Diese Präsentation wurde erfolgreich gemeldet.
Die SlideShare-Präsentation wird heruntergeladen. ×

Dr. James Hughes - Combating Antimicrobial Resistance: The Way Forward

Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige

Hier ansehen

1 von 32 Anzeige

Dr. James Hughes - Combating Antimicrobial Resistance: The Way Forward

Herunterladen, um offline zu lesen

Combating Antimicrobial Resistance: The Way Forward - Dr. James Hughes, Professor of Medicine and Public Health with Joint Appointments in the School of Medicine and the Rollins School of Public Health at Emory University, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.

More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship

Combating Antimicrobial Resistance: The Way Forward - Dr. James Hughes, Professor of Medicine and Public Health with Joint Appointments in the School of Medicine and the Rollins School of Public Health at Emory University, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.

More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship

Anzeige
Anzeige

Weitere Verwandte Inhalte

Diashows für Sie (20)

Andere mochten auch (20)

Anzeige

Ähnlich wie Dr. James Hughes - Combating Antimicrobial Resistance: The Way Forward (20)

Weitere von John Blue (20)

Anzeige

Aktuellste (20)

Dr. James Hughes - Combating Antimicrobial Resistance: The Way Forward

  1. 1. Combating Antimicrobial Resistance: The Way Forward James M. Hughes, MD Professor of Medicine and Public Health Emory University Atlanta, GA NIAA Antibiotic Symposium November 14, 2014
  2. 2. Disclosure No conflicts with this presentation
  3. 3. OUTLINE  The Problem  The Challenges  The Opportunities
  4. 4. IOM Definition of Emerging Infections New, reemerging or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future. 1992 The Problem
  5. 5. Table. Factors contributing to the emergence of infectious diseases according to IOM reports, 1992 and 2003 1992 IOM Report 2003 IOM Report Human demographics and Human susceptibility to behavior infection Technology and industry Climate and weather Economic development and land use Changing ecosystems International travel and commerce Poverty and social inequality Microbial adaptation and change War and famine Breakdown of public health measures Lack of political will Intent to harm *Boldface indicates factors that contributed to the emergence and spread of antimicrobial resistance.
  6. 6. The Washington Post March 16, 1993 “In 2002, out of 89 new drugs, no new antibiotics were approved.”
  7. 7. The Challenges Public Health Surveillance  Ongoing, systematic collection, analysis, and interpretation of outcome-specific data  Closely integrated with the timely dissemination of these data to those responsible for taking public health action to prevent and control disease or injury Thacker SB. In: Principles and Practices of Public Health Surveillance. New York: Oxford University Press, 2000.
  8. 8. Resistance World Health Day April 7, 2011 Market Failure Innovation Gap ESKAPE Bugs Bad Bugs / No Drugs “10 x ‘20” “No Action Today, No Cure Tomorrow” BMJ 2010;340:1115-18 % Drug Approvals # Combating Antimicrobial Resistance: Policy Recommendations to Save Lives
  9. 9. CDC AR Threats Urgent Threats (3) • C. difficile • CRE • Resistant N. gonorrhoeae Serious Threats (12) • MDR Acinetobacter • ESBLs • MDR P. aeruginosa • VRE • MRSA • Drug-resistant S. pneumoniae, NT Salmonella, Campylobacter Concerning Threats (3) • VRSA • Erythro-res GAS • Clinda-res GBS http://www.cdc.gov/drugresistance/threat-report-2013/
  10. 10. WHO AR Priorities Priority Pathogens • E. coli res to 3rd gen cephalosporins & FQs • K. pneumoniae res to 3rd gen cephalosporins & carbapenems • MRSA • Pcn-resistant S. pneumoniae • FQ-resistant Salmonella • FQ-resistant Shigella • N. gonorrhoeae with decreased suscept to 3rd gen cephalosporins http://www.who.int/drugresistance/documents/surveillancereport/en/
  11. 11. “A robust public health system— in its science, capacity, practice, and through its collaborations with clinical and veterinary medicine, academia, industry and other public and private partners—is the best defense against any microbial threat.” 2003
  12. 12. IOM Forum on Microbial Threats 2010 2012 Antibiotics as a Global Public Good
  13. 13. Microbial Adaptation and Change THE NEW YORKER, January 12, 1998 “10 x 20”
  14. 14. IDSA AR Priorities  Drug Development Pipeline  Bad Bugs, No Drugs  “10 by 20”  Increased Support for Basic and Translational Research  Rapid Point of Case Diagnostics  Surveillance of Use & Resistance  Humans and Animals  Antimicrobial Stewardship  Regulatory Reform for Clinical Trial Design and New Antibacterial Drug Approval
  15. 15. Combating Antimicrobial Resistance: Policy Recommendations to Save Lives  Economic Incentives  New Regulatory Approaches  Stronger Leadership and Improved Coordination of Federal Agencies  Enhanced Surveillance Systems  Strengthened Prevention & Control Programs  Funds for New Drug R & D  Rapid Diagnostics R & D  Elimination of Non-Judicious Use in Animals, Plants, & Marine Environments IDSA Clin Inf Dis 2011;52(Suppl 5):S397-428
  16. 16. Preventing Antimicrobial Resistance in Healthcare Settings and the Community
  17. 17. Core Elements • Leadership commitment • Accountability (single leader) • Drug expertise (pharmacist) • Action (recommendation implementation) • Surveillance (usage and resistance • Education (prescribers) • Data sharing
