Antimicrobial Resistance Dr Annaliese van Diemen Policy Advisor, Antimicrobial Resistance, DHHS Primary Care Partnerships, August 22 2019

What is Antimicrobial Resistance? Antimicrobial resistance (AMR) is when organisms, such as bacteria, fungi, viruses and parasites, develop or acquire resistance to the drugs we use to treat them. Traditionally considered in terms of bacteria and antibiotics Emerging issues with fungus and parasites (e.g. malaria) Has been documented since the first antibiotics were introduced – as early as the 1950s AMR is now considered one of the greatest threats to human health facing the world today The possibility of not being able to treat infections, particularly bacterial infections, is very real UN General Assembly declaration made in 2016 that AMR is a priority health issue

How does AMR develop? AMR is a naturally occurring process Various mechanisms for development Organisms can evolve to have increased defences to drugs via selection pressure Organisms can ‘turn on’ existing internal resistance processes (or genes) Organisms can acquire resistance genes or plasmids from other organism How are we contributing? Inappropriate use of antimicrobials in humans and animals Poor infection prevention & control practices Increased opportunities for the spread via international travel and trade pathways

https://www.reactgroup.org/toolbox/understand/antibiotic-resistance/

How is AMR spread? AMR organisms can be found in: Humans Animals Soil Water And can therefore be spread between any or all of those. In Australia high level resistance is being seen in a number of organisms which are imported via international travellers and/or spread in health care settings. Internationally resistance in HIV, tuberculosis and malaria is causing increasing concern

https://www.cdc.gov/narms/index.html

How does AMR impact patients? Longer courses of stronger antibiotics, more side effects – e.g. tuberculosis Increased requirements for IV or hospital based therapy – e.g. urinary tract infections Increased risk of passing on or acquiring resistant infections if therapy is not effective – e.g. gonorrhoea Colonisation with multi-resistant organisms – single room, contact precautions, higher risk of resistance if develop infections while in hospital Can cause stigma, poorer care outcomes Eventually can cause death and/or significant disability – long standing infections, amputations etc

How does AMR impact the health system? Many of the greatest achievements in medicine rely on effective antibiotics to be undertaken: Surgery – almost all of them Cancer therapy – especially chemotherapy Transplants Intensive care units/neonatal intensive care Obstetrics Care will become more expensive and less safe The ability to treat patients in the community for ‘simple’ infections will decrease significantly – shifting cost from the most efficient type of care to the least efficient

What can we do about it? What are the best buys? According the OECD, a broad policy campaign involving these elements could *save* $15 million and at least 180 deaths per year in Australia Improved hand hygiene Enhanced environmental hygiene Antimicrobial stewardship programs Delayed antimicrobial prescribing Rapid diagnostic tests Mass media campaigns

What are we doing about it? Global, National, State (pending) Strategies Pillars are all aligned OneHealth focussed Appropriateness of usage Infection prevention & control Surveillance and outbreak response Research priorities Collaboration Many of the implementation, regulatory, fiscal aspects of the national plan are state responsibility, but some sit at C’lth level Cooperation is essential

Questions? Contact: Resources: Annaliese.vandiemen@dhhs.vic.gov.au https://www.amr.gov.au https://www.ncas-australia.org/ https://www.who.int/antimicrobial-resistance/en/ https://www.reactgroup.org/ To receive this publication in an accessible format phone 90965007, using the National Relay Service 13 36 77 if required, or email Annaliese.vandiemen@dhhs.vic.gov.au Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services August, 2019. Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. This publication may contain images of deceased Aboriginal and Torres Strait Islander peoples. Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people. Indigenous is retained when it is part of the title of a report, program or quotation.