ANTIMICROBIAL STEWARDSHIP AND INFECTION PREVENTION — KEY TAKEAWAYS FROM ECCMID 2021

Among the central topics of ECCMID 2021 were antimicrobial resistance (AMR) and its management via antimicrobial stewardship (AMS), and infection prevention and control (IPC) measures. Summarized here are some of the main points discussed in the session “How to implement effective antimicrobial stewardship linked to infection prevention?”.

-    There is a need to update the current AMR research landscape. In addition to development of new treatments and technologies, more focus and funding should be given to their implementation, as well as establishment of robust AMS policy and strategy. Most AMR research is conducted in high-income countries, leading to interventions that are not always viable for lower-income countries.

-    Context is the key. There is no one-size-fits-all approach to antimicrobial stewardship. Differences in culture and socioeconomic capabilities between countries need to be considered. We need to learn how to manage the specific behavioural and socioeconomic      drivers of AMR. This may be achieved through cultural and behavioural research.

-    Antibiotic prescribing is a complex social process. The hospital setting is hierarchical with many unwritten rules. Health care providers are often reluctant to intervene in the prescribing policies of their peers. AMS often focuses on junior doctors, when senior doctors are those with the greatest influence on team policies.     

-    Call for agreement on AMR risks and coordinated AMS efforts. A survey of 149 IPC practitioners from 15 European countries showed that there is currently poor agreement on the individual and collective risks of AMR (Birgand et al., 2020). Furthermore, AMS efforts are hindered by the insufficiency of the current AMR surveillance, mainly due to lack of harmonisation of the surveillance efforts in Europe.

-    Combining AMS with IPC promotes increased effectiveness and cost-savings. Every infection prevented is an antibiotic treatment avoided. Proper implementation of IPC and AMS reduces the frequency of AMR infections, with a significant effect on preventing death and reducing health-care burden. Investment in IPC now will save lives and money in the long-run (OECD 2018).

-    Properly implementing IPC is not always easy. The World Health Organisation (WHO) has identified six core components of implementing IPC on a national level. However, only one-third of the countries participating in the Tripartite AMR country self-assessment survey (TrACSS) in 2019–2020 had properly implemented IPC in health-care facilities nationwide, with a third not having implemented IPC at all. The WHO attempts to tackle this by offering tools for IPC implementation, improvement, and monitoring.

-    AMS and COVID-19 — a learning opportunity. Some of the preventative treatment measures taken during the COVID-19 pandemic have undermined AMS efforts. For example, in Italy the use of antibiotics doubled between March 2019 and March 2020 (Italian Medicines Agency, 2020). The population that is at risk of severe COVID-19 disease overlaps with that which is at risk of hospital-associated infections and AMR. Neglecting AMS efforts in an attempt to prevent deaths from COVID-19 may result in an increase of avoidable deaths due to AMR. On the other hand, research networks and funding created during the pandemic may help pave the way for more efficient infection management in the future.     

 

ECCMID 2021 References:

- Novel strategies to influence antibiotic prescribing behaviour and infection prevention practice. Esmita Charani (London, United Kingdom). Presented online at ECCMID 2021 on 9 July 2021.
Linking prescribing to prevention: a practical approach. Evelina Tacconelli (Verona, Italy). Presented online at ECCMID 2021 on 9 July 2021.
Global implementation of infection control and stewardship programmes: the WHO perspective. Benedetta Allegranzi (Geneva, Switzerland). Presented online at ECCMID 2021 on 9 July 2021.

Additional References:

- Birgand G, Mutters NT, Ahmad R, et al. Risk perception of the antimicrobial resistance by infection control specialists in Europe: a case-vignette study. Antimicrob Resist Infect Control. 2020 Feb 14;9(1):33.     
- OECD (2018), Stemming the Superbug Tide: Just A Few Dollars More, OECD Health Policy Studies, OECD Publishing, Paris, 10.1787/9789264307599-en.
- Italian Medicines Agency (2020), National Report on antibiotics use in Italy. Year 2019. The Medicines Utilisation Monitoring Centre, Rome https://www.aifa.gov.it/en/-/l-uso-degli-antibiotici-in-italia-rapporto-nazionale-anno-2019.
- WHO (2018), Global Database for the Tripartite Antimicrobial Resistance (AMR), Country Self-assessment Survey (TrACSS), https://amrcountryprogress.org/.     
 

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