EH 3_2015

EUROPEAN HOSPITAL Vol 24 Issue 3/15 6 NEWS & MANAGEMENT Methicillin-resistant Staphylococcus aureus Austria’s notable national action plan Antibiotic resistance: The biggest single threat to global health In Europe, Austria statistically ranks in the midfield for antibiotics resist- ance. In 2013, for example, the country’s Methicillin-resistant Staphylococcus aureus (MRSA) rate was 9.1%. In the same year the rate in Sweden was 0% and in Greece around 50%. ‘The issue of antimicrobial resistance is very complex. Therefore we need a concerted strategy to fight this resistance,’ says tropical medicine and hygiene specialist Professor Petra Apfalter DTMH, who heads the Austrian National Reference Centre for Nosocomial Infections and Antibiotics Resistances. In her country that strategy is known as the National Action Plan for Antibiotics Resistance (NAP- AMR). Surveillance, hygiene and infection prevention, antimicrobial stewardship, diagnosis of infectious diseases, use of antimicrobial medi- cines as well as reporting and infor- mation are the main elements of the plan for human medicine. An additional range of measures covers veterinary medicine and the envi- ronment. In surveillance and reporting Austria fares well. The country’s Federal Ministry of Health has been publishing an annual report on antibiotics resistance and anti- biotics usage (AURES) since 2005. Professor Geoff Sussman is concerned at over-prescribing and misuse of antibiotics in clinical practice as well how they seep into the food chain through inappropriate use – to pro- tect against disease and stimulate growth in animal husbandry and breeding. Unless vigorous controls and restrictions are implemented in anti- biotics use, he fears the consequenc- es will be disastrous, with drugs that will no longer be effective against infections. Outlining his concerns to the annual meeting of the International Wound Infection Institute in London, Professor Sussman said: ‘Within the next 15 years we will run out of effective antibiotics and reach a situ- ation where millions of people will die from simple infections because there is nothing to treat them. If action is not taken now, we will soon be back in pre-penicillin era.’ As Associate Professor in the Faculty of Medicine, Nursing and Health Science at Monash University in Melbourne, he highlighted the example of tuberculosis (TB), a disease thought to be under con- trol a few years ago but which is Additionally, for a decade this country has been involved in the European networks for the collec- tion of data on resistance, EARS-Net (European Antimicrobial Resistance Surveillance Network) and ESAC- Net (European Surveillance of Antimicrobial Consumption Net work). The NAP-AMR has also uncovered improvement potential here. It contains objectives to cap- ture the most comprehensive data on antibiotics use, to promote feed- now appearing as multi-resistant TB, which will not respond to any antibiotics. Over-use and misuse of antibiotics is driving the resistance, added Professor Sussman, who is also a senior clinician in wound clin- ic at Melbourne’s Austin Hospital. ‘We have misuse of low strength antibiotics on what are not really real infections,’ he said. ‘Here, bacte- ria can cope with low strengths and gain resistance to high strengths. ‘Also, in surgery, it is not uncom- mon to use prophylaxis before an operation. That’s acceptable but some doctors continue using the antibiotic for another five days. That is no longer prophylactic, that is therapeutic and the overuse of the antibiotic.’ Bring in stricter controls Overuse is common in General Practice with patients demanding antibiotics for colds and sore throats that are virus based and in this area of medicine he believes gov- ernments must implement stricter controls on where and who can prescribe some of these more potent antibiotics. ‘A bigger problem,’ he pointed out, ‘is in parts of the world back systems for surveillance data and to develop information media for the general public. Whilst AURES is well established in specialist read- ership, the level of general public knowledge is pitiful. According to a Eurobarometer survey around 73% of Austrians believe that antibiotics are also effective against viruses. In respect of hygiene and infection prevention and control the objective, according to the NAP-AMR, is to fur- ther develop the existing strategy to like Asia where you do not need to see a doctor or get a prescription for antibiotics. You just walk into a store and buy them with no restric- tion at all.’ people and goods can travel to the other side of the world within a day then we need to develop regulations that apply worldwide.’ However, this is a difficult task – considering that, even within the European Union, there are countries that do not even comply with the most basic rules on the containment of resistance. ‘In Austria, and many other EU countries, antibiotics can only be obtained through prescriptions. In Spain, however, everyone can buy antibiotics in the supermarket.’ Professor Apfalter would like to see the World Health Organisation take over the reins to control antibi- otics resistance. ods are then less likely to run into the problems of resistance.’ The urgency of the situation is dramatically underlined in the World Health Organisation docu- ment Antimicrobial resistance: glob- al report on surveillance 2014. It states: ‘Antimicrobial resist- ance (AMR) threatens the effec- tive prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, virus- es and fungi. An increasing number of governments around the world are devoting efforts to a problem so serious that it threatens the achieve- ments of modern medicine. ‘A post-antibiotic era – in which common infections and minor inju- ries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.’ Areas taking a pro-active stance are Scandinavia and Australia, which has had therapeutic guidelines of antibiotic use for some years though many countries do not have them in place, he said. ‘But, there has to be concerted effort from the very top. ‘The World Health Organisation is already sending out the signals of how important it is and now gov- ernments, medical associations and agricultural organisations have to come together to fight this problem in a unified manner.’ consolidate hospital hygiene struc- tures (PROHYG 2.0). This describes the organisational framework for important measures of infection pre- vention and control in hospitals, such as hand washing and hand disinfection. Based on this, a draft quality standard was compiled last year that will be published towards the end of 2015. A further important component of the NAP-AMR is the antimicro- bial stewardship programme (ASP). This concerns the optimised use of antimicrobial substances to reduce the development of multi- resistant pathogens. The key strategies comprise an audit with intervention and feed- back, as well as limitations to the prescription of antibi- otics. ‘Without microbiological diag- nostics, that is without knowledge of the type of pathogen and resist- ance profile, neither surveillance nor infection prevention and control can be done in a mean- ingful way,’ the national action plan points out – of course because antibiotics only work against bacteria and not against viral infections. In Austria there are 40 laboratories that make their bacteriological findings available – not everywhere with high quality because currently no binding stand- ards are in place. The NAP-AMR therefore campaigns for a centralisa- tion of microbiological diagnostics. Sweden, where just a few facilities are responsible for large catchment areas of the population, is consid- ered as a role model. ‘The topic of antimicrobial resist- ance is global, and measures against it cannot be limited to national activ- ities, Apfalter emphasises. ‘When To help counter antibiotic resist- ance, Professor Sussman believes hospitals must work harder to con- trol hospital-acquired infections, curb nosocomial infections with improved cleaning regimes and restrict strong antibiotics for use on only very serious infections. Few new antibiotics have been seen in 40 years because it is not economically viable for industry to develop drugs that patients will only use for a matter of days and he believes it should fall to govern- ments to look at ways of funding research and developing new anti- biotics. Sussman also favoured a plan unveiled in a report by a UK gov- ernment-appointed review team in May calling on the global pharma- ceutical industry to pay for a £1.3 billion innovation fund to revitalise research into antibiotics. In return, guaranteed payments would be paid to companies that produce vitally needed new antibiotics. The move was devised in response to so few new antibiotics in devel- opment amid a global spread of resistant bacteria. The professor also wants to see science develop innovative ways of attacking the bacterium other than antibiotics. ‘There are mechanisms that can attack bacterial cells and do not involve antibiotics. Those meth- Surveillance, hygiene and infection prevention, antimicrobial stewardship, diagnosis of infectious diseases, use of antimicrobial medicines as well as reporting and information – Michael Krassnitzer reports. Within 15 years effective antibiotics will run out and, far from being an apocalyptic fantasy, a world in which common infections and minor injuries can kill is a very real possibility for the 21st Century. One of the world’s foremost wound experts has warned that antibiotic resistance is posing the biggest single threat to global health, Mark Nicholls reports Petra Apfalter heads the Institute for Hygiene, Microbiology and Tropical Medicine at the Elisabethinen Hospital in Linz, Austria. A specialist in hygiene and microbiology, she also heads the National Reference Centre for Nosocomial Infections and Antibiotics Resistance as well as f the Austrian AMR Focal Point for the European Centre for Disease Prevention and Control (ECDC). In addi- tion, Professor Apfalter, who studied Medicine and completed her specialist training at the University of Vienna, heads the National Antimicrobial Susceptibility Testing Committee Austria (NAC-AT) and a member of the Steering Committee at EUCAST (European Committee on Antimicrobial Susceptibility Testing). Geoff Sussman, who established the Wound Foundation of Australia, has been involved in research, clinical practice and teaching in the area of wound manage- ment for over 30 years. The inaugural Secretary of the World Union of Wound Healing Societies 2000-2004, he is also associate editor of the International Wound Journal and was awarded an OAM (Medal of the Order of Australia) in the Queen’s Birthday Honours in 2006 for his wound care work as a researcher, educator and clinician.

EH 3_2015

Seitenübersicht