The document discusses antimicrobial resistance (AMR) in India, including current challenges and strategies to address it. It provides an overview of AMR globally and in India, describing increasing resistance levels in many pathogens. It also outlines India's national policies and programs related to AMR containment, surveillance networks, and challenges such as inadequate community stewardship. Key mitigation strategies discussed are improving prescribing through antimicrobial stewardship programs in both hospitals and communities.
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
Awareness Session On Antimicrobial resistance “Antimicrobials: Spread Awaren...Nimra zaman
The World Antimicrobial Awareness Week (WAAW) was introduced by the World Health Organization (WHO) to increase global awareness of antimicrobial resistance.
The WAAW takes place every year from 18-24th of November.
The theme of World Antimicrobial Awareness Week (WAAW) 2021 is ‘Spread Awareness, Stop Resistance’.
During this week best practices are shared among the general public, health workers and policy makers to show the importance of stopping the further emergence and spread of antibiotic resistance.
AMR challenges in human from animal foods- Facts and Myths.pptxBhoj Raj Singh
This presentation talks about ÄMR: A public health threat, a “silent pandemic”.
Infections caused by Antimicrobial-drug-resistant (AMR) pathogens caused >1.27 million deaths worldwide in 2019 (low level or no surveillance) and increasing year after year which may be > million in coming decades. Covid-19 caused ~6.8 million deaths in >3 years but now the pandemic is ending but the AMR pandemic has no timeline for its ending. Many deaths are also attributed to AMR pathogens.
More antibiotic use (irrespective of the sector) = More AMR.
This presentation also talks about ways and means to mitigate the AMR pandemic. 1. Stopping the blame game. All are equally responsible for the emergence of AMR, the share of developed and educated communities is much more than poor and un-educated communities.
2. Working together: On-Line Real-Time AST Data Sharing Platform for different diagnostic and research laboratories doing AST routinely.
3. Implementing not only antibiotic veterinary and medical stewardship but antimicrobial production and distribution stewardship too.
4. Educating for Environmental health not only human, plant, and animal health.
5. AMR's solution is not in searching for alternatives to antibiotics but in establishing environmental harmony.
6. More emphasis on AMR epidemiology than on AMR microbiology and pharmacology.
7. Development of understanding that bacteria and other microbes are more essential for life on earth than the human race. Microbes can live without humans, but humans can’t without microbes.
Global-Health is of prime importance than economic growth/ greediness.
Literature Survey Antibiotic ResistanceTuhin Samanta
Anti-toxin obstruction happens when microscopic organisms change in light of the utilization of these medications. Microscopic organisms, not people or creatures, become anti-toxin safe. These microorganisms may contaminate people and creatures, and the diseases they cause are more diligently to treat than those brought about by non-safe microscopic organisms.
Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, and antifungals) from working against it.
FLOW OF THE SEMINAR
1. Definition – antibiotic resistance, Multi-resistance, cross-resistance in antibiotics
2. Evolution of resistance
3. Impact of resistance
4. The scenario of resistance: Global, India
5. Factors causing resistance
6. Mechanisms of resistance: Intrinsic and Acquired
7. Acquired mechanism of resistance
8. Quorum sensing
9. Mechanism of resistance in commonly used antibiotics
10. Methods for determining the resistance
11. Strategies to contain resistance
12. Antibiotic stewardship
13. Role of Pharmacologist
14. Initiatives undertaken by India to control resistance
Antibiotics are drugs which have saved and still saving hundreds of thousands of lives every year. Antibiotics are possibly the most vital advancement in the history of medicine and undoubtedly; they are among medicine's most prevailing sector. But the other side of the coin offers us “antibiotic resistance” which is a serious and one of the most threatening healthcare problems worldwide
One Health – an interdisciplinary approach in combating emerging diseasesILRI
Presentation by Hung Nguyen-Viet, Delia Grace and Jakob Zinsstag at the International Symposium of Health Sciences (iSIHAT 2013), Kuala Lumpur, Malaysia, 20-21 August 2013.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Please find the power point on Antimicrobial resistance. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Resistance to antibiotics is one of the main important facts that most nations are working on. Actually, in USA, it is considered as a health problem to solve. Why it happens? Here is a review to answer this.
Awareness Session On Antimicrobial resistance “Antimicrobials: Spread Awaren...Nimra zaman
The World Antimicrobial Awareness Week (WAAW) was introduced by the World Health Organization (WHO) to increase global awareness of antimicrobial resistance.
The WAAW takes place every year from 18-24th of November.
The theme of World Antimicrobial Awareness Week (WAAW) 2021 is ‘Spread Awareness, Stop Resistance’.
During this week best practices are shared among the general public, health workers and policy makers to show the importance of stopping the further emergence and spread of antibiotic resistance.
AMR challenges in human from animal foods- Facts and Myths.pptxBhoj Raj Singh
This presentation talks about ÄMR: A public health threat, a “silent pandemic”.
Infections caused by Antimicrobial-drug-resistant (AMR) pathogens caused >1.27 million deaths worldwide in 2019 (low level or no surveillance) and increasing year after year which may be > million in coming decades. Covid-19 caused ~6.8 million deaths in >3 years but now the pandemic is ending but the AMR pandemic has no timeline for its ending. Many deaths are also attributed to AMR pathogens.
