Tag Archives: antimicrobial stewardship

The ‘I’ and the ‘We’ of antimicrobial resistance

 

Not a day goes by where there isn’t a report somewhere about the threat of antimicrobial resistance. Our media is awash with grim stories about ‘superbugs’ emerging in patients and hospitals, with dire predictions about the future of healthcare and even humanity and the planet as we know it. There is much that we know about antimicrobial resistance. We know that antimicrobial resistance is a significant global health and security threat. We know that it is something that is increasingly the focus of the work of busy infection control professionals, ID physicians and pharmacists. We know that governments, non-government organisations and all manner of other organisations and groups around the world are marshalling resources, and launching campaigns and strategies to slow the pace and spread of antimicrobial resistance. We know that use of antimicrobials is the primary driver of resistance, and we know that this is accelerated by what is commonly described as overuse, misuse or inappropriate use.  We also know that there is considerable international evidence demonstrating the relationship between antibiotic overuse, misuse or inappropriate use of antibiotics and resistance, and we know the kinds of very many problems that arise from this. Recently here in Australia the First Australian Report on Antimicrobial Use and Resistance in Human Health[1] by the Australian Commission on Safety and Quality in Health Care documented the extent to which Australia has contributed to the rise of global problem. The news this report brought was mixed: in some areas it was cause for celebration; in others our worst fears were realised. We know there is much, much more work to be done.

There are other aspects to this, however, that are not well known to all. There are aspects of this that ‘we’ don’t know well or appreciate. We tend of overlook, forget, and even not appreciate that for millions of people around the world the concepts of antibiotic overuse, misuse or inappropriate use are completely alien.  For millions and millions of people around there world there is no access, or very limited access, to antibiotics. Antibiotics are precious commodities that many only dream of having. In their recent commentary in The Lancet Pamela Das and Richard Horton argued that focusing on resistance in terms of misuse or overuse fails to take a global perspective on the needs of the many for whom antibiotics are a precious resource.[2] As they rightly point out, we tend to overlook, or lack an appreciation for, the fact that many more people die from the lack of access, or delayed access,to antimicrobials than from resistant organisms. While this stark reminder should of course in no way serve to discourage efforts to more prudent use of antibiotics in settings where overuse, misuse or inappropriate use occurs, we must also turn our minds to how we can bring about both sustainable access and sustainable effectiveness for all. We must enhance non antimicrobial-based initiatives to reduce the burden of disease, such as immunisation to improve health outcomes with a system of Universal Health Coverage. We know that this is but one critical intervention to realising the efforts for our wider goal to conserve antibiotics and reduce selection pressure that drives resistance. Moreover, we must all think long and hard about who we actually are when it comes to antimicrobial resistance. In doing so we must all work just as hard to ensure fair access to antibiotics as we do to tackling excess.

Ramon

 

 

[1] Declaration of Interest: Professor Shaban was the project leader of a research consortium at Griffith University contracted by Australian Commission on Safety and Quality in Health Care to contribute to this report. No other interests to declare.

[2] Das P & Horton R. (2015) Antibiotics: achieving the balance between access and excess. The Lancet, Vol 387, Issue 10014, p102-104.

Daddy, you swallowed a bug

“Daddy, maybe you swallowed the bugs”

I was tucking my four year old son into bed. He asked how I was feeling and I said that I was feeling a little sick. He said ‘maybe you ate chicken that wasn’t cooked’. I explained that I had not eaten any chicken. He then said ‘maybe you touched some bugs and swallowed them’. Now, that was a plausible explanation.

This simple conversation made me think of two things:

  1. Am I talking about infection control too much with my son (or maybe we should all talk more about infection prevention with our kids)
  2. Although simple, he is onto something, that as a civilised intelligent species, we seem still not to appreciate. What I hear you ask…..

Antimicrobial resistance.

On the news today, I heard about Antarctic Sewage Contamination. Some of the most pristine oceans in the world are contaminated with raw sewage (ironically from research bases that are working in the interests of the environment).  The most stand out point is was that researchers found some mammals (e.g. seals) showing signs of antibiotics resistance.

How? Humans consume antibiotics – directly (e.g. treatment) or indirectly by consuming meat or similar products that provided antibiotics.

With the winter cold and flu season kicking off in the Southern Hemisphere, it is time we all took some personal and community responsibility by prudent antibiotic use – or even better, antibiotic avoidance. We can all talk to friends and our children about the importance of preserving this miracle drug and infection prevention.

So, my son, for a four year, has cracked something we still continue to have trouble accepting and or changing – the vicious cycle of the overuse and or misuse of antibiotics.

Just for the record, I didn’t have an antibiotics resistance diarrheal disease, nor did I end up with D+V. I must have only consumed a small dose of the bugs….

 

A journey of a thousand miles begins with a single step – Laozi

(This blog was inspired by the session at ECCMID 2016 also mentioned by Brett)

There are some things we Antipodeans are good at and are arguably international leaders, and some things we’re not (sporting references will be overlooked for now).

Take for example Australia’s innovative and novel National Hand Hygiene Initiative (NHHI). Obviously declaring conflict here, but a national program rolled out across Australia that recently had over 900 healthcare facilities submit compliance data is an example of what enthusiasm, strong leadership, central coordination and jurisdictional cooperation combined with adequate resources can achieve.

Clearly the start up of the NHHI was resource intensive, and this has been well documented,  and it is difficult to measure the precise effect the NHHI has had on HAIs, particularly when HAI surveillance in Australia is so disparate. Undeniably it has bought the importance of hand hygiene to the forefront of clinicians, executive and politicians. And when these groups listen to infection prevention, it’s a good thing.

Australia also leads the way in antimicrobial stewardship. At the recent ECCMID conference in Amsterdam, AMS was a common theme in many sessions, and several Australians presented new knowledge identified through novel audit tools. Feedback from across the globe has reflected much interest at the appropriateness data being generated.

And then there are things that make us watch in awe, like surveillance. My poster on national surveillance in Australia at ECCMID received a moderate amount of visitors (and not one mistook me for being Austrian). The top two comments were “Nice layout, good colors” and “Really, you don’t have a national surveillance program?”

As Brett has mentioned in his post, the final session at ECCMID was about surveillance and public reporting, and we had Eli Perencevich present perspectives from the US and Europe. England now has a public reporting tool where consumers can drill down to Trust by infection and time period for an assortment of HAIs, presumably this will expand to all mandatory surveillance activities in the future. A presentation by Maaike van Mourik from the Netherlands about semi and fully automated surveillance systems and their utility for the numerous stakeholders was inspiring. Maaike demonstrated how a semi automated surveillance system resulted in an impressive surveillance workload reduction for ICPs and 100% case sensitivity

Will we live to see the day in Australia where electronically sourced, risk adjusted HAI data is collected by an automated surveillance program which is then analysed and interpreted by infection prevention experts, and then submitted to a central agency where data is collated, benchmarks established, and published on an interactive webpage providing complete transparency for consumers?

Unfortunately many other countries are closer to that day than Australia, but we must move in this direction… A journey of a thousand miles…

Why have a national HAI surveillance program, (I hear you ask), when the surveillance you do is perfectly adequate for your needs? Answers to that question will be provided in later blogs!

PLR