Antimicrobial Resistance (AMR)

Prof Tjandra Yoga Aditama

Senior Advisor
WHO SEARO 1
 AMR was foreseen early
Alexander Fleming,
The time may come when penicillin
Nobel Lecture,
can be bought by anyone in the December 1945
shops. Then there is the danger that
he ignorant man may easily under
dose himself and by exposing his
microbes to non-lethal quantities of
he drug make them resistant”

6| |February 2016
 1928 - Sir Alexander Fleming discovered Penicillin - The first of
antibiotics that would prove to be some of the most efficacious life-
saving drugs

In the near future - Due to AMR, we are looking

at a world without antibiotics again
 Regional / Global Overview
Use of Antimicrobial Medicines ( % : no. of positive response/no. MS)
 Regional / Global Overview
Promotion of Public Awareness on AMR

45.4%

No. and % of MS that had conducted a campaign about AMR awareness ( from 2013)
 Regional / Global Overview
Infection Prevention & Control Program

81.8%
63.6%
 Global Antimicrobial Surveillance System (GLASS)

As of 9 December 2017, 50 countries have enrolled: 24 high-income countries, nine upper

middle-income countries, 11 lower middle-income countries, and six low-income countries.
29 January 2018 - WHO’s first release of surveillance
data on antibiotic resistance
• Widespread occurrence of antibiotic resistance among 500
000 people with suspected bacterial infections across 22
countries

• The most commonly reported resistant bacteria were

Escherichia coli, Klebsiella pneumoniae, Staphylococcus
aureus, and Streptococcus pneumoniae, followed by
Salmonella spp.

• And between 8% to 65% of E. coli associated with urinary

tract infections presented resistance to ciprofloxacin, an
antibiotic commonly used to treat this condition.
29 January 2018 - WHO’s first release of surveillance
data on antibiotic resistance

• Among patients with suspected bloodstream

infection, the proportion that had bacteria resistant
to at least one of the most commonly used
antibiotics ranged tremendously between different
countries – from zero to 82%.

• Resistance to penicillin – the medicine used for

decades worldwide to treat pneumonia – ranged
from zero to 51% among reporting countries.
 AMR is
already a
substantial
killer...and is
only
becoming
bigger
AR Requires Global Action
JEE (AMR) in SEAR
 No Antimicrobials –
What Would That Mean………
 “If antibiotics stopped working, we would find a substantial
increase in deaths due to infections”

 “In a world with few effective antibiotics, modern medical

advances such as surgery, transplants, and chemotherapy
may no longer be viable due to the threat of infection”
~
 What is at stake with AMR?
 Worldwide, common
infections becoming
more resistant to
antimicrobials
- Blood, urinary tract,
respiratory tract, sexually
transmitted, GI, skin,...

 Children, Women & Men

at higher-risk for severe
illness or death

2| | February 2016
 Modern Medicine at Risk

Cancer Treatment
• Patients who receive
• >600,000 patients
specialized care will receive
will be at highest chemotherapy in
20141
-risk
Cancer chemotherapy • ~60,000 cancer
- Complex surgery patients will be
hospitalized with
- Joint replacements neutropenia and
infections2
- Organ transplants • 1 in 14 of these will
die from this
- Sepsis complication2
1KantarHealth, Cancer Impact
- Dialysis 2Caggiano et al, 2005, Cancer
Antimicrobial resistance
A threat to patient safety

Each year, in the

Limitedoptions
Limited options for EU/EAA:
fortreatment
treatment
2.5 million attributable
extra hospital days

Increased lengthIncreased
of length25,000
of attributable deaths
hospital stays hospital stays

Increased patient
morbidity and mortality Increased patient
NOTE: Based on only 5 MDR
morbidity and
bacteria and 4 types of
Source: ECDC, 2009.
mortality
infection
In: http://ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time_to_React.pdf
 Huge overall costs
 Estimated yearly US Treatment costs go up when
costs today (by CDC) 1st line antimicrobials can’t
- Direct up to $20 billion be used
- Indirect up to $35
billion

 By 2050, one
projection
- Cumulative loss of
2% - 3.5% global GDP

5| |February 2016
International travel
Date Departure Destination
Today 14:10 MULTIDRUG-RESISTANT
Wasowu MICROORGANISMS
Today 14:35 MULTIDRUG-RESISTANT
Salhet MICROORGANISMS
Today 14:40 MULTIDRUG-RESISTANT
Morador MICROORGANISMS
Today 14:45 MULTIDRUG-RESISTANT
Korobondo MICROORGANISMS
Today 14:55 Baxjö
Today 15:00 Holmen
Today 15:00 MULTIDRUG-RESISTANT MICROORGANISMS
Fuja
Today 15:00 MULTIDRUG-RESISTANT
Chanbun MICROORGANISMS
Today 15:05 MULTIDRUG-RESISTANT
Tólos MICROORGANISMS
Today 15:05 MULTIDRUG-RESISTANT
Pasu Rial MICROORGANISMS
Today 15:10 Wasserdam
Today 15:15 MULTIDRUG-RESISTANT
Bolasir MICROORGANISMS
Today 15:15 Mørup

