Antimicrobial Resistance- The Present State and The Future - … · 2019-11-19 · Poster Presentation: ZigmondJ et al. 16th ICID Abstracts / International Journal of Infectious Diseases

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Antimicrobial Resistance: The Present State and The Future

By Dr Hebah Dada

Antimicrobial Resistance (AMR) The Present State and Future

Hebah Dada.MDNational AMR program Director at SCDC

• Introduction• Current state of AMR globally• National action plan and National AMR program• Current state of AMR in Saudi Arabia• Future of AMR

Outlines:

Introduction:• AMR infections claim at least 50,000 lives /year across

Europe and the US alone.

• medical experts are raising real concern for a return to the pre antibiotic age.

• over 20,000 potential resistance genes (r genes) are present.

• the functional resistance determinants in various microbes are far less in number.

Infect Drug Resist. 2018 Oct 10;11:1645-1658. doi: 10.2147/IDR.S173867. eCollection 2018

Causes of antibiotic resistance• overuse of antibiotics is the principal cause of resistance evolution

• inadequate regulations and usage imprecisions,

• awareness deficiency

• use of antibiotics as a poultry and livestock growth promoter rather than to control infection( about 80% in the US )

• online marketing which made the unrestricted availability of low-grade antibiotics very accessible.

Infect Drug Resist. 2018 Oct 10;11:1645-1658. doi: 10.2147/IDR.S173867. eCollection 2018

Causes of antibiotic resistance• Several studies have revealed that treatment indications, agent choice, and

antibiotic therapy duration are inappropriate in 30%–50% of the cases.

• a global map of 228 countries was drawn which depicted the consumption of antibiotics in livestock; it was estimated that the total antibiotic consumption was 63,151 tons in 2010.

• 67% rise in antibiotic consumption by 2030 that would approximately double in Brazil, Russia, India, China, and South Africa block of the rapidly developing and highly populated countries of the world.

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40(4):277–283.Read AF, Woods RJ. Antibiotic resistance management. Evol Med Public Health. 20142014;147(1).Lushniak BD. Antibiotic resistance: a public health crisis. Public Health Rep. 2014;129(4):314–316van Boeckel TP, Brower C, Gilbert M, et al. Global trends in antimicrobial use in food animals. Proc Natl Acad Sci U S A. 2015;112(18):5649–5654.

AMR Globally :

• 15 European countries more than 10% of bloodstream Staphylococcus aureus infections are caused by (MRSA), with several of these countries seeing resistance rates closer to 50%.1

• Emerging resistance to treatments for other diseases, such as TB, malaria and HIV, have enormous impacts in lower-income settings.

• Drug-resistant strains of TB :an estimated 480,000 new cases in 2013

• The spread of resistant strains of malaria is similarly well documented, and the development of resistance to antiretroviral therapy for HIV is closely monitored.

European Centre for Disease Prevention and Control Antimicrobial Resistance Interactive Database (EARS-NET) data for 2013World Health Organization Global Tuberculosis Report 2014

AMR Globally :

• Global consumption of antibiotics in human medicine rose by nearly 40% between 2000 and 2010

• the speed and volume of intercontinental travel today creates new opportunities for antimicrobial-resistant pathogens to be spread globally.

• No country can therefore successfully tackle AMR by acting in isolation.

Van Boeckel, T P et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. The Lancet Infectious Diseases 2014; 14(8): 742–750

Global Action plan

the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance

The global action plan sets out five strategic objectives:• improve awareness and understanding of antimicrobial resistance• strengthen knowledge through surveillance and research• reduce the incidence of infection• optimize the use of antimicrobial agents• develop the economic case for sustainable investment to increase

investment in new medicines, diagnostic tools, vaccines and other interventions.

Saudi Arabia

´Saudi Arabia as member of Global Health Security Agenda and G20

Ńational Action Plan and Road Map for AMR

Ńational AMR scientific committee.

ÁMR Program at SCDC

Saudi Arabia NAP

National AMR Program

Laboratory Surveillance

Antimicrobial Stewardship

Infection Control

AwarenessResearch and development

Surviellance

´ GLASS started 2016

´ SA enrolled on May 2017

´ By the end of 2017 69 countries around the world were enrolled

´ KSA one of the first Middle East countries participated in the program in 2017

´ On 2018 we double the submitted number of isolates

GLASS Journey

2017 2018

KSU was in charge and succeeded in collecting:- From 39 labs

participated. - Total of 4885

isolates.

SCDC took over at mid-year and submitted:- From 38 labs

participated. - Total of 8219

isolates.

2019

SCDC continuing the efforts and the collection of the data.

