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Global Travel – who goes?. Global Links of NDM to the UK. Kumarasamy et al ., Lancet Infect Dis 2010 10: 597-602. 15 million Visitors to the UK 2011. Visitors to the UK by Purpose – potential for MDR GN household spread. Potential Impact of Overseas Patients . *HES Data
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Global Links of NDM to the UK Kumarasamy et al., Lancet Infect Dis 2010 10:597-602
Visitors to the UK by Purpose – potential for MDR GN household spread
Potential Impact of Overseas Patients *HES Data ** P. Wilson Pers Comm
Carbapenemase-producing Enterobacteriaceae in the UK(n = 1659) Imported & ‘home grown’ Early cases often imported Neil Woodford: AMRHAI, Unpublished data
Currently very limited knowledge on basic epidemiology. • CRO carriage rates in specific high risk groups allowing targeted screening? • Duration of carriage? • Optimal method of patient screening – rectal swabs – reliability of self swabbing? • Optimal laboratory screening method? • Transmission rates in home/hospital? • Efficacy of decolonisation and isolation? • Cost effectiveness of interventions?
Concerted Action Required: ALL Sectors Improved Global Intelligence Cross Cutting Antibiotic Policy Surveillance Targeted & Structured Antimicrobial Stewardship • Centralised • Reporting • incl private sector Simpler cheaper laboratory tests • Aggressive Infection ..Control • Screening • Isolation • Reinforced Hand ..Hygiene • Contact precautions Unified Strategic Policy in DH/NHS Renewed Drug Pipeline Political Commitment & Investment Focussed Clinical Research 9
What is the key priority ?Refocus NHS Infection Prevention and Control onto MDR GNB