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The Problem of Antimicrobial Resistance: Contained and Controlled

This publication highlights the global problem of antimicrobial resistance (AMR) and the importance of a One Health approach. It discusses the changing face of antibiotic use in humans and animals, the incidence of AMR in different bacteria, and measures to prevent and control AMR. The publication also emphasizes the need for professional stewardship and expert consensus in antimicrobial stewardship.

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The Problem of Antimicrobial Resistance: Contained and Controlled

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  1. Published November 2018 Highlights William Malcolm Julie Wilson Pauline Dunlop On behalf of the SONAAR team HPS https://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3604

  2. HOW BIG IS THE PROBLEM OF ANTIMICROBIAL RESISTANCE?

  3. Contained and controlledThe 20 year vision • One health approach across humans, animals and environment • Global priority – international collaboration • Working with partners across all sectors • Contain and control • Lower burden of infection • Optimal use of antimicrobials • New diagnostics, therapies and vaccinations • Context • growing consumption of antibiotics • Predicted rise in attributable deaths and costs of AMR

  4. The UK’s five year national action plan

  5. What is One Health?

  6. Antibiotic use in humans

  7. Antibiotic use in humans, 2013-17.

  8. Antibiotic use by location in 2017 (DDD/1000/day)

  9. Antibiotic use in primary care,, 2013-17.

  10. The changing face of antibiotic use in primary care

  11. Antibiotic use by nurse prescribers in primary care, 2013-17.

  12. Antibiotic use by dentists, 2013-17.

  13. Antibiotic use within acute hospitals, 2013 to 2017.

  14. Antibiotic use in animals

  15. UK-VARSS 2017 Report

  16. UK-VARSS 2017 Report

  17. UK-VARSS 2017 Report

  18. Antimicrobial resistance in humans

  19. Incidence of bacteraemia caused by the most commonly reported Gram- negative bacteria

  20. Proportions of E. coli bacteraemia isolates non-susceptible to commonly used antibiotics

  21. Antimicrobial resistance in Gram-negative bacteria Figure 9: proportion of Acinetobacter spp. bacteraemiaisolates non-susceptible to commonly used antibiotics, 2013 to 2017 HPS. Scottish One Health AMU and AMR Annual Report 2017. https://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3604

  22. Incidence of carbapenemase-producing organism (CPO) isolates

  23. Number of CPO isolates (all body sites) by enzyme type reported in Scotland, 2003 to 2017.

  24. Incidence rates of enterococcal bacteraemia

  25. Vancomycin non-susceptibility in E. faecium

  26. Antimicrobial resistance in animals

  27. Surveillance for AMR in Animals in Scotland Passive surveillance: • From clinicalspecimens or carcases submitted/presented to Scottish Rural College (SRuC) disease surveillance centres & diagnostic laboratories (charging/cost recovery from animal keeper) • Salmonella (statutory organism) via SSSCDRL • Same AM panel and breakpoints as human isolates • All others (selected pathogens covered in the report) • AM panel and breakpoints (where these exist) relevant to animal species Active surveillance: • CommensalE. coli from healthy animals (40/month each from cattle, sheep, pigs and poultry) entering the food chain (Food Standards Scotland & Scottish Government) • Same AM panel and breakpoints as human isolates • Antimicrobial free as they are entering the food chain

  28. Number of laboratory confirmed reports of clinical Salmonella isolates from animals, 2013 to 2017 In 2017, 72.1% of Salmonella isolates were fully sensitive to all antibiotics against which they were tested

  29. Proportions of S. aureusclinicalcompanion animal isolates non-susceptible to commonly used antibiotics, 2013 to 2017

  30. Proportions of S. pseudintermediusclinicalcompanion animal isolates non-susceptible to commonly used antibiotics, 2013 to 2017

  31. Non-susceptibility of E. coli isolatesamong healthy bovine, ovine, porcine and poultry animals in 2017

  32. Behavioural Insights • Shared Professional Stewardship • doctors, dentists nurses, vets, pharmacists • pilot discussions in Orkney and Lanarkshire • Expert consensus • Antimicrobial stewardship (AMS) • One Health • Examination of barriers and facilitators to AMS • Companion animal vets and pet owning public • Farm animal vets and farmers

  33. Measures to prevent and control AMR in animals - Summary • Non-susceptibility in veterinary clinical isolates stable over 5y • Monitoring must continue in order to further our understanding of AMR in a One Health context • Carbapenemase producing Enterobacteriaceae and ESBLs were not found in healthy animals sampled • Veterinary Medicines Directorate operates Res-Alert system • Scotland’s Healthy Animals website (www.scotlandshealthyanimals.scot ), which hosts Scotland’s Poultry Hub, provides an important platform for guidance on disease avoidance and antibiotic stewardship for all animal keepers, their vets and the wider animal health community, as well as guidance on prevention of infectious disease for the public as countryside users • Scottish Veterinary Antimicrobial Stewardship Group formed in 2017

  34. https://antibioticguardian.com/

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