Global and UK Drivers for Antimicrobial Stewardship

(barriers and opportunities) Philip Howard

Consultant Antimicrobial Pharmacist philip.howard2@nhs.net

Twitter: @AntibioticLeeds

Draft WHO AMR Action Plan 2014

1. Increasing AMR awareness, insight, education and engagement

2. Identifying most important approaches for infection prevention. Effective implementation.

3. Optimizing the use of existing antimicrobials (human, animals and agriculture)

4. Identifying and closing critical gaps in knowledge 5. Develop & distribute new antibiotics and

technologies 6. Long term economic, developmental and social

costs and implications of AMR. Investment

First Global Survey of Antimicrobial Stewardship

Philip Howard, Celine Pulcini, Gabriel Levy Hara, Stephan Harbarth, Dilip Nathwani & Ian Gould

on behalf of ESCMID ESGAP & ISC AMSG

In Press: Journal of Antimicrobial Chemotherapy

20%

42%

81%

20%

50%

42%

52%

0%

8%

4%

0%

0%

8%

4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Africa (10)

Asia (12)

Europe (26)

North America (5)

Oceania (2)

South America (12)

Total (67)

Africa (10) Asia (12) Europe (26) North America (5) Oceania (2)South America

(12)Total (67)

Country stds (planning) 0% 8% 4% 0% 0% 8% 4%

Country AMS stds 20% 42% 81% 20% 50% 42% 52%

Countries with AMS Standards (n=67)

Do you have a hospital AMS programme?

14%

53%

66%

67%

47%

46%

23%

29%

20%

22%

29%

25%

Africa

Asia

Europe

North America

Oceania

South America

58% have an ASP, 22% are planning one

Planned

Yes

Mean ASP duration: 3 years (Europe 5yr to Africa 1yr)

29% 29%

15% 20%

9% 14%

17% 12%

23% 16%

7% 9%

Current AMS programme(763)

Planned AMS programme(348)

Hospitals top 3 barriers to providing a functional and effective AMS programme

No barriers

Lack of informationtechnology support and/orability to get data

Opposition from prescribers–

Administration not aware ofAMS programme

Other higher priority initiatives

Lack of personnel or funding

Indian hospital

Formal review of ASP by 37%

80%

86%

65%

96%

71%

58%

20%

14%

35%

4%

29%

42%

0% 20% 40% 60% 80% 100%

direct expenditure (87)

usage of broad spectrum agents (96)

length of stay / mortality metrics (40)

inappropriate prescribing (80)

healthcare acquired infections (66)

antimicrobial resistance (67)

No benefit shown Positive benefit shown

AMS Drivers in England

UK 5yr AMRS: 7 key areas for action

English Surveillance Programme for Antimicrobial Utilisation & Resistance

Antimicrobial usage reporting

Antimicrobial stewardship in hospitals

• 2003: £12m 3yr funding to establish AMS

• National AMS Standards in 2011: Start Smart then Focus

England AMS Standards Start Smart then Focus

after 24 hours

2015-6 England drivers • Quality Premium

– Overall aim, return to 2010 prescribing levels

– Reduce antibiotic prescribing by 1%

– Hospitals: validate data & carbapenems by 1%

– Primary care: 1% quinolones + cefalosporins + amoxicillin-clavulanate as % of total ABs

• NICE Antimicrobial Stewardship guideline – Consultation on draft in Dec-14, launch Apr-15

– Quality standards to assess implementation

Global and UK Drivers for Antimicrobial Stewardship

(barriers and opportunities) Philip Howard

Consultant Antimicrobial Pharmacist philip.howard2@nhs.net

Twitter: @AntibioticLeeds