Dr. A Sumathi - LINEARITY CONCEPT OF SIGNIFICANCE.pdf
Antibiotic Resistance .pptx
1. Multifaceted
approach to
combat
Antimicrobial
Resistance Prof. Farhan Ahmad Khan
Dept. of Pharmacology, Jawaharlal
Nehru Medical College, AMU, Aligarh,
India
International Webinar on Critical Care Emergency Medicine,
London 19th October, 2021
“Exploring the current issues and challenges in the path of critical care and Emergency medicine ”
2. Why Antibiotic Resistance (AMR) is necessary
Antimicrobial resistance (AMR) has become a major obstacle to the
treatment of infectious diseases worldwide.
3. Overview
Antibiotics are vital life-saving medicines
Antimicrobial resistance is both a global and local
problem
The link between antibiotic use and resistance
Antimicrobial stewardship (AMS)
Antimicrobial Awareness
4. Antibiotics
medicines used to treat infections
caused by bacteria.
no impact on treating infections
caused by viruses.
The term ‘antimicrobial’ refers to a
substance that inhibits or destroys
bacteria, parasites, viruses or fungi.
5. Narrow spectrum antibiotics
work against a limited group
of bacteria
• Lower resistance potential
Broad spectrum antibiotics
work against a larger group of
bacteria
Overuse of unnecessarily
broad spectrum antibiotics
can drive antimicrobial
resistance
Broad vs Narrow Spectrum Antibiotics
It is preferable to narrow spectrum antibiotics wherever possible
6. What is
antimicrobial
resistance
(AMR)?
Antimicrobial resistance (AMR) occurs when
bacteria, parasites, viruses or fungi change to
protect themselves from the effects of
antimicrobial drugs designed to destroy them.
This means previously effective antimicrobial
drugs (e.g. antibiotics) used to treat or prevent
infections may no longer work.
The World Health Organization (WHO) has
identified AMR as ‘one of the biggest threats to
global health’.
7.
8. Causes of AMR
• Over-prescription of antibiotics
• Patients not finishing the entire antibiotic course
• Overuse of antibiotics in livestock and fish farming
• Poor infection control in health care settings
• Poor hygiene and sanitation
• Absence of new antibiotics being discovered
9. Why are antibiotics
and antimicrobial
resistance
important?
• Antibiotics treat infections caused by bacteria
• Modern medicine, especially surgery and cancer
treatments, depends on effective antibiotics to
minimise the risk of infection
− Currently, antibiotics reduce post-operative
infection rates to below 2%
− Without effective antibiotics, this could
increase to around 40% to 50%. Up to 30% of
these patients could die from resistant
bacterial infections
− The risk of mortality without access to
effective antibiotics may make some
treatments and surgical procedures too risky
to continue
• Antimicrobial resistance results in substantial
financial cost for patients and healthcare systems.
10. How has
antimicrobial
resistance
developed?
Antimicrobial resistance is a natural phenomenon
Overuse, misuse and inappropriate use of antibiotics may
accelerate this
The delivery of more complex health care which may require
longer use of antibiotics
Prolonged hospitalisation
The potential impact of surgical procedures undertaken overseas
Resistant pathogens can now spread easily
•during hospitalisation if infection prevention is poor
•potential for cross-border transmission through increased travel.
11. How AMR
Spreads
Antimicrobial use is a key factor in the
development of antimicrobial resistance –
the more antimicrobials are used, the more
likely it is that resistance will develop.
Resistant bacteria arising in humans,
animals or the environment may spread
from one to the other,
and from one country to another.
12. Decline in
antibiotic
production
• Very few antibiotics have been
developed in the last 20 years
• Most ‘new’ antibiotics are
variations of existing antibiotics
• Only 5 novel classes have been
developed in the last 20 years.
