SUPERBUGS: STRUMENTI DI INTERVENTO NELL’ERA POST-ANTIBIOTICA Nicola Petrosillo Dipartimento Clinico e di Ricerca in Malattie Infettive INMI «L. Spallanzani», IRCCS - Roma

Emerging Threats in Healthcare 2

MDR organisms in the healthcare setting: from ESKAPE to ESCAPE We are currently facing new microbiological, infection control and clinical issues, and the epidemiologic variations observed in the last years highlighted the need of a change from the initial proposed acronym: “ESKAPE” “ESCAPE” E. faecium E. faecium S. aureus S. aureus K. pneumoniae  C. difficile A. baumannii A. baumannii P. aeruginosa P. aeruginosa Enterobacter species Enterobacteriaceae

Euro Surveill 2013; 18:46

ECDC/EMA: European Annual Cost Estimates of Five Top MDRB

Hospital and Societal Costs of Antimicrobial-Resistant Infections (ARIs) An economic analysis of the Chicago Antimicrobial Resistant Project dataset: 188 / 1391 patients (13.5%) with ARI Medical costs attributable to ARI $18,588 - $29,069 / patient Excess LOS 6.4 – 12.7 days Attributable mortality 6.5% Societal costs $10.7 - $15.0 million Roberts RR et al. Clin Infect Dis 2009;49:1175-84.

Less surgery for the risk of AMR Caesarean sections contribute about 2% to world GDP Joint replacements add about 0.65% Organ transplant add about 0.1% These are just a small number of the areas in modern medicine that risk being undermined if we do not have effective antibiotics in the future Concerns for international travels less trade affecting mainly developping countries

Estimates of Preventable Infections, Deaths, and Costs 10

Antimicrobial Stewardship Programs ASPs are designed to optimize antimicrobial therapy, 1-to improve patients’ outcomes, 2-ensure cost-effective therapy and 3-reduce adverse effects associated with antimicrobial use, including antimicrobial resistance and C difficile occurrence

INFECTION CONTROL AND ANTIBIOTIC STEWARDSHIP Although the responsibilities of antimicrobial stewardship programs and infection control departments are different, collaboration between these groups is essential in promoting optimal outcomes, providing cost-effective care, reducing the development of resistance, and preventing the spread of infection.

Infection control departments must rely on stewardship programs to help minimize excessive antibiotic exposure, which ultimately decreases the level of risk that patients face with regard to acquiring infections due to multidrug-resistant organisms.

Antimicrobial stewardship programs rely on good infection-control practices, in a complementary fashion, to minimize the patient-to-patient spread of multidrug resistant bacteria. Poor infection control practices can lead to increasing number of patients with multidrug-resistant infections, which leads to a downward spiral of increased utilization of broad-spectrum antibiotics and the further development of resistance.

Additionally, antimicrobial stewardship programs and infection control practitioners are well positioned to identify and improve patient outcomes linked to a specific disease because they already target patients with specific infections, disease states, or patients receiving certain antimicrobials.

Interactions between ASP and IC professionals Drug-based antimicrobial stewardship Disease-based antimicrobial stewardship and multidisciplinary bundle Device-associated Infection Prevention Barriers to implementation and maintenance of stewardship programs Making a business case for antimicrobial stewardship Measuring the impact of the Program

From competence to meta-competence Antimicrobial Stewardship (A-Teams) Thera-py Antimicrobial Stewardship (A-Teams) ID-doctor Intensivist Pharmacist Theragnostic-concept Clin. Microbiol. ABS Clin. Microbiol - infection prevention PHS Moleculair Medisch Microbioloog Infection Control Practitioner Infection Prevention Stewardship Dia-gnostic Stewardship Dik et al. 2015 Future Microbiology Courtesy Prof. A Friedrich