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Effective Surveillance of AMR
Susan Hopkins Healthcare Epidemiologist, Public Health England Consultant Infectious Diseases & Microbiology, Royal Free London Honorary Senior Lecturer, University College London
Objectives • To outline key surveillance in relation to AMR
• To outline the importance of data sharing
• To share experiences
English Surveillance Programme for Antibiotic Use and Resistance (ESPAUR) Established by PHE in 2013 in response to the strategy Terms of reference updated in 2015, at year 2 review Focuses on bringing together NHS, PHE, Private sector across all prescribers and clinicians to improve
Surveillance data on AMR and prescribing Antimicrobial stewardship activities Education and training for healthcare professionals Work with Comms/ Marketing for the Public
3 ESPAUR 2014: Year 2 Report
Presentation title - edit in Header and Footer
Population 56million Four regions, 15 PH centres, 27 NHS area teams Eight Knowledge and Intelligence Teams
– London – South West – South East – West Midlands – East Midlands – North West – Northern and Yorkshire – East
Other local presence – ten microbiology laboratories – field epidemiology teams
Additional support – Local teams can also draw on national
scientific expertise based at Colindale, Porton Down and Chilton
Local presence
Prevention of AMR
infections
Environment
Surveillance & epidemiology
Healthcare workers
Antimicrobials Administrative procedures
Know about infection control
Delivery
Symptomatic patients isolated
Sufficient isolation rooms
Systems in place to respond to ↑ in cases
Systems in place to detect & trigger response ↑ in cases
Lab SOPs reliably identify cases
Systems in place to recognise epidemic/ virulent strains
Systems in place to monitor & benchmark
prescribing
Policy available – hospital/GPs
Reduce use of broad spectrums
Antibiotic pharmacist
Can recognise cases early
Know how to monitor & treat cases
Can identify high risk patients
Systems in place to identify & manage cases
Stop unnecessary Rx
High frequency of hand hygiene
Prudent prescribing
Patient equipment cleaned after each use
Systems in place to assure high standard of cleaning
Chlorine used for cleaning in outbreaks
Research to understand causes and risk factors
Research to evaluate prevention measures
AMR: role of surveillance & epidemiology
Surveillance Data Flows
HIV MRSA/MSSA C difficile E coli SSI ICU PPS
Influenza VTEC
Data Sources
Data mgmt systems
Analysis & output
ESPAUR, One Health EARS, ESAC, HAI-net ECDC
HPUs GPs Laboratories: Ref & clinical
IHR & EWRS Outbreaks
& Incidents
NOIDS ePACT IMS
RCGP & Q-Research NHSD FWE HAI SGSS
Clinicians 1° & 2° N H S
Direct AMU ONS WHO/ ECDC
Deaths H I V & STI
A&E
EDSS
Surveys
B P S U , Serology PPS
Aetiological Reporting
Syndromic Reporting
Event Reporting
Other Reporting
SGSS: Second Generation Surveillance System
CSC March 2014 7
Laboratory text files(preferred method)
SGSS LaboratoryData Import
Legacy CoSurv/Amsurv files
Bespoke Excel format (CDR and
AMR)
sFTP
Web Upload
Web Data Entry
Laboratory Person
SGSS Data
Warehouse
ReportingWeb
Business Intelligence Layer (BI)
Mining and Analysis
APIHPZone
External networks PHE network
BI Security layerRole based model based
on requirement / permission to view patient
level or aggregate data
SGSS Operational Database
Resistance in Escherichia coli • Proportion resistance stable • Increased rate of bacteraemias & antibiotic resistant bacteraemias • Regional variation across the country
E. coli isolates non-susceptible to ciprofloxacin, 3rd gen cephalosporins and gentamicin, England 2010-2013
Proportions of E. coli bloodstream infection isolates non-susceptible to indicated antibiotics, NHS Area Team, 2013
Grey areas represent ATs where <70% of isolates had susceptibility data available ESPAUR - BSAC Roundtable Series
Carbapenems ~0.3% of total use 31% increase from 2010 to 2013 99% hospital use Majority of regions increased Huge variability across AT
Consumption of most commonly used carbapenems, DID, 2010-2013
Consumption of carbapenems by General Practice and Hospitals, DID, 2010-13
Map of carbapenem consumption by ATs, DID, 2013
Proportion of Carbapenems Resistant K. pneumoniae Isolates in Participating Countries 2006-2012
Data source: ECDC (EARS-Net))
2006 2010
2012 2014
Conclusions • Antimicrobial resistance a significant threat
• crosses hospital and community • crosses organisations, borders, regions etc
• Need effective information for action • antimicrobial use and resistance • voluntary and mandatory surveillance • sentinel and routine surveillance • geographical and organisation specific
• Laboratory and Surveillance Strategy goes hand in hand • early interaction and development key • decide on outputs (i.e. key needs and information for action/ policy etc) • develop feedback systems
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