More antibiotic use (irrespective of the sector) = More AMR.
This presentation also talks about ways and means to mitigate the AMR pandemic. 1. Stopping the blame game. All are equally responsible for the emergence of AMR, the share of developed and educated communities is much more than poor and un-educated communities.
2. Working together: On-Line Real-Time AST Data Sharing Platform for different diagnostic and research laboratories doing AST routinely.
3. Implementing not only antibiotic veterinary and medical stewardship but antimicrobial production and distribution stewardship too.
4. Educating for Environmental health not only human, plant, and animal health.
5. AMR's solution is not in searching for alternatives to antibiotics but in establishing environmental harmony.
6. More emphasis on AMR epidemiology than on AMR microbiology and pharmacology.
7. Development of understanding that bacteria and other microbes are more essential for life on earth than the human race. Microbes can live without humans, but humans can’t without microbes.
Global-Health is of prime importance than economic growth/ greediness.
Literature Survey Antibiotic ResistanceTuhin Samanta
Anti-toxin obstruction happens when microscopic organisms change in light of the utilization of these medications. Microscopic organisms, not people or creatures, become anti-toxin safe. These microorganisms may contaminate people and creatures, and the diseases they cause are more diligently to treat than those brought about by non-safe microscopic organisms.
Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, and antifungals) from working against it.
FLOW OF THE SEMINAR
1. Definition – antibiotic resistance, Multi-resistance, cross-resistance in antibiotics
2. Evolution of resistance
3. Impact of resistance
4. The scenario of resistance: Global, India
5. Factors causing resistance
6. Mechanisms of resistance: Intrinsic and Acquired
7. Acquired mechanism of resistance
8. Quorum sensing
9. Mechanism of resistance in commonly used antibiotics
10. Methods for determining the resistance
11. Strategies to contain resistance
12. Antibiotic stewardship
13. Role of Pharmacologist
14. Initiatives undertaken by India to control resistance
Antibiotics are drugs which have saved and still saving hundreds of thousands of lives every year. Antibiotics are possibly the most vital advancement in the history of medicine and undoubtedly; they are among medicine's most prevailing sector. But the other side of the coin offers us “antibiotic resistance” which is a serious and one of the most threatening healthcare problems worldwide
One Health – an interdisciplinary approach in combating emerging diseasesILRI
Presentation by Hung Nguyen-Viet, Delia Grace and Jakob Zinsstag at the International Symposium of Health Sciences (iSIHAT 2013), Kuala Lumpur, Malaysia, 20-21 August 2013.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Please find the power point on Antimicrobial resistance. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Resistance to antibiotics is one of the main important facts that most nations are working on. Actually, in USA, it is considered as a health problem to solve. Why it happens? Here is a review to answer this.
Evaluation of Prescribing Patterns of Antibiotics in General Medicine Ward in...ijtsrd
Knowledge about antibiotic utilization and resistance patterns of most common microorganisms are unavailable in tertiary care hospitals. To assess the pattern of antibiotic utilization and outcome of patients in a General Medical Ward, all positive blood cultures BC over a 4 month period from July 2019 to October 2019 were retrospectively reviewed. Sixty five positive BC were recorded in which patients 43 males and 22 females . 72 of the patients received antibiotics before or soon after obtaining the BC, and ceftriaxone was the most frequently prescribed antibiotic 41.93 , either alone or in combination with other antibiotics. The bacteraemia was due to gram positive cocci in 60.46 of cases, gram negative rods in 30.23 , and gram positive rods in 9.30 . Positive BC due to contamination was not included. The most common gram positive cocci were Staphylococcus epidermidis, followed by S. aureus, while the most common gram negative bacilli were Brucella species, Proteus mirabilis, and Klebsiella sp. The suspected sources of the bacteraemia were respiratory 21.2 , urinary 19.2 , or skin 19.2 . A subsequent change in the antibiotics regimen was done in 69.76 cases after BC results became available with no apparent effect on the outcome. Adding Cefotaxime, Amoxicillin clavulonic acid, piperacillintazobactum, vancomycin and clindamycin was the most frequent change done 19.4 for each equally . Complications developed in 69.76 of patients, with 88.66 of them suffering from sepsis shock. 69.23 of the patients improved and 30.77 expired death was related to infection in 87.5 of cases. In conclusion, most bacteremia in the medical ward of the hospital were due to gram positive cocci, which should be considered in antibiotic selection prior to BC. Vageeshwari Devuni | Debabrata Chaudhary "Evaluation of Prescribing Patterns of Antibiotics in General Medicine Ward in a Tertiary Care Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-1 , December 2019, URL: https://www.ijtsrd.com/papers/ijtsrd29618.pdf Paper URL: https://www.ijtsrd.com/pharmacy/pharmacology-/29618/evaluation-of-prescribing-patterns-of-antibiotics-in-general-medicine-ward-in-a-tertiary-care-hospital/vageeshwari-devuni
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
In India, bacteria that cause common infections, such as urinary tract and bloodstream infections, are becoming resistant to nearly all antibiotics. This resistance is due to a combination of factors: uncontrolled access to antibiotics, gaps in infection prevention and control (IPC) practices, and high rates of communicable diseases. Antibiotic resistance, or AR, is a serious problem throughout the country, and threatens to reduce the usefulness of antibiotics both in India and around the world.
