Year : 2014 | Volume
: 139 | Issue : 1 | Page : 182--183
The evolving threat of antimicrobial resistance: Options for action
Department of Microbiology All India Institute of Medical Sciences New Delhi 110 029, India
Department of Microbiology All India Institute of Medical Sciences New Delhi 110 029
|How to cite this article:|
Kapi A. The evolving threat of antimicrobial resistance: Options for action.Indian J Med Res 2014;139:182-183
|How to cite this URL:|
Kapi A. The evolving threat of antimicrobial resistance: Options for action. Indian J Med Res [serial online] 2014 [cited 2020 Sep 21 ];139:182-183
Available from: http://www.ijmr.org.in/text.asp?2014/139/1/182/128385
World Health Organization, Geneva, Switzerland) 2012. 122 pages. Price: CHF 30.00 / US $ 36.00; in developing countries: CHF 21.00 / US $ 25.20
This book is a step towards the commitment of WHO to patient safety across the globe, in context of the relevance and immediate importance of containment of antimicrobial resistance. The WHO global strategy and recommendations for containment of antimicrobial resistance was published in 2001. These recommendations focused around five important technical areas related to antimicrobial resistance namely, surveillance, judicious use, reducing use in animal husbandry, control of healthcare associated infections, and promoting innovation in research. Further, the WHO patient safety initiative was put forward in 2010 which puts forth antimicrobial resistance control as a priority. This was followed by World Health Day in 2011 dedicated to the theme on control of antimicrobial resistance.
After the WHO recommendations were published in 2001, it was expected that all the countries would initiate a national plan and identify problems in the implementation of various strategies recommended. This was done to generate evidence, based on the experiences of different nations to understand and define practical intervention strategies and bring out national guidelines on cost-effective antimicrobial resistance control. The need for these practical intervention strategies is a priority now as enough publications and guidelines are available on the approaches to the control of antimicrobial resistance. It is now time to start intervention programmes and determine their effectiveness.
In 2008 an international consultation process was started by the WHO with inputs from many international experts in the field of antimicrobial resistance resulting in the present publication. The working group has reviewed, analyzed and compiled the evidence generated after implementation of the recommendations 2001 from those countries which already had antimicrobial resistance control policies in place, from those which have initiated the process and made progress, and from low-, middle- and high-income countries. The positive impact from these experiences or otherwise has been presented in this publication so as to put forth the lessons learnt and gaps identified in the process. This publication also aims to increase awareness amongst policymakers regarding their role in planning implemen[Table 1]nterventions.
Chapter 2 discusses about the surveillance to track antimicrobial use and resistance in bacteria. The example of European Surveillance of Antimicrobial Consumption (ESAC) has been provided with quantifiable outcomes and the experience from PAHO (The Pan American Health Organization) and EARS (European Antimicrobial Resistance Surveillance) nets using computers has been presented. Data on retail sales from Latin countries and India and South American pilot projects on community based surveillance have also been analyzed and discussed. The gaps identified in this strategy such as lack of common definitions, poor laboratory capacity and problems in coordination of networks have been highlighted.
The chapter on the measures to ensure better use of antibiotics enumerates different experiences in implementation of this strategy including the French experience of a national plan of action, the Chile experience on restriction of sales of antibiotics to prescriptions and the Australian experience of forcing an integrated package of measures especially for specific antimicrobials. A combined bottom-up and top-down approach of Thailand model along with its sustainability is also presented. Similarly, some attempts made by Zambia, Vietnam and Swedish governments have been provided. The gaps identified such as, lack of a comprehensive strategy and regulatory framework, poor awareness at all levels and inadequate laboratory testing facilities have been discussed.
Chapter 4 on reducing antimicrobial use in animal husbandry presents experience of Denmark, Austria, USA and Canada on the impact of decrease in the use of a particular antibiotic in animals. The gaps identified (lack of systematic information on prevalence of antimicrobial resistance in bacteria of animal origin and quality data on evaluation of impact) have been presented.
The chapter on infection prevention and control in healthcare facilities describes the experience on the use of alcohol based hand rub in reducing the transmission of MRSA and other infections in hospital settings as a part of this strategy in Switzerland and Australian hospitals. Major gaps identified in this strategy such as, the sustainability of practices, change in human behaviour and increased need for resources have been analyzed.
Chapter 6 on fostering innovations to combat antimicrobial resistance describes the need for financial support from scientific organizations, and the thrust areas identified are drug discovery, point of care diagnostic tests and potential vaccines to prevent infections.
The appendices have summarized WHO 2001 recommendations, and 2011 WHO day policy briefs as ready references. Finally, while many publications are already available on the approaches and recommendations to control antimicrobial resistance, this publication is actually a presentation as well as an analysis of the evidence base generated by experiences from different countries in defining problems, designing strategies, determining outcomes, presenting success or failures and defining gaps that need to be addressed. Everyone can learn lessons from this evidence base including doctors, scientists and administrators.