Findings from AMR surveillance in Bangladesh Dr. Zakir Hossain Habib Principal Scientific Officer (Associate Professor) Department of Microbiology Member Secretary AMR Surveillance Coordination Sub-Committee Institute of Epidemiology, Disease control & Research (IEDCR)
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Findings from AMR surveillance in Bangladesh
Dr. Zakir Hossain HabibPrincipal Scientific Officer (Associate Professor)
Department of Microbiology
Member Secretary
AMR Surveillance Coordination Sub-Committee
Institute of Epidemiology, Disease control & Research
(IEDCR)
Antimicrobials are probably one
of the most successful forms of
treatment in the history of
medicine
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3
Alexander
Fleming.
Gerhard
Domagk
411/26/2019
Prevention and Containment of Antimicrobial ResistancePrevention and Containment of Antimicrobial Resistance
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Any use of antimicrobials, howeverappropriate and conservative, contributes tothe development of resistance,
but
widespread unnecessary and excessiveuse makes it worse
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Pathway of antibiotics for human and veterinary use in the environment.
9
As things stand, AMR is projected to cause more deaths than cancer by 2050. Image courtesy of Jim O'Neill, Chairman of the Review on Antimicrobial Resistance.
Deaths attributable to AMR every year compared to other major causes of death
The isolate is non-susceptible to at least 1 agentin ≥3 antimicrobial categories
The isolate is non-susceptible to at least 1 agent in all but 2 or fewer antimicrobial categories
Non-susceptibilityto all agents in allantimicrobial categoriesfor each bacterium
MDR
XDR
PDR
56%21%
14%
9%
Percentage of MDR, XDR, PDR Pseudomonas aeruginosa (n=724)
MDR(n=403)
XDR(n=149)
PDR(n=98)
Other thanMDR,XDR,PDR (n=74)
33%
43%
26%
8%
Percentage of MDR, XDR & PDR Proteus spp. (n=179)
MDR (n=62)
XDR (n=76)
PDR (n=26)
Other thanMDR,XDR,PDR (n=15)
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53%
23%
13%
11%
Percentage of MDR, XDR & PDR Klebsiella pneumoniae (n=647)
MDR (n=347)
XDR (n=147)
PDR (n=82)
Other thanMDR,XDR,PDR (n=71)
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73%
13%
3%
11%
Percentage of MDR,XDR & PDR in E. coli (n=1068)
MDR (n=778)
XDR (n=138)
PDR (n=31)
Other thanMDR,XDR,PDR (n=121)
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Percentage of MDR, XDR and PDR Acinetobacter spp.(N=159)
7043%
5937%
2214%
85%
XDR
PDR
MDR
Non - MDR, XDR, PDR
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Percentage of MDR, XDR and PDR Enterococcus spp.(N=89)
11%
3337%
5562%
XDR
PDR
MDR
Non - MDR, XDR, PDR
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Distribution of Pan drug-resistant bacteria (PDR) bacteria
Organism ICU Medicine Surgery Others Total
E. coli 8 8 6 9 31
P. aeruginosa 9 2 5 82 98
K. pneumoniae 36 29 11 13 89
Acinetobacter spp. 46 4 2 7 59
Enterococcus spp. 1 0 0 0 1
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Antibiotic
consumption
37%
9% 9% 8% 8% 7%5%
2% 2% 2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Antibiotics used for patients in all sites (n=7486)
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23%22%
12%11% 11%
6%
3%2%
1% 1%
0%
5%
10%
15%
20%
25%
Antibiotic used in UTI (n=921)patients in all sites
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20%
9% 9%8%
3%2% 2%
1%
0%
5%
10%
15%
20%
25%
Antibiotic used in UTI (n=558) patients of (OPD) Outpatient
department
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20%
6%
3%2% 2% 2%
1%
0%
5%
10%
15%
20%
25%
Antibiotic used in UTI (n=365) patients from (IPD)Inpatient
Department
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42%
22%
12%
5% 4% 3% 2% 2% 2% 2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Antibiotic used for patients with Wound infection
(n=2303)
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44%
33%
11%
5% 4%2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Cip
rofl
oxa
cin
(n=
34
0)
Azi
thro
myc
in(n
=2
52
)
Cef
tria
xon
e(n
=84
)
Do
xycy
clin
(n=
36
)
Met
ron
idaz
ole
(n=2
9)
Cef
ixim
e(n
=1
8)
Antibiotic used for Diarrhoea patients (n=766)
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47%
15%
4% 4% 3% 3% 2% 2% 2% 2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Antibiotic used in Septicaemia patients (n=2106)
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29%
16%
5%3% 3% 3% 2% 2% 2% 1%
0%
5%
10%
15%
20%
25%
30%
35%
Antibiotic used for pneumonia patients (n=1535)
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46%
25%
4% 3% 3% 3% 3% 3% 3% 2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Antibiotic used in ICU patients with septicaemia (n=1786)
Percentage of antibiotic usage in…
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Access
Which indicates the antibiotic of choice for each of the 25 most common infections. These antibiotics should be available at all times, affordable and quality-assured.
Watch
Which includes most of the “highest-priority critically important antimicrobials” for human medicine and veterinary use.
These antibiotics are recommended only for specific, limited indications
Reserve
Antibiotics that should only be used as a last resort when all other antibiotics have failed.
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Access, Watch and Reserve Antibiotics in the WHO Essential Medicines List
• Access group:
This group includes antibiotics that have activity against a wide range of commonly encountered susceptible pathogens while also showing lower resistance potential than antibiotics in the other groups. Selected Access group antibiotics are recommended as essential first or second choice empiric treatment options.
• Watch group:
This group includes antibiotic classes that have higher resistance potential and includes most of the highest priority agents among the Critically Important Antimicrobials for Human Medicine and/or antibiotics that are at relatively high risk of selection of bacterial resistance.
• Some ACCESS antibiotics, such as ceftriaxone or azithromycin, are also part of the WATCH group.
• Reserve group:
• This group includes antibiotics and antibiotic classes that should be reserved for treatment
of confirmed or suspected infections due to multi-drug-resistant organisms. Reserve group
antibiotics should be treated as “last resort” options.