1. Using AMR surveillance for developing policy AMR meeting Washington 13 April 2016

2. Goals of surveillance 1.To analyse trends and detect outbreaks 2.To evaluate interventions 3.To monitor progress of programmes AMR-NL@minvws.nl 2

3. 3 1. To analyse trends Comparison between countries NL is doing relatively well in health care Focus on veterinary measures since 2008 One Health National Action plan in 2015

4. AMR-NL@minvws.nl 4 To analyse trends (2) Comparison of biomass- corrected consumption of antimicrobials (milligrams per kilogram estimated biomass) in humans and food-producing animals by country in 26 EU/EEA countries in 2012. Source: ECDC/EFSA/EMA

5. Voettekst 5 Surveillance of AMR in the Netherlands - Humans Routine antimicrobial sensitivity testing (ISIS-AR) Hospital & general practice Clinical & screening samples Targetted surveillance (isolate based, centralized testing, sentinel surveillance) MRSA, CPE, foodborne infections N. meningitidis, N. gonorrhoeae, M. tuberculosis, Influenza, anaerobic bacteria, A. fumigatus, C. difficile General practice / nursing homes Outbreak surveillance ZI/AMR Outbreaks of hospital-infections / AMR Antimicrobial consumption (SWAB) Prescription data (community) Sales data (hospitals) Health-care associated infections Hospitals (PREZIES) Point-prevalence surveys Prospective surveillance SSI/CLABSI Nursing homes (SNIV) 5

6. Surveillance of AMR in the Netherlands – Food Animals Fo odborne pathogens (Salmonella, Campylobacter, STEC) Clinical samples (human) Foodstuffs Slaughterhouse surveillance Commensal indicator organisms (E.coli, Entereoccus) Farm sampling Slaughterhouse surveillance (raw meat) Antimicrobial consumption Sales data 6

7. NLD AMR surveillance >>> European Union Human - ECDC EARS-Net AMR invasive isolates (blood, CSF) ISIS-AR (RIVM/CIb) HAI-Net Healthcare-associated inf Hospitals (PREZIES, RIVM/CIb) Long-term care (SNIV, RIVM/Cib) ESAC-Net Antimicrobial consumption SWAB surveillance FWD-Net Salmonella, Campylobacter, STEC Sentinel surveillance (RIVM) C. difficile Sentinel surveillance (LUMC) Food Animals Antibiotic consumption EMA ESVAC (sales data, from MSs) Antibiotic Resistance EFSA & ECDC Human (through ECDC) Animals (direct MSs) Food (direct MSs) 7

8. AMR-NL@minvws.nl 8 2. Evaluate interventions

9. 3. Monitor progress AMR-NL@minvws.nl 9 Surveillance = information for action Targeted measures to detect > and eliminate the source map > and protect population groups at risk Identify > and block new transmission routes

10. Targets in healthcare avoidable healthcare-associated infections will be reduced by 50% incorrectly prescribed antibiotics across the entire healthcare chain reduced by at least 50% reduction in the emergence and spread of multiresistant bacteria in healthcare becomes visible infections and deaths due to antibiotic resistance in the Netherlands will remain at the current level or decrease possibilities for effective treatment of patients with infections with resistant bacteria will not reduce any further AMR-NL@minvws.nl 10

11. Economic impact (1) AMR-NL@minvws.nl 11

12. Economic impact (2) AMR-NL@minvws.nl 12

13. Room and need for improvement in NL Greater efforts are required on behalf of long- term care institutions Nursing homes and hospitals will participate in regional surveillance Real time surveillance? AMR-NL@minvws.nl 13

14. The policy dilemma on surveillance Surveillance as a base for targeted measures Use available surveillance data for policy development More surveillance and harmonization is costly and necessary? AMR-NL@minvws.nl 14

15. Further information/references Website: http://www.government.nl/topics/antibiotic-resistance Fact Sheet: https://www.government.nl/documents/leaflets/2015/09/22/tackl ing-antibiotic-resistance National Action Plan: https://www.government.nl/documents/parliamentary- documents/2015/06/24/letter-to-parliament-about-the-approach- to-antibiotic-resistance AMR Next magazine with business cases from human and veterinary health: http://www.eu2016.nl/documenten/publicaties/2016/02/10/amr- next AMR-NL@minvws.nl 15