Because of this emerging threat, India is committed to slowing the spread of AR. Two institutions within India’s Ministry of Health – the Indian Council of Medical Research and National Centre for Disease Control – each developed national networks of public and private hospitals to measure AR trends, prevent healthcare-associated infections (HAIs), and enhance appropriate use of antibiotics. The All India Institute of Medical Sciences is coordinating HAI measurement and prevention efforts in both networks. In addition, efforts in the state of Tamil Nadu focus on building district-level IPC capacity to prevent HAIs, focusing on maternal and neonatal patients.
The Indian Governamnet is is working closely with partners at the national and state level to:
Detect AR pathogens, including novel strains, by developing lab networks and lab expertise.
Use standardized surveillance to monitor and track AR infections in healthcare to learn how often these infections occur and to help develop strategies to prevent them.
Implement focused IPC activities and training.
Optimize use and reduce misuse of critical antibiotics through antibiotic stewardship programs.
AMR in Animal Origin Products A ChallengeSarzamin Khan
The AMR and its origin from the products of animal based products has been discussed. The AMR as challenge has been described and recommendation to minimize the risk of AMR
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Antimicrobial stewardship programs (ASP) are an essential practice to prevent increasing
resistance against antibiotics. A successful ASP monitors not only prescribing patterns and
practices but also contributes in minimizing the toxic effects of antibiotics. Moreover, ASP
also facilitates the selection of disease specific antibiotics and enforces rules and regulations to rationalize the use of antibiotics. The aim of the study is to highlight the core
elements of Hospital Antibiotic Stewardship Programs in Karachi. The key elements proposed by center of disease control (CDC) such as; leadership, accountability, drug
expertise, actions to support optimal antibiotic use, tracking (monitoring antibiotic prescribing, use and resistance), reporting information to staff on improving antibiotic use
and resistance and education were evaluated on Yes/No scale. The data was collected
from 44 hospitals of different categories in Karachi and all the major elements were
studied. It was observed that all the hospitals in one setting failed to comply with all the
guidelines. It has been concluded that efforts should be made to design ASP at each
hospital and implemented through suitable policies and procedures.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Light House Retreats: Plant Medicine Retreat Europe
AMR seminar 4.3.23.pptx
1. ANTI-MICROBIAL RESISTANCE:
CURRENT SCENARIO, FUTURE CHALLENGES AND
MITIGATING STRATEGIES IN INDIAN CONTEXT
Presenter- Dr. Yukti Bhandari, Senior Resident
Moderator- Dr. Vivek Sagar, Associate Professor
Department of Community Medicine and School of Public
Health, PGIMER, Chandigarh
2. Contents
• What is AMR?
• Current Global Scenario
• Indian Scenario
• Various challenges faced
• Mitigation strategies in place in India
• Discussion on new innovations
3. What is AMR?
Antimicrobial Resistance (AMR) occurs when
bacteria, viruses, fungi and parasites change over
time and no longer respond to medicines making
infections harder to treat and increasing the risk of
disease spread, severe illness and death.
Antimicrobial Resistance. Fact Sheet. World Health Organisation.
4. • The direct consequences of infection with
resistant microorganisms can be severe,
including
• longer illnesses and prolonged stays in hospital
• increased mortality
• loss of protection for patients undergoing
operations and other medical procedures
• increased costs
Global Action Plan on Antimicrobial Resistance, World Health
9. Detection of AMR
Phenotypic methods Genotypic methods
Relates only to the concentration of an
antimicrobial that inhibits bacterial growth in
vitro.
Provides the opportunity for accelerated
cultures, and may even be performed directly on
the clinical specimens.
They provide no indication of the mechanisms of
resistance which may disseminate to other
bacterial species.
These methods help assess the genetic makeup,
identify antimicrobial resistance genes and
understand the mechanism of resistance.
Time taken – 36-72 hours Time taken – 30 minutes - 8 hours
For eg. broth microdilution, disk diffusion,
gradient tests, agar dilution and breakpoint tests
etc.
For eg. Whole Genome Sequencing (WGS),
Nucleic acid amplification test, Polymerase Chain
Reaction (PCR), Fluorescent in-situ hybridisation
(FISH) etc.
Vasala A, Hytönen VP, Laitinen OH. Modern tools for rapid diagnostics of antimicrobial
resistance. Frontiers in Cellular and Infection Microbiology. 2020 Jul 15;10:308.
10. Global
Scenario
• WHO has declared AMR as one of the top 10 global
public health threats facing humanity.
• Misuse and overuse of antimicrobials are the main
drivers in the development of drug-resistant
pathogens.
• AMR has become a major threat to the treatment of
not only common bacterial infections, but also to
the treatment of -
• Fungal infections like Candida
• Parasitic diseases like malaria
• Viral diseases like HIV
• Important public health threats like Tuberculosis
Anti-microbial resistance, WHO Fact Sheet
11. Global Antimicrobial Resistance and Use Surveillance System
(GLASS)
• Launched by the World Health Organization (WHO) in 2015 to
support the strengthening of the antimicrobial resistance (AMR)
evidence base, the Global Antimicrobial Resistance and Use
Surveillance System (GLASS) is the first system that enables
harmonized global reporting of official national AMR and
antimicrobial consumption (AMC) data.
