0

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.