13. Antimicrobial
Stewardship
(AMS)
Antimicrobial Stewardship isn’t about “not using
antimicrobials” but rather “identify that small group of
patients who really need antibiotic treatment and then
explain, reassure and educate the large group of patients
who don’t”
• Stewardship means to protect something
• AMS is a systematic approach to optimising the use of
antimicrobials
• Goals of AMS are to:
‒ improve patient outcomes / patient safety
‒ reduce antimicrobial resistance
‒ reduce costs.
• AMS works hand-in-hand with infection prevention and
control, and environmental cleaning strategies
15. AMS during
COVID-19
• COVID-19 pandemic has presented many additional
challenges (including antimicrobial shortages) for managing
patients with infections
• It is even more important to prevent infections and reduce
inappropriate antibiotic use
• Key message:
• Explain to patient that antibiotics do not prevent or
treat COVID-19 but can cause adverse effects, allergic
reactions, drug interactions and increase risk of future
resistant infections
16. AMR
Awareness
Lack of antibiotic resistance awareness in
the community.
There should be educational programmes
to highlight the issue of AMR in the
people as Excessive use of antimicrobial
agents in animal husbandry is also one of
major causes of AMR.
17. How we
can combat
AMR
There should be systematic surveillance
antibiotic resistance awareness in the community.
There should be educational programmes to
highlight the issue of AMR in the people
The professions should look into ways and means
to support systematic data collection on antibiotic
use and appropriateness of use;
Hospitals should actively support effective
antimicrobial stewardship programmes.
19. Individual Level
Only use antibiotics when prescribed by a certified health professional.
Never demand antibiotics if your health worker says you don’t need them.
Follow your health worker’s advice when using antibiotics.
Never share or use leftover antibiotics.
Prevent infections by regularly washing hands, preparing food hygienically
Prepare food hygienically, following the WHO Five Keys to Safer Food
keep clean,
separate raw and cooked, cook thoroughly,
keep food at safe temperatures,
use safe water and raw materials) and
choose foods that have been produced without the use of antibiotics for growth promotion or disease
prevention in healthy animals.
20. Policy makers Level
• Ensure a robust national action plan to tackle antibiotic resistance is in place.
• Improve surveillance of antibiotic-resistant infections.
• Strengthen policies, programmes, and implementation of infection prevention and control
measures.
21. Health professionals
• Prevent infections by ensuring your hands, instruments, and environment are clean.
• Only prescribe and dispense antibiotics when they are needed, according to current
guidelines.
• Report antibiotic-resistant infections to surveillance teams.
• Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the
dangers of misuse.
• Talk to your patients about preventing infections (for example, vaccination, hand washing,
safer sex, and covering nose and mouth when sneezing)
22. Healthcare industry
• Invest in research and development of new
antibiotics, vaccines, diagnostics and other
tools.
23. Agriculture sector
Only give antibiotics to animals under veterinary supervision.
Give
Not use antibiotics for growth promotion or to prevent diseases in healthy animals.
Use
Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available.
Vaccinate
Promote and apply good practices at all steps of production and processing of foods from animal and plant
sources.
Promote and apply
Improve biosecurity on farms and prevent infections through improved hygiene and animal welfare.
Improve
24. WHO response
The “Global action plan on antimicrobial resistance” has 5 strategic objectives:
To improve awareness
and understanding of
antimicrobial resistance.
To strengthen
surveillance and
research.
To reduce the incidence
of infection.
To optimize the use of
antimicrobial medicines.
To ensure sustainable
investment in countering
antimicrobial resistance.
A global action plan on antimicrobial resistance, including antibiotic resistance,
was endorsed at the World Health Assembly in May 2015.
25. Key
messages
Antimicrobial resistance:
•occurs when an organism
evolves and develops
resistance to an antimicrobial
that should inhibit or destroy it
•is reducing the effectiveness
of antimicrobials to treat
infections
•is happening now
Few new antimicrobials
are being developed
The misuse, overuse, and
inappropriate use of
antimicrobials
contributes to
antimicrobial resistance
Antimicrobial
stewardship works hand
in hand with prevention
and control strategies to
help address
antimicrobial resistance.