  18. 18. Game Changers  Culture Independent Diagnostic Testing  Whole Genome Sequencing  Bioinformatics  Healthcare Reform  Electronic Health Records  Social Media  One Health
  19. 19. The Opportunities “One Health” Humans Domestic Animals Ecosystems Wildlife http://www.onehealthcommission.org/
  20. 20. Common Ground for Medical and Veterinary Communities  Antimicrobial resistance and usage  Avian, animal, and pandemic influenza  Other zoonotic diseases including those associated with exotic pet and wildlife trade  Foodborne disease  Healthcare-associated infections  Blood, organ, tissue safety  Pathogen discovery / new diagnostics  Drug and vaccine development  Disease eradication  Biosafety / Biosecurity  Bioterrorism / Biodefense
  21. 21. President Obama Executive Order Combating Antibiotic-Resistant Bacteria 9/18/14  National Security Priority  Interagency Task Force  Co-chairs: Secretaries of HHS, USDA, DoD  5 year National Action Plan by 2/15/15  Presidential Advisory Council  Stewardship (humans & animals)  Surveillance (repositories, curated genomic databases)  Outbreak Response  New Drugs  Rapid Diagnostics  Increased International Cooperation
  22. 22. National Strategy on Combating Antibiotic-Resistant Bacteria White House September 2014 Goals • Slow emergence / prevent spread • Strengthen “One Health” surveillance • Develop rapid diagnostics* • Accelerate basic and applied R&D • New antibiotics • Other therapeutics • Vaccines • Improve international collaboration *$20M prize for rapid PoC diagnostic for “highly resistant bacterial infections”, co-sponsored by BARDA & NIAID http://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf
  23. 23. Report to The President on Combating Antibiotic-Resistant Bacteria PCAST September 2014 Problem • ~ 2M infections, 23K deaths • $55 – 70B in direct & indirect costs Recommendations • Strong federal leadership • Effective surveillance & response • Genomics component • Expanded fundamental research • Robust clinical trial infrastructure & new regulatory pathways • Economic incentives for drug development, stewardship programs, & rapid diagnostics • Decreased use in animal agriculture • Ensure international co-operation http://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf
  24. 24. Ways Forward For Shared Stewardship • Replace the use of antibiotics when possible – Human medicine • Prevention—vaccination, infection control, preventive medicine – Animal medicine and agriculture • Vaccines, immunomodulators, farming practices
  25. 25. Ways Forward For Shared Stewardship • Reduce the use of antibiotics when possible – Human medicine • Stewardship programs in healthcare—e.g., automatic stop orders • Outpatient physician feedback and prescriber education—e.g., reduce prescribing for URT infections – Animal medicine and agriculture • Eliminate use of medically important antibiotics for growth promotion
  26. 26. Ways Forward For Shared Stewardship • Refine the use of antibiotics – Human medicine • Right drug, right dose, right duration • NHSN antibiotic use monitoring as a quality measure – Animal medicine and agriculture • Require veterinary oversight • Decrease use of critically important antibiotics • Monitor use in animal agriculture, including development of metrics
  27. 27. Needs for Moving Forward on Shared Stewardship • Shared commitment – Continuing dialogue, willingness to listen • Better data on use for humans and animals – Partnership between USDA, FDA and CDC (equivalent of NARMS for antibiotic usage) in collaboration with healthcare and food and pharmaceutical industries
  28. 28. Needs for Moving Forward on Shared Stewardship • Communication • Adopting a One-Health approach • Developing a shared language for human and veterinary medicine, industry, consumers, advocates • Research • Better quantitation of the relationship between agricultural use and resistance in human infections • Alternatives to antibiotic use in human and veterinary medicine and agriculture1 • Better ways to implement stewardship in human medicine 1. PCAST report, http://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf
  29. 29. Transatlantic Task Force on Antimicrobial Resistance • Activity #18: Establish a joint working group of international subject matter experts to identify key knowledge gaps in understanding the transmission to man of antimicrobial resistance arising as a result of the use of antimicrobial drugs in animals and on the development of effective intervention measures to prevent this transmission, including the development of alternatives to antimicrobial drugs. http://www.cdc.gov/drugresistance/pdf/TATFAR-Progress_report_2014.pdf page 17
  30. 30. Conclusions  Move beyond “the blame game”  Respond to and leverage Executive Order, CARB National Strategy, and PCAST recommendations  Identify priorities and develop metrics  Shared commitment to antimicrobial stewardship  Shared commitment to development of better data on usage and resistance in various settings  Development of a collaborative research agenda to improve evidence base  Shared commitment to communication and collaboration with professional societies public / private sector partners, and the public
  31. 31. Acknowledgements Emory Dianne Miller Samantha Lammie CDC Steve Solomon Rob Tauxe Jeff Morelli

×