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Europe and the fight against Antimicrobial Resistance

Europe and the fight against Antimicrobial Resistance. Vincent Houdry DG SANCO C3 Health Threats Unit. Intersectoral mechanism. SANCO: health, food, feed, animals, plants… ENV: biocides, agriculture, residues ENTR: pharmaceutical products, biocides

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Europe and the fight against Antimicrobial Resistance

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  1. Europe and the fight against Antimicrobial Resistance Vincent HoudryDG SANCO C3Health Threats Unit

  2. Intersectoral mechanism • SANCO: health, food, feed, animals, plants… • ENV: biocides, agriculture, residues • ENTR: pharmaceutical products, biocides • RTD: basic research, new antibiotics and tests • ECDC, EMEA, EFSA, JRC, non food scientific committees, community reference laboratory for AMR…

  3. Feed/animal/food • Zoonoses Monitoring directive (2003) • Decisions (2007) on Salmonella, Campylobacter, MRSA • RASFF: Rapid Alert System on Food and Feed • Prohibition of the use of antibiotics as feed additives (2003)

  4. Community reference laboratory on AMR • Directive on the monitoring of zoonoses and zoonotic agents • Monitoring of antimicrobial resistance • Ensure quality of antimicrobial susceptibility testing and harmonise procedures and methodologies

  5. DG Environment • Biocidal products directive (1998) • Revision of all active substances regarding safe use for human health and environment (before 2010) • SCENIHR: scientific opinion to assess AMR effects of biocides • Cross resistance to antibiotics as a new criteria in evaluation of biocidal products?

  6. DG Research • 5th FP 1999-2002: 20M€/year • 6th FP 2003-2006: 40M€/year • Translational research: Grace and Mosar • Animal health: alternatives to antibiotics and transmission of AMR • 7th FP 2007-2013: First call • AMR in human health • Biocides and AMR in food and animal health

  7. EFSA • Food as a vehicle for antimicrobial resistance: EFSA Q 2007 089 • Antimicrobial resistance of decontaminants substances (poultry carcasses)/SCENIHR • Data on AMR in zoonotics agents (salmonella, campylobacter) in animals and food of animal origin (Zoonoses directive)

  8. EMEA • Guideline to applicants to obtain more useful prescribing information • SPC: info on prudent use, prevalence of resistance • Veterinary unit: • Guidance on preauthorisation requirements for authorisation of antimicrobials – potential to select for resistance • Considerations on use of Fluoroquinolones for food producing species (cephalosporins, macrolides, lincosamines, streptogramins)

  9. ECDC • 3 meetings of NFP for AMR • Country visits on AMR • Working groups: • Clostridium difficile, MRSA • DSN: EARSS, ESAC, IPSE/HELICS • First EU Antibiotic day

  10. DG SANCO Human Health • EU Network for surveillance and control of communicable diseases (Decision 2119/98/EC) • Antimicrobial Resistance • Nosocomial Infections • Surveillance of specific pathogens

  11. EU Public Health Programme 2003-2008 • EUCAST: developing common methodology, case definitions and data to be collected for the surveillance on AMR • ESAC: monitoring the level of consumption of antibiotics in the EU. • EARSS: surveillance of AMR in the EU

  12. EU Public Health Programme 2003-2008 • IPSE: development of guidelines and educational tools to better and effectively manage the risk of HCAI and AMR - Surveillance of AMR in intensive care units • ABS INTERNATIONAL: implementing strategies for the appropriate use of antibiotics in hospitals • BURDEN: information (morbidity, mortality and economic impact) on the burden of disease and resistance across Europe • E-Bug: development of educational programmes on antibiotics in schools

  13. EU Public Health Programme 2008-2013 • Work plan 2008 "Improve citizen's health security" • Promotion of risk assessment thematic networks for exchange and collaboration on critical issues (AMR)

  14. Community Strategy against AMR • Council recommendation on the prudent use of antimicrobial agents in human medicine: 2001 • Intersectoral mechanism • Strategies towards the prudent use • Surveillance Systems on usage of ATB and AMR • Control and preventive measures • Promote education and training of HCW and Inform the general public • First implementation report: 2005 • Commission staff working document

  15. First implementation report • Appropriate Intersectoral Mechanism • Development of Strategies and action plans • Lack of data at lower level; feedback to prescribers • Collaboration human/animal health • Ban OTC/Self medication • Prescription guidelines + monitoring impact • Hygiene and infection standards in health care institutions • Enlarge surveillance activities to antivirals and antiparasitic agents • Campaigns toward the general public

  16. Planned Actions in Human Health • Second implementation report on the Council recommendation on the prudent use of antimicrobial agents in human medicine (2009)

  17. Planned EU Actions in Human Health • Patient safety proposal • Commission Communication on Patient Safety • Council Recommendation on • patient safety and quality of health services • the prevention and control of healthcare associated infections

  18. Recommendation on HCAI • Healthcare-associated infections (HCAIs) affect an estimated 4.1 million patients and cause an estimated 37,000 deaths in the EU every year. • HCAIs lead to increase in length of stay, illness, mortality and costs. • Infections caused by these pathogens are often difficult to treat due to antimicrobial resistance (Council Recommendation 2002/77/EC). • Organisational and behavioural changes are needed to make an impact. • Studies and impact assessments show that intervening is cost-effective ! • However, a strong political commitment is needed !!!  EU initiative for a proposal for a Council Recommendation

  19. Content of recommendation on the prevention and control of HCAIs – national level • At the national level: • National strategy for prevention and control of HCAIs • National dedicated multidisciplinary Committee for implementation of national strategy • Senior management of healthcare institutions bear responsibility for quality of care • Recommended objectives of national strategy: • Implement control and preventive measures. • Organise infection prevention and control programmes. • Establish or strengthen active surveillance systems on HCAIs. • Foster education, training, research and information exchange.

  20. Content of recommendations on the prevention and control of HCAIs – EU level • Facilitate mutual information, consultation, cooperation and action. • Develop scientific guidance (ECDC). • Consider with Member States how to publicly report data on HCAIs. • Strategies for reduction of exposure of healthcare staff to HCAIs (= safety at work). • Funding research. • Cooperation with WHO and others. • Revise/update recommendations. • Submit regular implementation reports to the Council, on the basis of Member States’ reports on their follow-up to the Council Recommendation.

  21. EU action plan to fight TB • MDR and XDR TB • Framework action plan published next week • Next step • Who does what ? • timetable • indicators

  22. AMR on the political agenda • Council conclusions on AMR • Community • Hospital • New antibiotics • ….

  23. Thank you for your attention! Commission Public Health website: http://ec.europa.eu/health/index_en.htm EU Health Portal: http://ec.europa.eu/health-eu

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