Global and UK Drivers for Antimicrobial Stewardship
(barriers and opportunities) Philip Howard
Consultant Antimicrobial Pharmacist [email protected]
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 [email protected]
Twitter: @AntibioticLeeds