, BARDA, and much more, 130 pages, free of charge: (email at garance@waaar.ch ; or check on the London publisher website: www.globalhealthdynamics.co.uk)
See also:
Implementation of a simple innovative system for post-prescription antibiotic review based on computerized tools with shared access.
Journal of Hospital Infection
The authors (Dinh et al) reviewed 2106 targeted antibiotic prescriptions (2012-2014) Among them, 389 (18.5%) generated an alert and 293 (13.9%) were re-evaluated by the infectious disease specialist. Recommendations (mostly de-escalation or discontinuation) were necessary for 136 (46.4%) and the prescribers' acceptance rate was 97%. The estimated intervention time was <30 min/day for each AMT member (...) Conclusion: This computerized, shared access, antibiotic stewardship strategy seems to be time saving, and effectively limits misuse of broad-spectrum antibiotics.
Web=link: http://www.journalofhospitalinfection.com/article/S0195-6701(16)30537-0/fulltext
Indian Health Ministry publishes National Infection Control Guideline - Report by Dr Abdul Ghafur, Coordinator, Chennai Declaration on AMR
"Primum non nocere is a Latin phrase that means "first, do no harm."
Infections acquired in health care settings are among the major causes of death and increased morbidity among hospitalized patients. They are a significant burden both for the patient and for public health. Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one HCAI (Health Care Associated Infections).1 The endemic burden of HCAI is also significantly higher in low- and middle-income than in high-income countries, in particular, in-patients admitted to intensive care units and in neonates.1 High-income countries spend a good share of their health care budget on establishing and improving infection control standards in their hospitals, whereas, in the developing world, infection control is often neglected due to a lack of awareness, lack of infrastructure and financial constraints.
Indian hospitals are especially affected by the challenge of Gram-negative super bugs. Tens of thousands of hospitals in India, with dissimilar infrastructure necessary for the practice of infection control and the sheer size of the Gram negative bacterial challenge in the country, are the major deterrents to compile uniform infection control recommendation for all hospitals. A “best of the ability approach”- to contain the spread of these bacteria, may be the practical and implementable methodology in the Indian scenario. Hospitals with good infrastructure must follow all precautions to the best possible extent, while hospitals with resource constraints should follow precautions to the best of their ability and affordability.
Indian Health Ministry has published 'National Infection control guideline'. The document will guide better infection control practices and serve as a prototype for infection control manuals in all hospitals in India. In India, health is predominantly a state subject. There are 29 states and 7 Union territories. Health Ministry has initiated sincere efforts to convince all states to implement National action plan and National Antibiotic and Infection control policies.
Health Ministry and the contributors have tried their best to adapt international recommendations to the background Indian scenario. The document is open for public consultation.
- Abdul Ghafur. Call for global action to halt the superbug.MJA 2013;198 (5):251 https://www.mja.com.au/journal/2013/198/5/call-global-action-halt-superbug
- http://www.ncdc.gov.in/writereaddata/mainlinkfile/File661.pdf
AMR-Times noted: As part of the Clean India campaign and prior legislation on hospital waste management (a reminder in the document here), this document reminds the readers on the links between AMR and Health care Associated Infections (HCAIs) which is worth noting as most of the published literature as well as countries presenting their National plans on AMR in the United Nations omit to mention Infection Prevention and Control (IPC), even though IPC was agreed upon as a priority in the GAPAMR.
The Indian IPC guidelines remind the readers that:
“The organisms that cause HCAIs include:
- MRSA: Methicillin resistant Staphylococcus aureus.
- MDROs: Multi drug (multiple antibiotics) resistant bacteria mostly Gram negative bacteria like Klebsiella, Esch. Coli, Acinetobacter, Pseudomonas, Chrysobacterium, Stenotrophomonas, etc.
- ESBLs: Extended spectrum β lactamases (Gram negative bacteria).
- NDMs: New Delhi Metallo enzymes (Gram negative bacteria).
- XDRs: Extremely drug resistant microorganisms (Eg. XDR Mycobacterium tuberculosis and XDR Gram negative bacteria).”
