Antimicrobial Resistance: What Does It Represent?

1. Briefing on 4th Meeting of Antimicrobial Resistance National Focal Points Ljubljana (Slovenia), 13 March 2008Dominique L. MonnetSenior Expert, Antimicrobial Resistance& Healthcare-Associated-InfectionsScientific Advice Unit, ECDC

2. Several inter-related compartments of healthcare (food animals, food, general population and patients in the community, hospitals, nursing homes and long-term care facilities) Many types of infection (bloodstream, respiratory tract, skin and soft tissue, urinary tract, surgical site, related to medical devices, etc.) Many bacteria/microorganisms Many antimicrobials and mechanisms of resistance A “topic” rather than a disease Antimicrobial Resistance: What Does It Represent?

3. Approximately 3 million HCAI and 50,000 deaths attributable these infections each year in EU-25 Source: ECDC Annual Epidemiological Report 2006. 1/4 to 1/2 of these deaths (EU-25) are due to the most common MDR bacteria, i.e. MRSA, VRE, 3GC-R E. coli/Klebsiella sp./Enterobacter sp., MDR P. aeruginosa, carbapenem-R Acinetobacter sp., in the 4 main types of HCAI: BSI, pneumonia, SSTI, UTI) D.L. Monnet, unpublished based on EARSS and other published studies These are conservative estimates, i.e. underestimates! Burden of HCAI and Multidrug-Resistant (MDR) Bacteria in the European Union

4. ECDC opened in May 2005 Antimicrobial resistance (AMR) and healthcare-associated infections is one of the seven priority topics/disease area for action Basis: Council Recommendation of 15 November 2001 on the prudent use of antimicrobial agents in human medicine (2002/77/EC) One AMR National Focal Point designated by each Member States and EEA/EFTA country Four meetings of AMR National Focal Points since 2006 Eight country visits to discuss AMR issues based on the Council Recommendation Antimicrobial Resistance in Europe and the ECDC

5. 23 Member States + 1 EEA/EFTA country represented European Commission: DG SANCO, DG RTD Discussions on visuals, slogan and key messages for the European Antibiotic Day (toolkit for MS) Review of the progress of Member States on two key elements of Council Recommendation (2002/77/EC): ”Intersectoral Coordination Mechanism”, i.e. national, multidisciplinary coordination group National strategy and corresponding action plan Plans for European Antibiotic Day 4th Meet. of AMR National Focal Points, Ljubljana, 13 March 2008

6. National, multidisciplinary coordination group to plan and coordination prevention and control of antimicrobial resistance 19 (63%) have an ICM in place Large variation in the level of implementation and the range of activities Several countries, only implemented since the past 2-3 years 7 countries do not have an ICM 2 had one ICM, but activity has stopped 2 are preparing their ICM 4 countries did not report ”Intersectoral Coordination Mechanism” (ICM)

7. Strategy for the prevention and control of AMR and a corresponding multi-year action plan (activities, timeline) 8 (27%) have a written national strategy and/or an action plan 18 countries do not have a written national strategy or action plan 3 countries are preparing a second action plan 1 country (only available for one region, plans to expand) 5 countries are preparing their first strategy/action plan 4 countries did not report National AMR Strategy and Action Plan