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Work Underway onAntimicrobial Resistance
(& Healthcare-Associated Infections)
Dominique L. MonnetScientific Advice Unit
1
AMR & HCAI Activities, 2005-2007
• Member State have designated AMR National Focal Point (sometimes two) for ECDC
• 3 meetings of AMR National Focal Points• 8 country visits to discuss AMR (and several more
planned)
2
1. Development of a Member State Coordinating Group
2. Organized multidisciplinary and multisectoral collab. on local level
3. Laboratory capacity4. Monitoring of antibiotic resistance5. Monitoring of antibiotic usage6. Antibiotic utilization and
treatment guidance7. Infection control8. Educational programs on AMR9. Public information related to AMR
10. Marketing related issues
DonePlannedDone by WHO
Country Visits to Discuss AMR
3
AMR & HCAI Activities, 2005-2007(continued)
• Clostridium difficile expert working group: 1 background document (published), 1 guidance for control (in press)
• MRSA expert working group• Evaluations of and decisions about DSNs: EARSS
(temporarily outsourced), ESAC (temporarily outsourced), IPSE/HELICS (integrate in 2008)
• Co-operation with EFSA on AMR surveillance in bacteria from food animals
• Planning of First European Antibiotic Awareness Day, debate at the European Parliament
4
Total Outpatient Antibiotic Use (ATC J01)in 29 European Countries, 1998-2005
Source: ESAC, 2007. Adapted from: Muller A, et al. Eurosurveillance (11 October 2007)
*Total use for Bulgaria and Iceland, and for Greece (2004 & 2005 only). **Reimbursement data, which do not include over-the-counter sales without a prescription.
National media campaign
National media campaign
Media coverage
Media coverage
Education prog. for paediatricians
Education prog. for paediatricians
5
AMR & HCAI Workplan 2008, Strategy 1.1:Health, economic and social impact
• Development and implementation of basic and enhanced surveillance for HCAI in Europe
Prepare integration of the IPSE/HELICS network, IPSE pilot studies on indicators• Contribute to the standardisation of antimicrobial susceptibility testing
European antimicrobial susceptibility testing guidelines (EUCAST)• Explore the possibility of additional surveillance networks
Clostridium difficile survey (report in 2009)• Participate in the revision of WHO Defined Daily Doses for antibacterials
European conference (with international participation, WHO Collab. Ctr.)• Contribute to addressing AMR issues related to food animals and food
(EFSA WG)• Prepare implementation of an alert and response system for AMR and
HCAI events (as part of EPIS)• Start preparing an EU-wide point prevalence survey on HCAI (survey in 2009,
report in 2010)• Explore integration of AMR and HCAI surveillance (2009)
6
AMR & HCAI Workplan 2008, Strategy 1.2: Determinants
• Obtain baseline data on “European citizens and antibiotics”Small EU-wide Eurobarometer survey on the knowledge, attitudes and behaviour of European adults towards antibiotics and antibiotic resistance (using previously used and validated questions)
• Report about antibiotics obtained over-the-counter (OTC) without a prescription in the EU
from Eurobarometer survey
Postponed to 2009
7
AMR & HCAI Workplan 2008, Strategy 1.3: Prevention and control methods
• Provide guidance on various strategies for C. difficile control• Provide advocacy and guidance on various strategies for MRSA control
Advocacy paper on some MS successes in controlling MRSA (2008)2 “guidance” papers (CA-MRSA, HA-MRSA) reviewing strategies (2009)
• Analysis of the gap between increasing multidrug (MDR) resistance and the lack of novel antibacterial drugs (with EMEA)
Model future trends of MDR bacteria in EU (2008)ECDC-EMEA Joint Technical Report on trends in multidrug resistance, the need for new antibacterial drugs and the role of EU agencies (2009)
• Promote MS participation in WHO Global Patient Safety Challenge: “Clean Care is Safer Care”
Coordination of action between ECDC and WHO• Start working a curriculum for a training course on the control of MDR
bacteria (available in 2009, first course in late 2009 or 2010)• Provide case definitions for AMR & HCAI (2009)
8
AMR & HCAI Workplan 2008, Strategy 1.4: Programmes at EU level and in MS
• Improve coordination of activities and build capacity in MS5 initial country visits to discuss AMR + 2 post-visits4th meeting with AMR National Focal Points (13 March 2008) and Joint Meeting of CMOs and AMR National Focal Points (14 March 2008), Slovenia
• Provide information on AMR & HCAI on ECDC websiteBuild up AMR & HCAI part of the ECDC website”Science Watch” on AMR & HCAIReport on major events in the field of AMR & HCAIStart adding country specific information and links
• Provide expert advice on prevention and control of HCAIHCAI Advisory Group
• Increase awareness of European citizens about AMR and antibioticsWorkshop on initiatives from MS to improve the rational use of antibiotics (autumn 2008, France)First Annual European Antibiotic Day (18 November 2008): toolkit, dedicated website, national campaign materials)
9
Capacity
building
Ad-hoc
studies
Surveillance
Com
munic.
Training
Regulatory
Guidelines
& reports
Technicalsolutions
AMR in outpatients
AMR in hospitals
AMR inintensivecare units
Antimicrobial useIn outpatients
OTC use ofantimicrobials
Antimicrobial usein hospitals
Antimicrobial usein intensive care
Hospital infectioncontrol
AMR in LTCFs & nursing homes
Pan-resistantmicroorganisms
New antimicrobials
Non-human AMR & antimicr. use
AMR in non EU Member States
Antimicrobialavailability
AM
R&
HC
AI
10
Capacitybuilding
Ad-hocstudies
Surveillance
Communic.
Training
Regulatory
Guidelines& reports
Technicalsolutions
AM
R in
ou
tpat
ient
s
AM
R in
ho
spita
ls
AM
R in
inte
nsiv
eca
reun
its
Ant
imic
robi
alus
eIn
out
patie
nts
OTC
use
ofan
timic
robi
als
Ant
imic
robi
alus
ein
hos
pita
ls
Ant
imic
robi
alus
ein
inte
nsiv
e ca
re
Hos
pita
l inf
ectio
nco
ntro
l
AM
R in
LTC
Fs&
nu
rsin
gho
mes
Pan-
resi
stan
tm
icro
orga
nism
s
New
an
timic
robi
als
Non
-hum
anA
MR
&
ant
imic
r. us
e
AM
R in
non
EU
M
embe
rSta
tes
Ant
imic
robi
alav
aila
bilit
y
Vet. (EFSA)
Pipeline proj.& need (EMEA)
MDR & XDRprojections
AMR&HCAI2008
Eff. red. use
Cl. diff.
survey
Consolidate DSNs: EARSS, ESAC, IPSE/HELICS, EUCAST
EUCAST - AST guidelines
HA-MRSA
control
MRSA control,incl. CA-MRSA
DDDConf.(WHO)
OTCreport
Euro-Barometer
Country visitsNational focal point meeting + meeting with CMOs
European Antibiotic Awareness DayEU workshop
Basic and country information on ECDC website
Pat. safety (WHO)
IC Adv.Comm.
EU training program on control of MDR microorganisms,start with curriculum (CfT)
Train.(WHO)
Strategy 1.1, Strategy 1.2, Strategy 1.3, Strategy 1.4
Case definitions for AMR & HCAI
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.