26. World
Antimicrobial
Awareness
Week
Held annually since 2015, that aims to increase
awareness of antimicrobial resistance worldwide and to
encourage best practices among the general public,
health workers and policy makers to avoid the further
emergence and spread of drug-resistant infections.
WAAW takes place every year from 18 to 24 November.
The slogan has previously been, “Antibiotics: Handle with
Care” but changed to “Antimicrobials: Handle with Care”
in 2020 to reflect the broadening scope of drug resistant
infections.
This presentation has been designed to be a resource used to explain antimicrobial resistance and the relationship to antibiotic use. It is designed for organisations to customise as they like.
It will highlight the increased chance of resistant bacteria spreading readily between people in the community, as well as in primary care services, hospitals and aged care homes.
This presentation will also outline the significant effect that antimicrobial resistance has on the community; individual patients; health services; and, the health system more broadly.
Content covered in this presentation includes:
The link between antibiotic use and the development of antimicrobial resistance
The importance of appropriate antibiotic use as one strategy to contain and control antimicrobial resistance
The action being undertaken globally and in Australia to prevent, monitor and reduce antimicrobial resistance
The role antimicrobial stewardship (AMS) programs play in supporting the appropriate use of antibiotics.
Antimicrobial resistance is one of the most significant challenges for the provision of safe, high-quality health services across the world. The term ‘antimicrobial resistance’ refers to the failure of an antimicrobial (which includes antibiotics) to inhibit or destroy bacteria, parasites, viruses or fungi for which it has been designed using standard dosing regimens
Antimicrobial resistance has a direct effect on patient care and creates a set of critical ongoing challenges to health service delivery. It can increase a patient’s length of hospital stay and severity of patient illness. Severe infections caused by bacteria that do not respond to available ‘last-line’ antimicrobials (including antibiotics) can result in septicaemia and death.
Antimicrobial resistance also increases the complexity of treatment, and places a significant burden on patients, health service organisations and the health system.
Amina J. Mohammed (Deputy Secretary-General of the UN) was quoted as saying that “Antimicrobial resistance is one of the most pressing issues globally, not only for human health but it is a multi-sectoral problem involving animal health, agriculture, the environment, trade and many other sectors”.
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO was quoted as saying “A lack of effective antibiotics is as serious a security threat as a sudden and deadly disease outbreak. Strong, sustained action across all sectors is vital if we are to turn back the tide of antimicrobial resistance and keep the world safe."
Prof Dame Sally Davies, England’s chief medical officer was quoted as saying “We will be given the choice of, well you can have an expensive treatment that’s likely to cure you, but you’ll get an infection that is likely to be resistant and you’ll probably die of it,” she told MPs. “Meanwhile all transplants will be out of the window because they are all prone to infections. There will be a lot of suffering and modern medicine will be lost.”
NPS MedicineWise maintains a list of important antibiotic resistance myths:
https://www.nps.org.au/medical-info/consumer-info/antibiotic-resistance-the-facts
Consumers are aware that antibiotics treat infections. However, consumers may not be aware that antibiotics are essential in preventing infection after surgical procedures and for patients receiving chemotherapy.
Antimicrobial resistance has significant and direct implications on patient care. Antibiotics play an essential role in preventing infection after surgery. For example, people currently undergoing surgery procedures (such as hip and knee replacements) receive standard prophylactic antibiotics and currently experience infection rates of around 0.5-2.0%. If access to effective antibiotics were reduced through antimicrobial resistance, post-operative infection rates could rise to around 40-50%, and up to 30% of these patients could die from these infections.
Antimicrobial resistance also impacts on a range of treatment options, such as chemotherapy for cancer patients, which may no longer be a viable or safe option due to the increased risk of complications and infections resulting post treatment. This reduction in safe and viable treatments, and services able to be offered by health facilities, would have a negative effect on the effectiveness of the healthcare system in the long term.
