CLINICAL ISSUES :: AMR


prevention and control programs, access to essential anti- biotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology labo- ratory capacity and data collection systems to improve our understanding of this important human health threat.


AMR is real, preventable, and actionable There are immediate areas of action that we can take today to make an impact against drug-resistant infections.


Infection prevention Preventing infections, particularly healthcare-associated infec- tions (HAIs) that spread in hospitals, need to be considered as the first line of defense against AMR. According to the CDC, resistant bacteria cause 18% of central line-associated blood- stream infections (CLABSIs), 15% of surgical site infections (SSIs) and 10% of catheter-associated urinary tract infections (CAUTIs) in U.S. hospitals.5 • The CDC has tools available to assess infection prevention practices and guide quality improvement. • Combatting AMR globally requires WASH (Water, Sanitation, and Hygiene) and IPC in all healthcare systems. In many low- to middle-income countries, WASH is inad- equate with 1 in 3 healthcare facilities lacking hand hygiene materials at point of care and over 900 million people using healthcare facilities with no water service. Learn more about this challenge and efforts underway on the WHO, UNICEF, and WaterAid’s websites. • The Society for Healthcare Epidemiology of America (SHEA) has updated their training course in best practices in infection prevention and control for hospital clinicians with direct patient care responsibilities. The online program, known as Prevention Course in HAI Knowledge and Control (Prevention CHKC), is currently available. Preventing infections through vaccinations is critical for


reducing the need for antibiotics. Vaccines are available for only one of the six leading global AMR pathogens, S pneu- moniae. While vaccine programs are underway for several bacterial pathogens, it is also important to note that vaccines for viruses, the influenza or rotavirus vaccines, also play a role in preventing febrile illness. A reduction in febrile ill- ness, which can lead to a reduction in antibiotic prescribing and can reduce the development of resistance. A recent study by Gupta, et.al, demonstrates that periods of high influenza activity corresponds with high rates of antibiotic resistance in respiratory and non-respiratory infections. While this study does not demonstrate causality, it does show the anecdotal link between AMR and flu season.6


Antibiotic and diagnostic stewardship Antimicrobial stewardship programs in healthcare settings are designed to optimize antibiotic therapies, with the intention of slowing the emergence of drug-resistance. Accurate and rapid diagnostic testing is a crucial element of stewardship. Diagnostic testing can identify the infection-causing organism, determine whether it is resistant and guide the appropriate therapeutic choice. Essentially, antibiotic stewardship means being smarter—more discriminating and more appropriate— about how we (as a society) use them.


Awareness and advocacy To change behaviors and practices around antibiotic utilization, the risk of drug resistant infections needs to better understood


by organizations and individuals. Antimicrobial resistance is a complex problem that involves human health, animal manage- ment, and agriculture practices. The Antimicrobial Resistance Fighter Coalition is a is a bold collective of like-minded organi- zations, leaders, and individuals united in their commitment to address the threat and burden of antimicrobial resistance The podcast series, Superbugs and You, is co-produced by


the Antimicrobial Resistant Fighter coaltion and Center for Infectious Disease Research and Policy (CIDRAP). The podcasts address this global AMR crisis through conversa- tions with patients, clinicians, and researchers to discover how super- bugs are affecting people and health- care systems globally. It highlights sactions that the average citizen can take today to make sure the drugs we already have stay effective, in order to protect ourselves, our families, and our communities. Are you ready to take action against drug-resistant infec-


tions? Download Activation Kits from the Anticrobial Resistant Fighter Coaltion’s website. Each kit includes an introduction and overview on how the specific audience can use the kit, talking points and messaging, materials to use in digital and news media, specific action items you can take to combat AMR, and resources to use within your com- munity to reach decision-makers. Halting and reversing this mas-


sive challenge will require the combined resources and efforts of both public and private sectors. AMR has no single solution, and the challenges cannot be solved without multiple players working


collectively on a common AMR agenda. REFERENCES


1. Institute for Health Metrics and Evaluation. The latest estimates of global anti-microbial resistance show urgent policy action is needed to save lives. Accessed February 8, 2022. https://www.healthdata.org/news-release/ latest-estimates-global-anti-microbial-resistance-show-urgent-policy-ac.


2. Centers for Disease Control and Prevention. 2019 AR threats report. Accessed February 8, 2022. https://www.cdc.gov/drugresistance/biggest- threats.html.


3. Ukuhor H. The interrelationships between antimicrobial resistance, COVID-19, past, and future pandemics. J Infect Public Health. 2021;14(1):53-60.


4. O’Neill J (chair). Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Accessed February 8, 2022. https://amr-review.org/ sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20 crisis%20for%20the%20health%20and%20wealth%20of%20nations.


5. Weiner LM, Fridkin SK, Aponte-Torres Z, et al. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:235–241.


6. Gupta V, Yu KC, Kabler H, Watts, et al. Antibiotic Resistance Patterns and Association With the Influenza Season in the United States: A Multicenter Evaluation Reveals Surprising Associations Between Influenza Season and Resistance in Gram-Negative Pathogens. Open Forum Infect Dis. 2022 Jan 25;9(3):ofac039. doi: 10.1093/ofid/ofac039.


Diane Flayhart, MBA, is the Global Program Leader for Antimicrobial Resistance at BD. Flayhart works to champion and support development of new Antimicrobial Resistance (AMR) program initiatives in global awareness, infection prevention/control and antimicrobial stewardship. Flayhart leads efforts for the Antimicrobial Resistance Fighter Coalition, which is mobilized by BD.


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