This document discusses antimicrobial resistance (AMR) issues in the Asia Pacific region. It notes that AMR is a global crisis and Asia is an epicenter with high resistance rates. Surveillance programs have been established in some countries but more coordination is needed regionally. Awareness campaigns and promoting appropriate antibiotic use are important strategies. National and international policies and regulations are urgently required to control AMR through surveillance, stewardship, infection prevention and vaccination efforts. Regional collaboration through groups like APEC is important to combat the growing threat of AMR.

1. Alessandro Pontes-Arruda,LLB, MD, MSc, PhD, FCCM
Overview of emerging infectious disease
issues in the Asia Pacific region
Antimicrobial resistance (AMR) &
Healthcare associated infection (HAI)

2. Bugs strike back !
Global crisis of AMR
TIME magazine (June 26, 2006)

3. Molton JS, et al. Clin Infect Dis 2013 doi: 10.1093/cid/cit020.
NDM-1 positive Enterobacteriaceae
Boston
2010
Guatemala
2011
UK
2009
Sweden
2008
Singapore
2011
Japan
2009
Sydney
2010
Kenya
2009
South Africa
2011
India
2008
KPC positive Klebsiella pneumoniae
North
Carolina
1996
UK
2009 Greece
2007
Israel
2004
South Africa
2011
China
2004
Singapore
2010
Sydney
2010
Colombia
2008
Brazil &
Argentina
2008
Global crisis of AMR
AMR is an emerging infectious disease that spreads globally

4. WHO and WEF highlight the clinical and economic risk* of AMR
Impact of AMR
Antimicrobial resistance ; Global report on surveillance, World Health Organization (WHO), April 2014 ;
World Economic Forum. Global Risks 2013. 8th Ed. & 2014, 9th Ed.
* Losses to GDP : 0.4 ~ 1.6 %

5. Major examples of AMR
Asia is an epicenter of AMR in most bacterial pathogens
* Highest reported prevalence of resistance to prototype antibiotics, + CAP : community-acquired pneumonia, HAP : Hospital-acquired pneumonia
Community
pathogen
Disease Antibiotic % resistance* Focus area
S. pneumoniae CAP+ Macrolide 73% Asia
E. coli UTI 3rd Cephalosporins 95% Asia
S. typhi Enteric infection Ciprofloxacin 84% Asia
Hospital
pathogen
Disease Antibiotic % resistance* Focus area
S. aureus HAP+, bacteremia Methicillin 82% Asia
E. coli HAP, bacteremia Ciprofloxacin 96% Asia
K. pneumoniae HAP, bacteremia 3rd Cephalosporins 81% Asia
P. aeruginosa HAP Carbapenem 30% Asia
A. baumanii HAP Carbapenem 68% Asia
WHO, Antimicrobial Resistance : Global report on surveillance. 2014; Kim SH, et al. AAC, 2012;56(3):1418-26; Chung DR, et
al. Am J Respir Crit Care Med. 2011;184(12):1409-17; Singhal L, et al. Indian J Med Microbiol. 2014;32(2):149-52

6. Global strategy to combat AMR
APEC has been focusing on AMR since 2010
“International campaign program
to control AMR in the AP region”2nd project
(2012-2013)
“International initiatives
to control AMR in the AP region”1st project
(2010-2011)
“APEC symposium on control and
prevention of AMR”3rd project
(2013)
“Implementation of international
Campaign program to control AMR”4th project
(2014)

7. Control of
AMR
Surveillance
of AMR and
antibiotic
use
Infection
control
Increased
awareness
Appropriate
use of
antibiotics
Policy &
regulation
Vaccination
APEC strategy to combat AMR
APEC AMR projects proposed six major action plans

8. Song JH. APEC project : International initiatives to control AMR. 2011.
Country Program Year of established
14
countries
Asian Network for Surveillance of Resistant Pathogens
(ANSORP)
1996
Korea
 Korean Network for Studies on Infectious Diseases
(KONSID)
 Korean Nationwide Surveillance of Antimicrobial Resistance
(KONSAR)
1997
China
Ministry of Health National Antimicrobial Resistance
Surveillance Net (Mohnarin)
2004
Japan Japanese Nosocomial Infection Surveillance (JANIS) 2000
Malaysia Malaysia Antibiotic Resistant Surveillance Program (MARSP) 1990
Philippines National antimicrobial resistance surveillance program 1988
Singapore The Network for Antimicrobial Resistance Surveillance
Taiwan Taiwan Nosocomial Infections Surveillance System (TNIS) 2007
Thailand
 National Antimicrobial Resistance Surveillance of Thailand
(NARST)
Surveillance of AMR in AP region
There are a few surveillance programs in the region

9. Song JH. APEC project : International initiatives to control AMR. 2011.
Surveillance of AMR in AP region
ANSORP is the representative international system in Asia
Organizer : Jae-Hoon Song
Headquarter : Samsung Medical Center
Local Network Organizers (LNO)
ANSORP Member Hospitals
Principal & co-investigators
Local ANSORP Networks (LAN) Headquarter
Japan
India
Thailand
Vietnam
Hong Kong
China
Philippines
Taiwan
Malaysia
Singapore
Indonesia
Sri Lanka
Saudi Arabia
Korea
14 countries/area
65 cities,
111 hospitals,
201 investigators

10. Surveillance of AMR in AP region
There are major hurdles of AMR surveillance in AP region
Lack of awareness
about impact of AMR
Lack of laboratory capacity
and standard platform
Limited funding and
human resources
Lack of national and
regional coordination

11. No international program
in Asian countries
Awareness of AMR
Antibiotic awareness campaign is urgently needed

12. Professional society /
Government
Awareness of AMR
Campaign 4 is a new international awareness campaign in Asia

13. Awareness of AMR
Campaign 4 will be introduced to Asia
Website : www.campaign4.org / www.icareproject.org

14. Van Boeckel TP, et al. Lancet Infect Dis. 2014. S1473-3099(14)70780-7.
Appropriate use of antibiotics
Asia showed increased antibiotic consumption (2000 to 2010)

15. • Antibiotics account for 28% of global counterfeit drugs
- Counterfeit antibiotics account for 5% of global antibiotic market
• 78% of them were made in SE Asia
• 44% of them were consumed in SE Asia
Counterfeit
antibiotic
use
South-East
Asia, 44%
Sub-Saharan
Africa, 30%
Europe &
North America,
9%
Others, 17%
No active
ingredients,
43%
Defects in
counterfeit
antibiotics
Bad quality,
24%
Weakly
dosed, 21%
Wrong active
ingredients, 7%
Bad packaging, 5%
Delepierre A, et al. Med Mal Infect. 2012;42(6)247-255.
Appropriate use of antibiotics
Counterfeit antibiotics are very common in Asia

16. Appropriate use of antibiotics
Appropriate use of antibiotics is urgent and critical
Antimicrobial stewardship
Practice guidelines for
major infections
Policies & regulations to
control and monitor
antibiotic use
R & D of novel antibiotics

17. Policy & regulation
National & international regulation is urgently required
• Legal control of antibiotic
supply, distribution and sales
• Public-private collaboration for
surveillance of AMR
• Awareness campaign for
general public & HCP
National priority
• Development of international
surveillance system
• Awareness campaign
• International collaboration for
control and prevention of AMR
International initiatives

18. Policies and regulations
Surveillance of AMR
Increased
awareness
Appropriate
antibiotic use
Infection
prevention &
control
Vaccination
Control and prevention of AMR
APEC economies should collaborate to combat AMR

19. - Johann Wolfgang Goethe
“Knowing is not enough, we must apply
Willing is not enough, we must do”