12. GLASS enrolment map as on 30 April 2021
Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report, 2022
13. AMR and
Sustainable
Development
Goals
• In 2020, two new AMR indicators were included in
the monitoring framework of the SDGs linked to the
health target 3.d (“strengthen the capacity of all
countries, in particular developing countries, for
early warning, risk reduction and management of
national and global health risks”).
• These indicators monitor proportion of bloodstream
infections (BSIs) due to:
• Escherichia coli resistant to 3rd generation
cephalosporins
• Methicillin-resistant Staphylococcus
aureus (MRSA)
15. All-age rate of deaths attributable to and associated
with bacterial antimicrobial resistance by GBD region
2019
Murray CJ, Ikuta KS, Sharara F,
Swetschinski L, Aguilar GR, Gray A
et al. Global burden of bacterial
antimicrobial resistance in 2019: a
systematic analysis. The Lancet.
2022 Feb 12;399(10325):629-55.
1·27 million deaths
47,600 DALYs
16. Global Action Plan on Anti-Microbial Resistance
In May 2015, World Health Assembly adopted a global action
plan on antimicrobial resistance, which outlines five objectives:
To improve awareness and understanding of antimicrobial resistance
through effective communication, education and training
To strengthen the knowledge and evidence base through
surveillance and research
To reduce the incidence of infection through effective sanitation,
hygiene and infection prevention measures
To optimize the use of antimicrobial medicines in human and animal
health
To develop the economic case for sustainable investment that takes
account of the needs of all countries and to increase investment in new
medicines, diagnostic tools, vaccines and other interventions.
17. Indian Scenario
Antibiotic % Resistance (with 95% C.I.)
Aminopenicillins 87% (83-90%)
Fluroquinolones 86% (85-87%)
Cephalosporins 3rd Gen 83% (82-84%)
Amoxicillin-clavulanate 60% (51-69%)
Carbapenems 41% (38-44%)
Piperacillin-tazobactam 28% (26-30%)
Aminoglycosides 17% (15-19%)
Data from GLASS. ResistanceMap. https://resistancemap.onehealthtrust.org/AntibioticResistance.php
AMR in Human Beings:
Resistance of E. coli to Antimicrobials in India
More than 70% isolates of Klebsiella pneumoniae and Acinetobacter baumannii and 50% of
Pseudomonas aeruginosa were also resistant to fluoroquinolones and third generation
cephalosporins.
18. Indian
Scenario
AMR in Animals and Food:
• 48% of Gram-negative bacilli detected in cow and buffalo
milk were extended-spectrum β-lactamases (ESBL)
producers (West Bengal) and 47.5 per cent were resistant
to oxytetracycline (Gujarat).
• Vibrio cholera and V. parahaemolyticus, isolated from the
retail markets of shrimps, shellfish and crabs in Kerala
were 100 per cent resistant to ampicillin, while resistance
to ceftazidime ranged from 67 to 96 per cent.
• In the poultry industry, presence of ESBL producers vary
from 9.4% in Odisha to 33.5% in Madhya Pradesh to 87%
in Punjab.
• Salmonella species in broilers varied from 3.3% in Uttar
Pradesh to 23.7% in Bihar with 100% isolates being
resistant to ciprofloxacin, gentamicin and tetracycline in
Bihar and West Bengal.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.
19. Indian
Scenario
AMR in the Environment
• The groundwater and surface water that are used for
drinking and recreational purposes have been reported
with 17% of E. coli, resistant to third generation
cephalosporin, in central India, 7% in Kashmir, 50% in
Sikkim and 100% in Hyderabad.
• The rate of isolation of E. coli resistant to third generation
cephalosporin at water treatment plants was 25, 70 and
95% when the inlet to the plant was domestic water
alone, domestic waste along with hospital effluent and
hospital effluent alone, respectively.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.
20. Development of AMR related policies in India
2010
• Establishment of
National Task Force on
AMR Containment
2011
• Situation Analysis of
AMR
• National Policy on
AMR Containment
• Jaipur Declaration on
AMR containment
• National Programme
on AMR Containment
(12th FYP)
2012
• National Program on
Antimicrobial
Stewardship,
Prevention of Infection
and Control (ASPIC) by
ICMR
2013
• National AMR
Surveillance Network
by NCDC and ICMR
21. Timeline and Development of AMR in India
2014
• Inclusion of antibiotics in
Schedule H1 category to
avoid non-prescription sales
of antibiotics
2016
• Launch of the Red Line
Campaign on Antibiotics to
create awareness regarding
rational usage of antibiotics
• National Treatment
Guidelines for Antimicrobial
Use in Infectious Diseases
by NCDC
2017
• National Action Plan for
Containment of AMR
• Delhi Declaration on AMR
• The Food Safety and
Standards (Contaminants,
Toxins and Residues)
Regulations in food animals
22. Timeline and Development of AMR in India
2018
• Kerala Antimicrobial
Resistance Strategi Action
Plan
2019
• Treatment guidelines for
Antimicrobial Use in
Common Syndromes by
ICMR
• Madhya Pradesh State
Action Plan for
Containment of
Antimicrobial Resistance
2020
• National Guidelines for
Infection Prevention and
Control in Healthcare
Facilities
• State Action Plan to
combat Antimicrobial
Resistance in Delhi
2021
• Standard Operating
Procedures for National
Programme on
Antimicrobial Resistance
Containment
• Launch of One Health
Consortium
23. National
Programme
on AMR
Containment
(2012-2017)
Objectives of this programme were:
• Establish a laboratory-based AMR surveillance
system in the country to generate quality data on
antimicrobial resistance
• Carry out surveillance of antimicrobial usage in
different health care settings
• Strengthen infection control practices and promote
rational use of antimicrobials through Antimicrobial
stewardship activities
• Generate awareness amongst health care providers
and community on antimicrobial resistance and
rational use of antimicrobials.