©Istockphoto
Clonal spread of S. pneumoniae 23F

Finland
France
BM4200
1978 ?
Cleveland Spain
South Korea
Tennessee

Mexico Taiwan
Hong Kong
Philippines
Thailand
Colombia Malaysia
Singapore
Brazil

Chile South Africa

Uruguay
Argentina
1
Slide courtesy: Keith Klugman
 Why is AMR a Global Health
Concern?
The rate at which microbes are
acquiring resistance is
GREATER
than the rate at which
antimicrobials are being
discovered
 AMR Over Time

Global Action Plan AMR

33 |
 Humans + Animals = One
Health

Prudent use of antibiotics:

Everyone is responsible!
Antibiotic use for growth promotion and
disease prevention
2/3rds of the tonnage of antibiotics sold
worldwide are used in agriculture
• Agriculture
Antibiotic Injection Antibiotic Spray

H
 AMR in SEAR: Challenges

• Various challenges including

– high burden of infectious diseases
– unregulated sale of antibiotics
– widespread antibiotic use in animal farming
– low awareness among professionals and public
– improper food chain system and food handling
– inadequate Public Health infrastructure &
sanitation and hygiene
– need of strong political commitment and law
enforcement
68th World Health Assembly
May, 2015

Tackling antimicrobial drug

resistance

Delegates at the World Health

Assembly endorsed a Global Action
Plan (GAP) to tackle AMR
- including antibiotic resistance, the
most urgent drug resistance trend.

The Global Action Plan (GAP) has 5

Strategic objectives
 SEAR AMR National Action Plan

High-Level Preparatory (HLP) Meeting for the

42
Seventieth Session of the Regional Committee for South-East Asia,
42 WHO-SEARO, New Delhi, 10–13 July 2017
UN General Assembly
 United Nations high-level meeting on
antimicrobial resistance
• 2016: United Nations recognized the global rise of antimicrobial
resistance (AMR) as a threat to global health and human
development.

• Global leaders met at the United Nations General Assembly in

New York in September 2016 to commit to fighting antimicrobial
resistance together

• This was only the fourth time in the history of the UN that a
health topic is discussed at the General Assembly (after HIV,
NCD, and Ebola)
 AMR is the Greatest Threat to Modern
Medicine

Antibiotic resistance is a
global health crisis that
should be addressed with
. the utmost urgency
Dr. Tedros Adhanom-
, Ghebreyesus
Director General
World Health Organization

Global Action Plan AMR

45 |
1. Improve awareness and understanding

2. Strengthen knowledge through surveillance &

research

3. Reduce incidence of infection

4. Optimize use of antimicrobial medicines

5. Ensure sustainable investment

17| | February 2016

 AMR contributes to SDGs 1, 2, 3, 12 and
17

50 | TITLE from VIEW and SLIDE MASTER | 1/17/19

 AMR Threatens Global Progress

AMR strikes hardest on the Antibiotic residues from hospitals,

poor pharmaceutical companies and
 Rate of resistance is high agriculture contaminate the water
 Lack of affordable treatment
 Poor infection prevention
Untreatable infections in *Cumulative costs of AMR is
animals threaten sustainable predicted to be US $120 trillion
food production for our by 2050
population
It is crucial to balance access,
Antimicrobials are fundamental innovation and conservation of
components of all health antimicrobials to contain AMR
systems
All of which require multi-stakeholder
partnerships
*World Bank Group Report on Drug-Resistant Infections (March
2017)

Global Action Plan AMR

51 |
Transforming our world: the 2030 Agenda for Sustainable Development

‘We will equally accelerate the pace of progress made in fighting malaria, HIV/AIDS, tuberculosis,
hepatitis, Ebola and other communicable diseases and epidemics, including by addressing growing
antimicrobial resistance and the problem of unattended diseases affecting developing countries’
 Facets of AMR

SDG UHC

Global Action Plan AMR

56 |
 AMR Core Campaign

Slogan : Stopping AMR is Everybody’s

Business
 Make better use of existing
antibiotics
Image Courtesy of Shutterstock
 AMR
• Masalah Kesehatan Global, Prioritas
• Mempengaruhi banyak aspek penangan
pasien
• Perilaku petugas kesehatan dan
masyarakat luas
• One Health
• Excess vs Access
• GAP & NAP – implementasi (negara,
daerah, RS/klinik, dokter, perawat dll)