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ANTIMICROB IAL R E S I S TANCE


severe COVID-19 largely overlaps with the population at risk of HCAIs. The question arises: will high income societies continue to accept substantial numbers of avoidable deaths caused by HCAIs, while risking an unprecedented economical and societal crisis to protect the same risk group from COVID-19?


She pointed out that the necessary efforts against HCAIs are marginal compared with the current activities against COVID-19. However, the pandemic has changed our ways of thinking and paved the way for more efficient measures against other types of infections; we have learned to deal with epidemiological big data more efficiently. New networks for innovative research are in place, venture capital will be more easily available for development programmes and public opinion will back stronger government commitments to tackling HCAIs.19 “Ultimately, reducing AMR can be achieved only with a coordinated effort of preventative measures and stewardship approaches,” said Prof. Tacconelli. She called for the development of an integrated, modular strategy of evidence- based intervention programmes of infection control and antibiotic stewardship. New education tools linking infection control and therapeutic perspectives with a meta- competence approach will be required, while the integration of infection control and clinical management also needs to be achieved in guidance documents. “Finally, the COVID-19 experience should not be lost; sustainability plans must be developed to ensure that the new COVID-19 coordinated networks can be reused for AMR. Creating perpetual cohorts to prevent and treat infectious diseases seems the right investment to increase preparedness and avoid waste of research funding and manpower. The lesson seems even more important when we consider that other communicable diseases, such as antimicrobial resistant infections, have not disappeared and are adding to the burden of the pandemic,” she concluded.


Reference 1 Healthcare Standards in Europe, July 2013. 2 Epidemiology Network (EPI.net), https://epi-net.eu 3 Savoldi A, Carrara E, Gladstone BP, Azzini AM, Göpel S, Tacconelli E. Gross national income and antibiotic resistance in invasive isolates: analysis of the top-ranked antibiotic-resistant bacteria on the 2017 WHO priority list. J Antimicrob Chemother. 2019 Dec 1;74(12):3619-3625. doi: 10.1093/jac/dkz381. PMID: 31730162.


4 Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis. 2015 Dec;15(12):1429-37. doi: 10.1016/S1473-


JANUARY 2021


3099(15)00270-4. Epub 2015 Oct 22. PMID: 26482597.


5 Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta- analysis in World Health Organization Regions. Gastroenterology. 2018 Nov;155(5):1372-1382. e17. doi: 10.1053/j.gastro.2018.07.007. Epub 2018 Jul 7. PMID: 29990487; PMCID: PMC6905086.


6 Tacconelli E, Carrara E, Savoldi A, Harbarth S, et al; WHO Pathogens Priority List Working Group. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic- resistant bacteria and tuberculosis. Lancet Infect Dis. 2018 Mar;18(3):318-327. doi: 10.1016/ S1473-3099(17)30753-3. Epub 2017 Dec 21. PMID: 29276051.


7 Tacconelli E, Cataldo M.A.,Dancer S.J., et al, ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients, Clin Micro and Infect, ESCMID Publications, Jan 2014, accessed at: https://www.clinicalmicrobiologyandinfection.com/ article/S1198-743X(14)60007-0/fulltext


8 Ibid. 9 Schuts EC, Hulscher MEJL, Mouton JW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 2016 Jul;16(7):847-856. doi: 10.1016/S1473- 3099(16)00065-7. Epub 2016 Mar 3. Erratum in: Lancet Infect Dis. 2016 Jul;16(7):768. PMID: 26947617.


10 Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, Tacconelli E. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis. 2017 Sep;17(9):990-1001. doi: 10.1016/S1473- 3099(17)30325-0. Epub 2017 Jun 16. PMID: 28629876.


CSJ


11 Ibid. 12 Ibid. 13 Feazel LM, Malhotra A, Perencevich EN, Kaboli P, Diekema DJ, Schweizer ML. Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. J Antimicrob Chemother. 2014 Jul;69(7):1748-54. doi: 10.1093/jac/dku046. Epub 2014 Mar 14. PMID: 24633207.


15 Kim YC, Kim MH, Song JE, Ahn JY, et al. Trend of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in an institution with a high rate of MRSA after the reinforcement of antibiotic stewardship and hand hygiene. Am J Infect Control. 2013 May;41(5):e39-43. doi: 10.1016/j. ajic.2012.12.018. Epub 2013 Mar 19. PMID: 23522710.


16 Viale P, Tumietto F, Giannella M, et al. Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy. Clin Microbiol Infect. 2015 Mar;21(3):242-7. doi: 10.1016/j.cmi.2014.10.020. Epub 2014


Nov 11. PMID: 25658534.


17 Valiquette L, Cossette B, Garant MP, Diab H, Pépin J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis. 2007 Sep 1;45 Suppl 2:S112-21. doi: 10.1086/519258. PMID: 17683015.


18 Savoldi, A., Foschi, F., Kreth, F. et al. Impact of implementing a non-restrictive antibiotic stewardship program in an emergency department: a four-year quasi-experimental prospective study. Sci Rep 10, 8194 (2020). https://doi. org/10.1038/s41598-020-65222-7


19 Vehreschild M, Tacconelli E, Giske C, Peschel A, Beyond COVID-19 – a paradigm shift in infection management? Lancet Infect Dis 2020 Published Online October 9, 2020 https://doi.org/10.1016/ S1473-3099(20)30789-1


Professor Tacconelli


Evelina Tacconelli (MD, PhD) is a professor of infectious diseases, head of the division of infectious disease at the University Hospital of Verona, Italy, and of the DZIF research clinical unit for healthcare-associated infections at the University Hospital of Tübingen, Germany. Her main areas of interest are prevention and treatment of healthcare- associated and antibiotic resistant infections.


About FIS/HIS 2020


This international conference includes the collaboration of societies with interests in different aspects of infectious diseases, clinical microbiology, biomedical science and infection control. The conference ran live from 9-11 November and featured over 40 sessions from internationally renowned speakers, 200 virtual posters and a sponsor forum, providing an invaluable source of education. If you are a healthcare professional with an interest in healthcare infection diagnosis, treatment, prevention and control, you will benefit from accessing the conference content, which is available now.


Extended conference access for all:


l Registration open until 9 February 2021 l Access all conference content until 5 November 2021


View the programme and register at: https://his.org.uk/training-events/ fis-his-2020


WWW.CLINICALSERVICESJOURNAL.COM l 29


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