National Centre for Disease Control, 2012
24. National Health Policy 2017
The problem of anti-microbial resistance calls for a -
• Rapid standardization of guidelines regarding antibiotic use
• Limiting the use of antibiotics as Over-the-Counter medication
• Banning or restricting the use of antibiotics as growth promoters
in animal livestock.
Pharmacovigilance including prescription audit inclusive of
antibiotic usage, in the hospital and community, is a must in order
to enforce change in existing practices.
The policy also includes AMR as one of areas where the private
sector could play an active role in through use of the corporate
social responsibility platform.
25. National Action Plan on Antimicrobial Resistance
(NAP-AMR) 2017 – 2021
The following are the specific objectives of the NAP-AMR:
1.Define the strategic priorities, key actions, outputs,
responsibilities, and indicative timeline and budget to slow
the emergence of AMR in India and strengthen the
organizational & management structures to ensure intra- &
inter-sectoral coordination with a One Health approach;
2.Combat AMR in India through better understanding and
awareness of AMR, strengthened surveillance, prevention
of emergence and spread of resistant bacteria through
infection prevention and control, optimised use of
antibiotics in all sectors, and enhanced investments for AMR
activities, research and innovations;
3.Enable monitoring and evaluation (M&E) of the NAP-AMR
implementation based on the M&E framework.
28. National Programme on
Antimicrobial Resistance
Containment
• This guidance document defines standards for
antimicrobial susceptibility testing, data
collection and reporting processes for sites
participating in the AMRSN co-ordinated by the
NCDC.
• It provides guidelines to ensure consistent AST
procedures and systematic AMR surveillance data
reporting from sites across the network.
29. India's Antimicrobial Resistance Surveillance &
Research Initiative
India’s Antimicrobial Resistance Surveillance & Research Initiative https://iamrsn.icmr.org.in/index.php/about
The Indian Council of Medical Research (ICMR) has been
supporting research on antimicrobial resistance through
the Antimicrobial Resistance Research & Surveillance
Network (AMRSN) since 2013.
Data collected from the network is used to track resistance
trends and to better understand mechanisms of resistance
in the key priority pathogens using genomics and whole
genome sequencing (WGS).
The data collected from the network has enabled
compilation of drug resistance data on six pathogenic
groups on antimicrobial resistance from the country.
31. Antimicrobial
Resistance
Research &
Surveillance
Network
Under AMRSN, there are nodal centres (NCs) for each
pathogenic group in four tertiary care hospitals from the
country.
• Enterobacterales causing sepsis (PGIMER, Chandigarh)
• Fungal pathogens (PGIMER, Chandigarh)
• Gram-positives: staphylococci and enterococci,
(JIPMER, Puducherry)
• Typhoidal Salmonella (AIIMS New Delhi)
• Diarrhoeagenic bacterial organisms (CMC Vellore)
• Streptococcus pneumoniae (CMC Vellore)
• Gram-negative non-fermenters (CMC Vellore)
Annual Report, Anti-microbial Resistance Research and Surveillance Network, 2021
32. NARS-NET
• Under the National Programme on AMR
Containment, National AMR Surveillance
Network has been established which is a
network of state medical college
laboratories from across the country for
generating AMR surveillance data through
a sentinel surveillance system.
• MoHFW identified NCDC in July 2017 as
the National coordinating centre for AMR
surveillance.
33. Challenges in
AMR
Surveillance
Network in India
Not representative of entire country; Reflection of tertiary care settings and
not the general community
High antibiotic use in the community and inadequate implementation of
measures to curb sale of over-the-counter antimicrobials; Prior antibiotic
exposure data difficult to capture
Continued training support for the staff in order to undertake quality
antimicrobial susceptibility testing (AST) and surveillance
Funding to sustain the quality data over a long period
Limited access to clinical pharmacists
Physician immunity to changes regarding stewardship policies
Data sharing and private sector involvement
Walia K, Madhumathi J, Veeraraghavan B, Chakrabarti A, Kapil A, Ray P, Singh H,
Sistla S, Ohri VC. Establishing Antimicrobial Resistance Surveillance & Research
Network in India: Journey so far. Indian J Med Res. 2019 Feb;149(2):164-179. doi:
10.4103/ijmr.IJMR_226_18. PMID: 31219080; PMCID: PMC6563732.
34. Antimicrobial
prescribing
facts: The 30%
Rule
30% of all hospitalized in-patient at any given
time receive antibiotics.
Over 30% of antibiotics are prescribed
inappropriately in the community.
Up to 30% of all surgical prophylaxis is
inappropriate.
30% of hospital pharmacy costs are due to
antimicrobial use.
10-30% of antimicrobial cost can be saved by
antimicrobial stewardship programs.
