Factors unique to the Asia Pacific (including environmental, socio-economic, agricultural, geographic and demographic) mean the region acts as an epicenter for antimicrobial resistance that impacts healthcare systems.[2],[3] Home to 60% of the world's population, many of the region's low- and middle-income countries also have less stringent healthcare policies, and antibiotics are often easily available.[4] In Thailand alone, more than US$170 million was spent on antibiotics in 2010, and at least 88,000 infections were antimicrobial resistant, resulting in at least 3.24 million additional days in hospital, and 38,000 deaths.[5]
To address this, the AMR Summit Expert Group, united leaders from 14 medical societies/organizations, is joined by the AMS Working Group, which is dedicated to improve the quality of antimicrobial stewardship in Asia through tailored initiatives, such as the development of the region's first AMS Blueprint and specialized antimicrobial stewardship training to resource-constrained hospitals.
Antimicrobial resistance happens when microorganisms, such as bacteria and fungi, develop the ability to stop an antimicrobial - or multiple antimicrobials - from working against it. As a result, infections can grow, and even spread to others.
The misuse and overuse of antibiotics is accelerating the process of antimicrobial resistance beyond the speed of medical research. This means that common illnesses, such as minor wound, and simple surgeries, such as Cesarean-section, tonsillectomy, may become life-threatening once again, similar to pre-antibiotic era. Moreover, modern medical treatments, such as cancer therapy, organ transplantation and joint replacement, cannot be done without effective antibiotics.
Professor Cheng-Hsun Chiu, co-chairperson of the meeting, emphasized the importance of combined efforts between local governments, hospital administrators, and pharmaceutical companies to drive public awareness, and practice and policy change. "A long-term solution involves public education, but healthcare professionals also need to be re-educated about proper antibiotic practices. We also need decision-makers and leaders at a government and institutional level to champion and drive initiatives on antimicrobial stewardship, surveillance, diagnostics and access to novel antimicrobial agents."
For the first time ever at the Joint Asia Pacific AMR Summit-AMS Working Group Meeting, experts from national medical societies in Asia Pacific collectively recommend 12 core interventions to promote the success of antimicrobial stewardship (Table). "Every government, stakeholder and responsible personnel can use the 12 core interventions as a checklist to ensure essential interventions for antimicrobial stewardship are met, as part of the commitment to combat antimicrobial resistance," said Dr Pisonthi Chongtrakul from Thailand's National Strategic Plan on AMR.
The Joint Asia Pacific AMR Summit-AMS Working Group Meeting marks the beginning of an ongoing regional commitment to work towards a world with no unnecessary deaths due to antimicrobial resistance.
Table. 12 core interventions to promote the success of antimicrobial stewardship+
1. A mandated multi-disciplinary national body to coordinate surveillance and appropriate use of antimicrobials
2. National clinical guidelines for diagnosis, prevention and treatment of infections*
3. Novel treatment and essential antimicrobial list based on treatments of choice
4. Strengthening drugs and therapeutics committees in districts and hospitals
5. Problem-based AMS and infection control training in undergraduate curricula
6. Continuing medical education on AMS as a licensure requirement
7. Supervision, audit and feedback
8. Independent information on antimicrobials
9. Public education about appropriate use of antimicrobials and consequences of antimicrobial misuse
10. Avoidance of perverse financial incentives
11. Appropriate and enforced regulation for antimicrobial use and disposal
12. Sufficient government expenditure to ensure availability of antimicrobials, diagnostics, and staff to tackle AMR issues
+ Adapted from World Health Organization (WHO) Policy Perspectives on Medicines - Promoting rational use of medicines: core components. Available at: https://apps.who.int/medicinedocs/pdf/h3011e/h3011e.pdf. Accessed 26 October 2019.
* in human, animal and agriculture.
Disclaimer: The Joint Asia Pacific AMR Summit-AMS Working Group Meeting was coordinated by Pfizer. The sponsor had no role in the content development, discussion, recommendations and outcomes from the meeting.
References
[1] Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. 2014.
Available at: www.amr-review.org/Publications.html. Accessed October 2019.
[2] Kang C-I, Song J-H. Antimicrobial resistance in Asia: current epidemiology and clinical implications. Infect Chemother 2013;45:22–31.
[3] Lai C-C, Lee K, Xiao Y, et al. High burden of antimicrobial drug resistance in Asia. J Glob Antimicrob Resist2014;2:141–147.
[4] Hsu L-Y, Apisarnthanarak A, Khan E, et al. Carbapenem-resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev2017;30:1–22.
[5] Sumpradit N, et al.New chapter in tackling antimicrobial resistance in Thailand. BMJ 2017;358:j3415.
About AMR Summit Expert Group
The Antimicrobial Resistance (AMR) Summit Expert Group consists of leaders of 14 clinical microbiology, infection control, infectious disease and critical care medical societies/organizations from India, Indonesia, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand and Vietnam. The key objective of the group is to strategize on combating antimicrobial resistance in Asia, with a focus on lobbying for government commitment, creating healthcare professional and public awareness, and through multi-sectoral partnerships, eg, animal and environmental health. The group's inaugural meeting was held in Bangkok, Thailand in November 2018, and was supported by Pfizer.
About Antimicrobial Stewardship Working Group
Antimicrobial Stewardship (AMS) Working Group was founded in 2017 by 6 infectious diseases and antimicrobial stewardship experts from Asia to improve the quality of antimicrobial stewardship in the region. Since its formation, the AMS Working Group has trained healthcare professionals from across Asia on building and sustaining antimicrobial stewardship culture; started preceptorship programs at antimicrobial stewardship training centers in Singapore, Taiwan and India; published an Asian antimicrobial stewardship consensus paper, and developed the AMS Blueprint – a toolkit to help Asian hospitals implement antimicrobial stewardship programs. The group's initiatives and work have been supported by Pfizer.
APPENDIX
The following medical societies were represented at the AMR Summit and AMS Working Group initiatives:
Indonesia:
Indonesian Society for Clinical Microbiology
The Indonesian Society of Tropical and Infectious Diseases
Japan:
The Japanese Society for Infection Prevention and Control
Malaysia:
Malaysian Society of Infectious Diseases and Chemotherapy
Philippines:
Philippine Hospital Infection Control Society, Inc.
Philippine Society for Microbiology and Infectious Diseases
Singapore:
Society of Intensive Care Medicine (Singapore)
Taiwan:
Infection Control Society of Taiwan
Infectious Disease Society of Taiwan
Vietnam:
Vietnam Society for Infectious Diseases