Proportion of samples with non-susceptibility results for bacteria species and antibiotic under surveillance.

Staphylococcus aureus

Pathogens non-susceptibility overview

WHO. Global Antimicrobial Resistance Surveillance System (GLASS) Report Early implementation 2017-2018. Pages 182-185

Staphylococcus aureus

MOH antibiogram

MRSA

34.9% Alkharsah, et al. Annals of Clinical Microbiology and Antimicrobialsvolume 17, (2018)

King Fahd hospital of the University (KFHU) in Al-Khobarin the Eastern Province of Saudi

January 2010 to September 2011

106

MRSA constituted 48.8% (40.4-57.2%), the Middle East (47.5%; 38.7-56.4%)

Poster Presentation: Zigmond J et al. 16th ICID Abstracts / International Journal of Infectious Diseases 21S (2014)

Africa and Middle East

2014 84 MRSA infection studies (15,789 individuals; 23,170 isolates) and 30 MRSA colonization studies (5,894 individuals, 3,773 isolates) were identified


E.coli



E.coliMOH Antibiogram


Klebsiella Pneumoniae



Klebsiella PneumoniaeMOH antibiogram

Klebsiella PneumoniaeMOH antibiogram

CRERegion/year: 2 largest hospitals in Abha city in the Southern province of Saudi

Arabia. April and September in 2015

Number of patients: 54 K. pneumoniae isolates

Rate :

Comment Increasing age and intensive care unit admission were associated

with CRKP isolation. No producers of blaIMP and blaKPC were detected among

all tested isolates

Al-Zahrani IA, er al., Saudi Med J 2018;39(1):23–30

CRE:Region/year: Riyadh, Saudi Arabia, between January 2011 and December 2012. Number of patients: 71 CRKP isolates Rate :

Comment: A polyclonal OXA-48 gene was the most common carbapenemase followed by NDM-Coproduction of OXA-48 and NDM-1 in 6/71 (8.5%)

Zaman T, et al., BMC Infect Dis 2018;18:205.

CRERegion/year: Riyadh, Saudi Arabia, March 2014 to May 2014Number of patients: 31 carbapenem-insensitive isolatesRate : All carbapenem-insensitive isolates were carbapenemase producers, with 41.9% and 58.1% being class B carbapenemases class D OXA-48, respectively. While the prevalence of ESBL producers was 80.6%.

Comment The predominant carbapenemases in the isolates that had carbapenem MIC ≤ 4 µg/ml and MIC ≥ 12 µg/ml were bla OXA-48-type and bla NDM-type respectively. CTX-M-1-like was the dominant ESBL.

Al-Agamy MH, Et al., Jinfect Public Health 2018;11:64–8

CRE:Region/year: Saudi Arabia. January and June 2012Number of patients: 242 nonrepetitive Gram-negative bacteria (Enterobacteriaceae, P. aeruginosa and A. baumannii)Rate : OXA-48 and NDM-1 are the dominant carbapenemases among Enterobacteriaceae with low prevalence of VIM. Comment No KPC or IMP genes were detected. the first report of OXA-48, NDM-1, and VIM-4 enzymes in Enterobacter from the Kingdom.

Memish ZA, et al. Microb Drug Resist 2015;21(June(3)):307–14,

CRERegion/year: Gulf Cooperation Council (GCC). July 2011 and January 2013Number of patients: 413 clinical Escherichia coli and Klebsiella pneumoniae isolates Rate : 62 isolates (53 were K. pneumoniae, and 9 were E. coli) which screened positive for potential carbapenemase production were assessed, and 45 were found to produce carbapenemase. No KPC-type, VIM-type, or IMP-type producers were detected.

Comment Multiple clones were detected with seven clusters of clonally related Klebsiella pneumoniae. Awareness of CRE in GCC countries is important in controlling the spread of CRE in the Middle East

Zowawi HM, et al., Antimicrob Agents Chemother 2014;58:3085–90,.


Acinetobacter



Acenitobacter

MOH antibigram

Future:

Future:

Future plan :• Improve laboratories network that link all surveillance

laboratories to regional laboratories and subsequently to the national laboratory

• Improve laboratories capacity for detection of AMR • Improve National data collection for AMR and antibiotic

consumption• Participate in GLASS EAR for emerging antimicrobial resistance

detection• Perform phenotypic and genotypic testing in central collection

reference site• Perform sophisticated molecular testing for organisms of interest

including sequencing

Thank You

Documents

Antimicrobial Resistance- The Present State and The Future - … · 2019-11-19 · Poster Presentation: ZigmondJ et al. 16th ICID Abstracts / International Journal of Infectious Diseases