Antimicrobial Stewardship Program Guidelines. ICMR
35. Antimicrobial
Stewardship
• Coordinated interventions
designed to improve and
measure the appropriate use
of antimicrobial agents by
promoting the selection of
the optimal antimicrobial
drug regimen including
dosing, duration of therapy,
and route of administration.
Antimicrobial Stewardship Program Guidelines. ICMR
37. Antimicrobial
Stewardship in
Community Settings
• Antimicrobial stewardship in community settings is
required to help out health care practitioners which
are often compelled to treat empirically and to prevent
use of unregulated drugs approved in the community
and to prevent self medication and antibiotics on over
the counter.
• The core elements of AMSP in primary care OPDs and
community settings includes:
• Accountability for optimizing antibiotic prescription
• Use of evidence based diagnostic criteria and
treatment recommendation
• Self-evaluate antibiotic prescribing practices
• Use effective communication strategy to educate
patients.
Antimicrobial Stewardship Program Guidelines. ICMR
38. Standard Operating Procedures from ICMR
• External Quality Assessment
Scheme (EQAS)
• Bacteriology
• Mycology
• Veterinary practices
• Rational Prescribing guidelines
• Hospital Infection Control
guidelines
39. Factors behind acceleration of AMR in India
• Huge burden of infectious diseases
• Poor sanitation, poor implementation of infection control practices
• Close animal-human interface
• Lack of infectious disease specialists
• Lack of diagnostics
• Absence/non-adherence to standard treatment guidelines
• Irrational self-administration or prescription
• Drugs available without prescription
• Poor quality of drugs
Advancing Antimicrobial Stewardship. ICMR
40. AMR in HIV
To minimize the emergence and transmission of drug resistant HIV, WHO recommends that
ART and pre-exposure prophylaxis (PrEP) programmes be accompanied by measures to
monitor the quality of ART and PrEP delivery and the routine surveillance of HIV drug
resistance.
Nevirapine (NVP) or efavirenz (EFV)-based regimens were the most frequent ART regimens
initiated in 16 of 20 countries reporting survey findings to WHO (2014–2020). In 21 of 30
surveys reported, pretreatment drug resistance to NVP or EFV in populations initiating first-
line ART exceeded 10%.
The high levels of observed pretreatment drug resistance to NVP or EFV emphasize the
need to fast-track the transition to the integrase strand-transfer inhibitor dolutegravir
(DTG)-based first-line regimens in accordance with WHO recommendations
HIV Drug Resistance Report 2021
41. AMR in Malaria
Chloroquine-resistant P. falciparum first developed independently in three to
four areas in Southeast Asia, Oceania, and South America in the late 1950s
and early 1960s.
P. falciparum has also developed resistance to nearly all of the other
currently available antimalarial drugs, such as sulfadoxine pyrimethamine,
mefloquine, halofantrine, and quinine.
Most recently, resistance to the artemisinin and non-artemisinin
components of artemisinin-based combination therapy has emerged in parts
of Southeast Asia, impacting the efficacy of this vital antimalarial class.
Drug Resistance in the Malaria-Endemic World. CDC. 2018
43. AMR in Tuberculosis
• The first national anti-tuberculosis drug
resistance survey (NDRS) revealed that 28% of TB
patients were resistant to any drugs (22% among
new and 36.82% among previously treated).
• MDR-TB was 6.19% among all TB patients with
2.84% among new and 11.60% (CI 10.21–13.15%)
among previously treated TB patients.
• In 2021, 48,232 MDR/RR-TB patients were
diagnosed.
• 8,455 Pre-XDR-TB, 376 XDR-TB and 13,724 H
mono/poly patients were diagnosed.
45. Role of Surveillance in AMR
• Cornerstone for assessing
the spread of AMR.
• Inform local, national and
global strategies.
• Inform infection prevention
and control responses.
• Monitor the impact of
local, national and global
strategies.
WHO. Initiatives. GLASS. WHO. Initiatives. GLASS
46. WHO AWaRe Tool
• The AWaRe Classification of antibiotics was developed in 2017 by the
WHO Expert Committee on Selection and Use of Essential Medicines
as a tool to support antibiotic stewardship efforts at local, national
and global levels.
• Antibiotics are classified into three groups, Access, Watch and
Reserve, taking into account the impact of different antibiotics and
antibiotic classes on antimicrobial resistance, to emphasize the
importance of their appropriate use.
• It is a useful tool for monitoring antibiotic consumption, defining
targets and monitoring the effects of stewardship policies that aim to
optimize antibiotic use and curb antimicrobial resistance.