In 2014 the UK Government commissioned a review on antimicrobial resistance which investigated the global economic cost of infections caused by resistant bacteria. The work by KPMG and RAND Europe indicated that if the current trend of increasing antimicrobial resistance continues, by 2050 about 10 million people may die every year as a direct result of resistant bacterial infections for which there is no effective antimicrobial (which includes antibiotics). Gross domestic product would also decrease as a result of antimicrobial resistance, which the review indicated would translate to a reduction in global economic output worth between US$60 - US$100 trillion.
https://www.vox.com/2014/12/12/7382299/new-report-drug-resistant-infections-will-kill-more-people-than
Antimicrobial resistance occurs when bacteria develop resistance to an antimicrobial that was previously an effective treatment. Bacteria develop natural defences against antibiotics. When this occurs, potentially due to prolonged exposure to or overuse of a particular antibiotic, the antibiotic’s effectiveness to treat the infection decreases, and may reach a point where the antibiotic has no benefit.
The overuse of antibiotics in health (human and animal) and agriculture has increased the amount of exposure bacteria have to them, giving bacteria more opportunity to develop resistance. The process of natural selection (‘survival of the fittest’ – favouring bacteria that develop the strongest natural defences) fuels the increasing prevalence of antimicrobial resistance.
New challenges in infection control resulting from more complex health care (for example, outpatient chemotherapy) and increasing domestic and international travel have increased the spread of resistant bacteria both between individuals and between countries.
When patients have longer hospital stays, this may increase the chance of patients acquiring resistant organisms from other patients.
So why can’t new antibiotics be developed to tackle resistance? Well they can but there are reasons why this is a very slow and complex process.
Many pharmaceutical companies have stopped developing antibiotics over the last 20 years, resulting in very few new antibiotics being developed and released onto the market. The reason for this decline is that antibiotics, in particular, are extremely expensive and resource-intensive to develop.
The World Health Organisation reviewed the publically available information on the current clinical development pipeline of antimicrobial agents. Their review showed the current clinical pipeline is still insufficient to mitigate the threat of antimicrobial resistance (particularly Gram-negative bacteria and TB). And most agents in the pipeline are modifications of existing antibiotic classes – therefore they are only short term solutions as they usually cannot overcome multiple existing resistance mechanisms.
Ref:
ANTIBACTERIAL AGENTS IN CLINICAL DEVELOPMENT - An analysis of the antibacterial clinical development pipeline, including tuberculosis (http://apps.who.int/iris/bitstream/10665/258965/1/WHO-EMP-IAU-2017.11-eng.pdf?ua=1 )
Antimicrobial management or stewardship programs have been developed in response to the need to reduce unnecessary and inappropriate antimicrobial use.
They are part of a broader system for infection prevention and control to minimise resistance.
An AMS program alone is not sufficient to control resistance. To be effective a program needs to be established in conjunction with a comprehensive infection prevention and control program that includes hand hygiene, standard and transmission based precautions and cleaning and disinfection.
Antimicrobial stewardship is taking into account:
Evidence of efficacy
Toxicity of the drug
Ecological harm – the effect on resistance or development of Clostridioides difficile (formely called Clostridium difficile) infection.
Successful antimicrobial stewardship requires executive support and clinical leadership as well as team work between prescribers, pharmacists and nurses.
Essential elements of an antimicrobial stewardship program include:
Use of treatment guidelines that take into account local microbiological susceptibility patterns
An antibiotic formulary that includes restricting board spectrum and later generation antimicrobials to patients in whom use is clinically justified
Selective reporting of susceptibility testing consistent with hospital treatment guidelines
Monitoring and auditing antibiotic usage
Reviewing antibiotic prescribing with intervention and feedback to prescribers.
You may wish to play this clip providing an overview of Antimicrobial Stewardship https://www.youtube.com/watch?v=-G4cEYQBVu4&app=desktop
Key messages of this presentation:
Antimicrobial resistance is a worldwide problem that affects human and animal health
The misuse, overuse, and inappropriate use of antimicrobials has contributed, and continues to contribute, to antimicrobial resistance.
