National surveillance services a helpful investment in educating healthcare professionals

Transcription

1 National surveillance services a helpful investment in educating healthcare professionals Neil Woodford Head, Antimicrobial Resistance & Healthcare Associated Infections (AMRHAI) Reference Unit Crown Copyright

2 International Consensus: Antimicrobial Resistance is a Critical Threat 2 BSAC Roundtable, 24th Sept 2014 Crown Copyright

3 DH s Seven Key Areas for Action Improving infection prevention and control practices. Optimising prescribing practice. Improving professional education, training and public engagement. Developing new drugs, treatments and diagnostics. Better access to and use of surveillance data. Better identification and prioritisation of AMR research needs. Strengthened international collaboration. 3 BSAC Roundtable, 24th Sept 2014 Crown Copyright

4 National & international capacity building Without lab testing, we re blind to (the extent of) the problem Improve lab access; aim for a reference lab in every country Each serving as the hub of a national network Each acting as a spoke in an international network Performing essential techniques, proficient to international standards Sharing data / experience 4 BSAC Roundtable, 24th Sept 2014 Crown Copyright

5 Surveillance schemes International National UK as an example EARS-Net ESAC Euro-GASP SENTRY SMART MYSTIC TEST BSAC Mandatory reporting Voluntary Co-Surv / LabBase AMWEB ESPAUR GRASP Reference Laboratory data 5 BSAC Roundtable, 24th Sept 2014 Crown Copyright

6 What can we teach using surveillance data?

7 Make our fight against evolution something tangible evolution is often an arms race evolution is often an arms race antibiotic development vs. antibiotic resistance antibiotic development vs. antibiotic resistance bacteria evolve in real-time bacteria evolve in real-time Now, here, you see, it takes all the running you can do, to keep in the same place." 7 BSAC Roundtable, 24th Sept 2014 Crown Copyright

8 Key messages Use of every antibiotic has been affected by resistance Every bacterial species has developed resistance to key antibiotic classes Few bacteria have become resistant to every antibiotic class but their numbers are increasing Any use of any antibiotic in any setting contributes to the problem Will we celebrate their centenary in 2028 or mourn their demise? 8 BSAC Roundtable, 24th Sept 2014 Crown Copyright

9 Resistance is an entirely natural response Development of new antibiotic Emergence of resistance 9 BSAC Roundtable, 24th Sept 2014 Crown Copyright

10 Guiding empiric therapy: e.g. gonorrhoea 10 BSAC Roundtable, 24th Sept 2014 Crown Copyright Courtesy Dr Stephanie Chisholm, STBRU

11 The resistance ratchet keeps turning Pathogen Established problems Emerging threats E. faecium VRE, HLGR, Amp-R Lin-R, Dap-R, Tig-R S. aureus MRSA (ha/ca) Van-R, Lin-R, Dap-R Klebsiella ESBLs Carbapenemases, RMTases, Col-R Acinetobacter MDR, Carbapenemases Tig-R, Col-R Pseudomonas MDR, except Col Carbapenemases, Col-R Enterobacter AmpC, ESBLs Carba-R, Carbapenemases, RMTases E. coli Cip-R, ESBLs Carbapenemases, RMTases 5 of 7 ESKAPEEs are Gram-negative The resistance issue for the next 5-10 years Highlighted in UK 5 Year AMR Strategy 2013 to BSAC Roundtable, 24th Sept 2014 Crown Copyright

12 What we ve done well: MRSA bacteraemias in England 2,500 2,000 Number of Reports 1,500 1, BSAC Roundtable, 24th Sept 2014 Crown Copyright

13 Number of bacteraemia reports and what we must do better: E. coli bacteraemias 30,000 25,000 Escherichia coli Staphylococcus aureus 20,000 15,000 10,000 5, BSAC Roundtable, 24th Sept 2014 Crown Copyright LabBase2 data, England only

14 Carbapenem non-susceptibility, 2011 (Ears-Net) E. coli K. pneumoniae 14 data risk giving a false sense of security to non-experts only 9% of UK carbapenemase producers are from blood cultures 3 countries reported >5% non-susceptibility in K. pneumoniae BSAC Roundtable, 24th Sept 2014 Crown Copyright EARS-Net

15 Surveillance in the absence of high rates?...reference labs can provide early alerts Spider s web effect Very sensitive to new emergences / arrivals Works when resistance is still below the Programme radar 15 BSAC Roundtable, 24th Sept 2014 Crown Copyright

16 CPE in the UK, Imported & home grown Frequency Early cases often imported IMP VIM KPC OXA-48 NDM IMI KPC + VIM NDM + OXA-48 Klebsiella spp. 79%; E. coli 12%, Enterobacter spp., 7%; others 2% 16 BSAC Roundtable, 24th Sept 2014 Crown Copyright AMRHAI, Unpublished data

17 Limiting the impact of carbapenemases Microbiology and IPC appropriate patient management empiric therapy adjusted as necessary: escalate, add in, or de-escalate (stewardship) rapid implementation of infection control procedures prevent onwards transmission National guidance prompted by reference laboratory (and surveillance) data 17 BSAC Roundtable, 24th Sept 2014 Crown Copyright

18 Integrated surveillance of a complex problem Colonized residents or visitors Non-human reservoirs: foodstuffs (domestic or imported) Non-human reservoirs: animals and environment Hospital treatment or travel overseas Inter-hospital transfers (UK) Victims from conflict zones Multiple risks to be assessed to minimize damage We need better intelligence 18 BSAC Roundtable, 24th Sept 2014 Crown Copyright