2021 AWaRe Classification. https://www.who.int/publications/i/item/2021-aware-classification
49. Steps of rational
antimicrobial use
• Making a clinical diagnosis
• Limiting empiric antimicrobial therapy
• Know your bugs
• Choose appropriate antimicrobial
• De-escalation/Modification
• Identify clinical situations where antimicrobial use
needs to be stopped
• Reduce duration of therapy
• Optimize pharmacodynamics and
pharmacokinetics
50. Strategies to improve Antimicrobial Use
Front-end strategies:
• Antimicrobials are made available through an approval process (formulary
restriction and preauthorization)
• Shows immediate reduction in use and expenditure of restricted antibiotics
Back-end strategies:
• Antimicrobials are reviewed after antimicrobial therapy has been initiated
(prospective audit and feedback)
• Timely de-escalation of antibiotics
• Reduction in inappropriate use
Principles of Antimicrobial Prescribing. CMC Vellore & WHO
51. Strategies to improve Antimicrobial Use
Advantages Disadvantages
Pre-
authorization
• Reduces empiric initiation of
inappropriate Antimicrobials
• Encourages early and frequent review
of culture data
• Reduces costs
• May delay therapy
• Loss of prescriber
autonomy
• Impacts only restricted
agents
Prospective
Audit &
Feedback
• Visibility of the stewardship is increased
• More data is available and hence
uptake is better
• Educative and collaborative effort
which could address de-escalation and
duration of therapy
• Prescriber autonomy is maintained
• Labor intensive
• Compliance voluntary and
prescriber reluctance to
change if patient better
Principles of Antimicrobial Prescribing. CMC Vellore & WHO
52. Antimicrobial Stewardship in PGIMER
Shafiq N, Kumar MP, Kumar G, Rohilla R,Saha S, Gautam V, Agarwal R, Ray P, Singh G, Muralidharan J,Arora P. Antimicrobial Stewardship Program of
PostgraduateInstitute of Medical Education and Research, Chandigarh:Running Fast to catch the Missed Bus. J Postgrad Med EduRes 2017;51(3):123-127
55. Priority 1 -
Stepping up
leadership for
the AMR
response
WHO Strategic Priorities on AMR. 2022
56. Priority 2 – Driving public health
impact in every country to address
AMR
• National AMR action plans in 148
countries
• Practical guidance and tools to
member countries
• Annual World Antimicrobial
Awareness Week (18-24 November)
– the theme for 2022 was
“Preventing Antimicrobial
Resistance Together”.
WHO Strategic Priorities on AMR. 2022
57. Strategic Priorities
Priority 3 – Research and Development for better access to quality AMR
prevention and care
• Development of priority bacterial and fungal pathogen lists
• List of Critically Important Antimicrobials for Human Medicine
Priority 4 – Monitoring AMR burden and global AMR response
• GLASS
• Tripartite AMR Country Self Assessment Survey (TrACCS)
WHO Strategic Priorities on AMR. 2022
58. Antimicrobial Resistance: A complex multi-factorial problem requiring orchestrated
interdisciplinary response. From the Australian Academy of Science Report. 2017
59. One Health Consortium
• The Department of Biotechnology under the Ministry of Science and Technology, has
launched the country’s first One Health consortium.
• This Consortium consists of 27 organisations from human, veterinary and related
environmental fields.
• It envisages carrying out surveillance of important bacterial, viral and parasitic infections
of zoonotic and transboundary pathogens in India.
• It also looks into the use of existing diagnostic tests and the development of additional
methodologies for the surveillance and understanding the spread of emerging diseases.
• There exists a need to make mitigation of AMR as one of the priorities of the One Health
Consortium.
Press Information Bureau, Ministry of Science and Technology, GoI, Dec 2021
60. TrACCS Country Report 2022 - India
Tracking AMR Country Self Assessment Survey (TrACSS) 2022 Country Report
61. Innovations
Kumar M, Sarma DK, Shubham S, Kumawat M, Verma
V, Nina PB, Jp D, Kumar S, Singh B, Tiwari RR. Futuristic
non-antibiotic therapies to combat antibiotic
resistance: A review. Frontiers in microbiology. 2021
Jan 26;12:609459.
63. Artificial Intelligence in AMR
• Development of synthetic antimicrobial peptides using AI
• A class of small host defense peptides, found in all classes of biological species.
• AI guided discovery and development of new antibiotics
• Discovery of new and structurally different antibiotics from the ones already known using AI.
• Assisting in appropriate antibiotic prescription
• Appropriate therapy selection, dose, and correct administration route
• Prediction of antibiotic resistance
• ML techniques to predict early AMR or the probability of a microbial agent becoming resistant
• Prediction of severity of infection
• Machine/deep learning tools for infectious pathology recognition and appropriate management
Rabaan AA, Alhumaid S, Mutair AA, Garout M, Abulhamayel Y, Halwani MA et al. Application of Artificial
Intelligence in Combating High Antimicrobial Resistance Rates. Antibiotics (Basel). 2022 Jun 8;11(6):784.
64. Future directions for India
Promoting further research on the drivers of AMR with due importance to components other than
antimicrobial use for human health alone.
Framing of antibiotic stewardship plans for healthcare settings to monitor and ensure judicious use of
antimicrobials, including all tiers of healthcare - primary health centres, secondary and tertiary hospitals.
Strict vigilance and control over sale of antimicrobial agents.
Prescription audit to bring down the over the counter (OTC) sale.
Disciplinary control over the functioning of hospital effluent plants with periodic assessment and
reporting of antimicrobial residue in the discharge.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.
65. Future directions for India
Regulation of wastewater discharges from pharmaceutical companies with regular monitoring
of antimicrobial residues in them along with provision of legislative support to punish offenders
Framing and implementing rules and regulations for the use of antimicrobial agents in food
animals including farmed seafood
Improving agricultural practices by ensuring use of environment-friendly manure and fertilizers
Educating the masses at the community level regarding AMR and formulating educational
bodies/non-governmental organizations for continued dissipation of information.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.
