Antimicrobial Resistance Surveillance in Abu Dhabi

Transcription

1 Antimicrobial Resistance Surveillance in Abu Dhabi Middle East Infection Prevention Summit 4 June 2015, Conrad Hotel, Dubai, UAE Dr. med. Jens Thomsen MPH Environmental Health Section Occupational and Environmental Health Department Public Health and Research Division

2 2012: WHO calls on governments and other concerned parties for action to combat AMR Bacteria are starting to become so resistant to common antibiotics that it could bring about the end of modern medicine as we know it. Margaret Chan, Director General, World Health Organisation (WHO) March Due to misuse we are losing our first-line antibiotics and every antibiotic ever developed is at risk of becoming obsolete, as the world could be entering a Post-Antibiotic Era

3 AMR Reports to US President and UK Prime Minister (2014) 3

4 Global Health and Economic Burden of AMR AMR-related deaths may increase from 700,000 to 10 million by 2050 AMR s impact on World GDP (in trillions of USD) Global Gross Domestic Product (GDP) reduction of 2-3.5% AMR: Tackling a Crisis for the Health and Wealth of Nations. The Review on Antimicrobial Resistance Report to the UK Prime Minister, Dec

5 By 2050: 10 Million Deaths attributable to AMR every year Source: AMR: Tackling a Crisis for the Health and Wealth of Nations. The Review on Antimicrobial Resistance Report to the UK Prime Minister, Dec 2014 (A RAND Europe and KPMG study) 5

6 WHO Global Policy Package to combat AMR (2011) 6 WHO, World Health Day, 2011

7 Proposed Strategy to Combat AMR in Abu Dhabi Emirate POM/OTC Regulations HAAD Standards AMR Surveillance IC Management Clinical Care Pathways Antimicrobial Stewardship Programs (ASP) Policies, Standards & Guidelines AMR Data Monitoring and Surveillance Establish Antimicrobial Resistance Surveillance Program (AD ARS) Monitor antimicrobial prescriptions HCFs to report MDRO cases Increase community and patients awareness Increase awareness among pharmacists and physicians Develop AMR reports and ID Bulletins Conference presentations Education and Awareness Other Repository of guidelines & antibiotic stewardship programs Advocate for AMR Surveillance Reference Laboratory Facilitate academic research Strengthen academic curriculum Ensure drug quality 7 Current HAAD activities

8 Quantifying and Monitoring the local Burden of AMR (Abu Dhabi) Planning Development Implementation The Abu Dhabi AMR Surveillance Program (AD ARS) 8

9 Abu Dhabi Antimicrobial Resistance Surveillance Program (AD ARS) Rationale Before 2010, an AMR surveillance program was not existing on Abu Dhabi or UAE level Reports demonstrate presence of MDRO in Abu Dhabi Emirate and suggest increasing trends of resistance Aim Establish at no costs - a Hospital- and Labbased Antimicrobial Resistance Surveillance Program for Abu Dhabi Emirate, the AD ARS 9

10 Early reports show increasing antimicrobial resistance in the UAE % Susceptible 100 Rising Bacterial Resistance/Decreasing Susceptibility to Common Antibiotics in Al Ain, UAE, S. aureus OXA-S P. aeruginosa PIP/TAZ-S P. aeruginosa IMI-S P. aeruginosa CEFTAZ-S P. aeruginosa CEFOTAX-S P. aeruginosa AMOX/CLAV-S P. aeruginosa SXT-S E. coli CEFOTAX-S E. coli CIPRO-S S. maltophilia SXT-S Al-Kaabi et al. EMHJ, 17:6,

11 SWOT Analysis: Feasibility of Establishing an Emirate-wide AMR Surveillance Program (2010) Internal (Attributes of the Organisation) POWER- HAAD is the Regulator, i.e. can issue Policies & Regulations SCOPE - HAAD oversees all AD HCFs, public and private EXPERTISE: Public Health surveillance, AMR, microbiology and epidemiology expertise available in-house Helpful S Strengths Harmful W Weaknesses STRATEGY: No approved AMR control strategy or action plan in place MANAGEMENT: Lack of senior management awareness and clear directions HR: No dedicated personnel FUNDING: None DATA: Huge amount of comprehensive data is available at hospital level TECHNOLOGY: IT infrastructure allows easy submission and reporting of data DATA ANALYSIS: Software is available free of charge and easy to use (WHONET 5.6) O Opportunities T Threats REFERENCES: First AMR surveillance program in the region: no examples to learn from DATA QUALITY: Are all labs accredited? SUPPORT FUNCTIONS: No AMR Reference Lab External (Attributes of the Environment) 12