The document also stresses the importance of learning and practicing good antibiotic stewardship in the hospital environment.
“The application of transmission-based precautions is particularly important in containing
multi-resistant organisms (MROs) and in outbreak management.”
“Each health care facility should have an antimicrobial use programme. The goal is to ensure effective economical prescribing to minimize the selection of resistant microorganisms.
- Formulation of guidelines with a multidisciplinary approach using the local antibiogram.
- Provide ongoing education on the rational use of antibiotics to clinicians and ensure implementation of antibiotic policies.
- Restricted antibiotic use,
- Use must be justifiable based on clinical diagnosis.
- Before initiating antibiotic treatment, appropriate specimens for bacteriological examination must be submitted to laboratory and selection of an antibiotic must be based on the sensitivity pattern, patient tolerance, and cost,
- An agent with as narrow a spectrum as possible should be used with appropriate dosage and duration of antimicrobial therapy.
- The correct dose must be used.
- Control antibiotic use - Selected antibiotics may be restricted in use.
- Cyclic rotation of antibiotics in a class,
- Discontinuation of antimicrobial therapy based on predefined criteria
- Carry out periodic prescription audits.
Web=link: http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
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The EpiShuttle transport system in the AMR & Global Health Security Era
Full Exclusive interview with EpiGUARD’s CEO, Fridtjof Heyerdahl in the July Newsletter
Note from the editor in chief: Will it be possible to face the challenge of AMR, of Universal Health Coverage and Global Health Security without accepting that health systems delivery need a complete overall in concept and technologies? We think not. Starting from the standpoint of the patient, we need point-of-care diagnostics, but not only that: we need to bring the care to the person, to the remotest corner of our planet, to truly make that possible in the age of internet and ambulatory care. We were attracted by the EpiSHUTTLE at the expo of ICPIC (the Geneva University Hospital sponsored Congress on Infection Prevention and Control), and we had a talk with the CEO and chief inventor of this patient-friendly and carer-protective as well as an imaginative tool to face epidemics such as Ebola.
We invite innovators to contact us so we can pull together a dossier on innovations for healthcare delivery in the AMR era. Over a year ago, the WHO gathered all representatives of Space Agencies (of China, France, India, Russia, or the USA, etc.) for a discussion on health impact and discoveries from space programs. Then, a WHA side event reported on the use of space program discoveries to monitor SDGs. As this author raised the issue then, and the WHO representative fully agreed: public health systems in LMIC, in particular, could benefit tremendously from innovators! Why not build the delivery systems for tomorrow?
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Recap: In our 12th issue, we held an exclusive interview with Rajiv Nath, the Joint Managing Director of Hindustan Syringes & Medical Devices (HMD); "One cent to save a patient from AMR?" you can read it by clicking here
Rajiv Nath is a passionate Injection Safety Advocate, he runs HMD, India, one of the leading Syringe & Needle Manufacturers Worldwide and is also the Forum Coordinator of AiMeD – Association of Indian Medical Device Industry – and has been leading many initiatives to make India a Manufacturing Hub of affordable high-quality Medical Devices
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For more information:
https://hmdhealthcare.com/
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Upcoming AMR-related events
September 6-8, 2017 USA
ASM/ESCMID Conference on Drug Dev to Meet the Challenge of Antimicrobial Resistance. September 6-8, 2017 Boston, Mass.
Web=link: https://www.asm.org/index.php/2017-asm-escmid-conference
Sept. 13-14 2017 - UK
Oxford Phages 2017,Bacteriophages in Medicines, Food and Biotechologies
Web=link: http://lpmhealthcare.com/phages-2017/
Sept 14-15, 2017, USA
World AMR Congress USA,
Washington DC
Web=link: http://www.terrapinn.com/conference/antimicrobial-resistance-congress-usa/Conference-Agenda-Day-1.stm
Oct. 1-3, 2017 Italy
Florence: Fifth world congress on targeting infectious diseases.Targeting Antibiotic Resistance. From Phage Therapy to Innovative Ideas
Web=link: https://www.tid-site.com/
October 11-14, 2017, Mexico
International Union Against Tuberculosis and Lung Disease
Expo Guadalajara Convention Centre will host the 48th Union World Conference on Lung Health in the capital of Jalisco, Mexico
Web=link: www.theunion.org
2018
Jan. 26-28, 2018, France
Congrès de Pneumologie de Langue Française (CPLF), Lyon Centre de Congrès
Web=link: http://www.congres-pneumologie.fr/
Jan 29 – Feb 3, 2018 Thailand
Prince Mahidol Award Conference Secretariat Institute for Population and Social Research
Mahidol University 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
Tel: (66) 2441-0203 to 4 ext 627 or 628
E-mail: pmaconference@mahidol.ac.th
www.pmaconference.mahidol.ac.th
February 15 -16, 2018, Dublin, Republic of Ireland
23rd International Symposium On Infections In The Critically Ill Patients; The aim of this two-day symposium is to review current concepts, technology and present advances in infections in critically ill patients. Sepsis, Pulmonary Infections, Basic Research, Pulmonary Infections Treatment and Prophylaxis Therapy of severe infections will be the topics of the main sessions presented by experts who will review and update the new advances on infections in the critically ill patient. At the end of each session a Clinical Controversy, Panel Discussion or Case Report Discussion will be organized.
Organized by:
- Antonio Artigas, MD Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Spain
- Jean Carlet, MD Consultant, President of the World Alliance Against Antibiotic Resistance (WAAAR)
- I. Martin-Loeches, MD, St James's Hospital. Trinity Centre for Health Sciences. HRB-Welcome Trust St James's Hospital, Dublin, Ireland
- Antoni Torres, MD, Pulmonology Department, Clinic Hospital of Barcelona, Ciberes, Spain
- Michael Niederman, MD, Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, USA
Web=link: https://www.srlf.org/en/agenda/evenement/23rd-international-symposium-on-infections-in-the-critically-ill-patient-2
May. 2-4, 2018, Amsterdam, The Netherlands
The International Forum on Quality and Safety in Healthcare (BMJ) , taking place in Amsterdam on 2-4 May 2018
Weblink: http://internationalforum.bmj.com/
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AMR-TIMES
This newsletter is published by the not-for-profit NGOs ACdeBMR/WAAAR and SOI.
Disclaimer: The named authors alone are responsible for the views expressed in this publication. The content does not commit the WAAAR or SOI associations.
The Editorial Board:
-Garance Fannie Upham, Editor in Chief (garance@waaar.ch; editor@amr-times.info)
-Mostafa El Yamany (Egypt and the Netherlands), pharmacist and Ph.D. Candidate on AMR, Editor (editor@amr-times.info)
-Amr El-Ateek, Pharm.D., researcher, and contributor
-Nora Mahfouf, (Algeria) Ph.D. student on AMR, journalist, and translator
-Jean-Jacques Monot, (France) Computer Engineer, database, and edition
-Aletha Wallace (Belgium/Liberia) Biotechnologist, MSc Health Sc. Management, contributor
-Chi XU (Graduate Institute, Switzerland), Associate Researcher & Reporter
-Christy Mulhall (Graduate Institute), Associate Researcher & Reporter
-Caterina Floriani Mussolini (Graduate Institute), Associate Researcher & Reporter
Subscription to this newsletter is free of charge.
We would like to encourage WAAAR members to renew their membership fees, only 30 euros a year, and 100 euros for NGOs and newer subscribers to become members. This can be done on the secured website linked with WAAAR: www.waaar.org (click on the word Registration)
We plan on the launch of an online journal shortly.
To that end, and to consolidate an editorial team which is basically made up of volunteers, please get in touch with the editorial team if you would like to contribute news or help in funding.
AMR CONTROL 2015 / 2016: WAAAR publishes a yearly book AMR CONTROL with over 30 world renown experts for each edition (2015 and 2016 and soon 2017) which can be freely downloaded or printed copies requested by postal mail by filling in the form on the London publisher's website. www.globalhealthdynamics.co.uk
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