66. AMR and GoI Initiatives
• ICMR has initiated antibiotic stewardship program (AMSP) on a pilot project basis in 20 tertiary care
hospitals across India to control misuse and overuse of antibiotics in hospital wards and ICUs.
• DCGI has banned 40 fixed dose combinations (FDCs) which were found inappropriate.
• ICMR worked in collaboration with Indian Council of Agriculture Research, Department of Animal
Husbandry, Dairy and Fisheries and the DCGI to ban use of Colistin as growth promoter in animal
feed in poultry.
• Various IEC activities like public conclave, poster and quiz competitions have been conducted by
National Centre for Disease Control (NCDC) in schools, colleges and Health melas to create
awareness about AMR, its containment & prevention and judicial use of antibiotics among the
common public.
• To raise awareness among the community and the health care providers, communication material
includes posters, videos and radio jingles has been developed with emphasis on prevention of
irrational use of antibiotics during viral-illnesses and also on infection prevention through hand
hygiene to prevent spread of infections.
Press Information Bureau. MOHFW. GoI. 5 Aug 2022
67.
68. AMR and
PGIMER
• WHO-AGISAR Monitoring the Antimicrobial Resistance Profile of Bacterial
Food-borne Pathogens in Humans, Food Animals and Retail Meat in India.
• 2017-21 ICMR-AIIMS-CDC India Collaborative Project: Capacity Building and
Strengthening of Hospital Infection Control to detect and prevent
antimicrobial resistance in India
• 2019 PHFI Project: Antimicrobial resistance and zoonotic transmission in
enteric bacteria at human and animal interface in an intensive food
production geographic area
• Nodal centre for surveillance of Enterbacterales causing sepsis & fungal
pathogens.
The median rates of third-generation cephalosporin- resistant E. coli causing bloodstream infections - 42%
methicillin-resistant S. aureus (MRSA) causing bloodstream infections - 35%
(Glass 2022)
The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa)
AMR in Human beings:
More than 70% isolates of Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii and 50% of Pseudomonas aeruginosa were resistant to fluoroquinolones and third generation cephalosporins.
42.6% of Staphylococcus aureus were methicillin-resistant.
Deljh
Activities carried out –
AMR Surveillance
National Treatment Guidelines
Infection Prevention & Control guidelines and surveillance of Healthcare associated infections
Strengthening Laboratory capacity for AMR detection
IEC
Review meetings, trainings and workshops
Kerala, Madhya Pradesh, Delhi
steps for developing the State Action Plan for Containment of Antimicrobial Resistance (SAPCAR):
Map the AMR stakeholders in the State
Compile the background document – AMR and its containment in the State
Organize a state workshop to draft the SAPCAR
Establish governance mechanisms for AMR containment in the state
Latest SOPs regarding
Surveillance of priority bacterial pathogens under National AMR Surveillance Network (NARS-Net)
Colistin susceptibility test
Vancomycin Susceptibility test
Vancomycin Screen Agar Test
Internal Quality Control
External Quality Assessment
Preservation of bacterial isolates
Responsibilities of Nodal Centers
-Phenotypic tests
– Genotypic tests for mechanism of resistance and clonality of isolates – Repository of relevant Isolates– Act as training hubs for other hospitals/regional centers– Data validation
Responsibilities of Regional Centers
Defined geographical area of responsibility
Receive training from NCs & become hub of training for its specified region
Isolate, identify, AMST, store microbes
Transport predefined representative DR, DS isolates to NCs
Over time period, take over part or full responsibilities of NCs
The most frequent diagnosis leading to antibiotic prescription includes sinusitis, acute otitis media, pharyngitis, cold and bronchitis, UTI and pneumonia.
The most concerned antibiotic use in community were fluroquinolones and macrolides to which more than 70% of resistance was prevailing in Indian settings.
Toolkits for assessment
-Antimicrobial Self-Assessment Toolkit
-Target
-Start Smart, Then Focus
Access – 91
Watch – 145
Reserve - 33
The WHO AWaRe (Access, Watch, Reserve) antibiotic book provides concise, evidence-based guidance on the choice of antibiotic, dose, route of administration, and duration of treatment for more than 30 of the most common clinical infections in children and adults in both primary health care and hospital settings. The information included in the book supports the recommendations for antibiotics listed on the WHO Model Lists of Essential Medicines and Essential Medicines Children and the WHO AWaRe classification of antibiotics.
Golden rules of antibiotic prescribing : “MINDME”
Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum of antibiotics
Dosage appropriate to the site and type of infection
Minimize duration of therapy
Ensure monotherapy in most cases
Persuasive
Education
Guidelines
Reminders
Audit & feedback
Restrictive
Formulary restriction
Compulsory order forms
Expert approval
Automatic stop orders
Recognized as Advanced Center of Clinical Pharmacology for Antimicrobial Stewardship Program
Infection control nurse – 5 in number
tracks all positive culture cases and maintains the surveillance data
Education & training of staff nurses, nursing students in infection control
Audits every 6 months – wards, ICUs, OTs
Monitor compliance to BMW practice
Sensitivity testing – Disc diffusion method,
Automatic antimicrobial susceptible testing – VITAC/VITEK
Antimicrobial sensitivity reports (yearly) – circulate to faculty emails
Hospital infection control committee
Infection control team