12 July 2011: HAAD issued a Standard mandating HCFs to monitor and report AMR Data to AD ARS (HAAD) HAAD Standard Monitoring and Reporting of Antimicrobial Resistance Mandates monitoring and reporting of antimicrobial resistance for all hospitals (n) and laboratories in Abu Dhabi Emirate Specifies data requirements and reporting mechanisms Regulatory instrument to establish the AD AMR Surveillance Program Issued July

13 The Abu Dhabi Antimicrobial Resistance Surveillance (AD ARS) System and Network MZH Delma Liwa Giathy Marfa Al Sila 2 Microbiology Labs SKMC 13 Hospitals 79 AHS clinics Tawam Al Mafraq Al Rahba Corniche Al Ain Al Wagan AHS Health Professionals, Scientific Community, APUA, Private HCFs CCL Extracts AD ARS Annual Surveillance Report HAAD Interactive Website Report.XLS.TXT BacLink (Data conversion tool) Data import AD ARS Database (WHONET 5.6) 2.4 m records ( ) Analysis Data Analysis (WHONET 5.6, Excel, SPSS v22) Reporting u/c 14 HAAD 14

14 AD ARS Data Base (5 Years): Key Figures 92 Healthcare facilities 2.5 m records 60 m data elements 358 MB 164 antimicrobials (25 classes) 481 different species 2,460,793 Antimicrobial susceptibility test results 205,436 bacterial/ fungal Isolates 80,383 Patients 153,477 Specimens from 212 Sources 15

15 AD ARS data base contains as much data from one Emirate and one year only, than has been published in the scientific literature for all GCC countries combined during 21 years All GCC countries, (21 years): 37,295 published isolates UAE: 491 isolates only (1.3%) Ary & Balkhy, ARIC, 2012 Abu Dhabi ARS 2014 only: 33,415 isolates reported 68 times more data in 1 yr than published in 21 yrs. (UAE) 16

16 Pathogens under AMR Surveillance S. aureus CNS S. pneumoniae S. pyogenes S. agalactiae E. faecalis/e. faecium E. coli K. pneumoniae Salmonella spp. Shigella spp. P. aeruginosa A. baumannii S. maltophilia H. influenzae N. gonorrhoeae M. tuberculosis C. albicans 17

17 Bacterial and Fungal Isolates reported to AD ARS (2014 only) 18

18 AD ARS collects data on all Types of Antimicrobial Susceptibility Tests (AST) conducted in Hospital Labs, but focuses on MIC data: µg/ml MIC (Broth dilution, VITEK) Agar Disk Diffusion (KB) E-Test 95.5% 4.0% 0.6% Test Result: S I R, based on: Minimal Inhibitory Concentration (MIC) Test Result: S I R, based on: Zone diameter (mm) Test Result: S I R, based on: Minimal Inhibitory Concentration (MIC) S = Sensitive, I = Intermediate, R = Resistant 19

19 Trend of Antimicrobial Susceptibility Test Methodology reported to AD ARS AST Method Trend ( ) 20

20 Software Solutions for AMR Surveillance: WHONET Abu Dhabi ARS uses BacLink & WHONET 5.6 for data analysis WHONET is: Endorsed by the WHO Easy to use Free of charge Download: Managed by: Harvard Medical School and Brighams Hospital, Boston, USA Technical and strategic support for 1200 laboratories in 90 countries worldwide Affiliations: WHO, ECDC, CLSI, APUA 21

21 Using WHONET 5.6 for AMR Surveillance, Example: Staph. aureus Select type of analysis & Antimicrobials Select organism of interest Select data file (time period) 22

22 WHONET 5.6 for AMR Surveillance: Examples of analysis outputs RIS Tables RIS Graphs MIC Distribution patterns Scatterplot Analysis 23

23 Summary and Conclusions Antimicrobial Resistance is a major global and local public health and economic threat Health Authority Abu Dhabi has made great progress in addressing the issue by Drafting AMR combat strategies Creating technical working groups Establishing at no costs - an AMR surveillance program Increasing awareness and educating healthcare professionals AD ARS allows to quantify and monitor the local burden of AMR 24

24 25 Dr. med. Jens Thomsen MPH Tel.: