1. Antimicrobial Resistance
Dr Annaliese van Diemen
Policy Advisor, Antimicrobial Resistance, DHHS
Primary Care Partnerships, August

2. 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

4. 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

6. 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

8. 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

9. 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

10. 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

11. 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

12. Questions? Contact: Resources: Annaliese.vandiemen@dhhs.vic.gov.au
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© State of Victoria, Department of Health and Human Services August, 2019.
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