Toward an action plan for antimicrobial stewardship

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By Charles Thompson

The Public Health Agency of Canada (PHAC) reports that at least 18,000 Canadians are hospitalized annually with drug-resistant infections. Our best guess is that anywhere between 3,000 and 3,500 Canadians die each year from drug-resistant infection and this number can only be expected to grow at current rates. The Director-General of the World Health Organization calls it a “slow moving disaster” and the O’Neill Review on Antimicrobial Resistance (AMR) has estimated that by 2050 the global death annual toll attributable to AMR will be 10 million per year. This is higher than the global mortality rates for all cancers and road traffic accidents combined. The cumulative cost between 2014 and 2050 of unchecked AMR is projected to be 100 trillion USD.

Now, Canada has an Action Plan for combating AMR through Antimicrobial Stewardship (AMS): the practice of promoting the appropriate use of antimicrobials to preserve their future effectiveness.

The collaboration that would bring the Action Plan to fruition was born in the summer of 2015, when HealthCareCAN CEO Bill Tholl traveled from Ottawa to Toronto with the President of PHAC and Canada’s Chief Public Health Officer to visit the Mount Sinai Hospital and University Health Network (MSH-UHN) healthcare facilities. He was on a fact-finding mission. Sometime earlier, Bill had been on a call with the new Chief Public Health Officer Dr. Gregory Taylor. “What can I do to help you out in your new role?” Bill asked. “Help speed up the development of an Antimicrobial Stewardship Action Plan,” replied Dr. Taylor simply. This was a new term with an old history and Bill was at MSH-UHN to learn from some of the doctors, nurses, pharmacists and staff who knew it best.

The aftershocks of the tour were dramatic. By January 2017, a national Action Plan on Antimicrobial Stewardship AMS entitled Putting the Pieces Together was released. The Action Plan was developed by HealthCareCAN in collaboration with the National Collaborating Centre for Infectious Diseases and with the support of PHAC.  It builds on the work of experts, key influencers and stakeholders in the fields of AMR and AMS who convened at a national roundtable in June 2016.

“This Action Plan is a crucial step towards preserving the effectiveness of antibiotics, and in reducing the threat of AMR. We need to act now before we have lost our ability to fight common infections,” said Tholl.

Putting the Pieces Together identifies ten key areas for action in AMS. Under that umbrella, three priority activities for immediate action have been identified: developing an evaluation protocol to ensure progress is measured consistently, improving professional practice through the development of guidelines for primary care prescribing, and improving professional and public education on AMS. A network of healthcare leaders, government representatives and healthcare stakeholders and influencers called ‘AMS Canada’ has emerged to collaborate and guide these programs and others identified under the Action Plan.

The MSH-UHN Antimicrobial Stewardship Plan (ASP) and many other programs across the country have grown out of the recognition that if we are to stem the tide, we need to work towards better stewardship of our antimicrobial arsenal, both in and out of hospital. Leadership has been an essential success factor towards developing the Action Plan, and much of the credit for its launch must go to Dr. Greg Taylor as well as to Dr. Andrew Morris, Yoshiko Nakamachi and their team of the MSH-UHN Antimicrobial Stewardship Program (ASP). They and other Champions of Change in AMS are at the vanguard of a growing national movement to use antibiotics and other antimicrobials more sensibly.

Reflecting on the road that led to the Action Plan, Bill Tholl is amazed at how MSH-UNH ASP’s journey also had unexpected consequences.  “It was a pretty extraordinary team effort,” said Tholl after his tour in 2015, “they got into this business to improve quality and they ended up saving a lot of money along the way”.

That being said, saving money isn’t the point. Canadians visiting an ailing relative or friend in hospital now expect to see isolation signs slapped on rooms because of methicillin-resistant Staphylococcus aureus (MRSA). Routine surgeries, medical procedures, and cancer treatments such as chemotherapy are becoming more dangerous due to the risk imposed by AMR that increasingly overwhelms the set of currently available antimicrobials. Indeed, the past year saw the emergence of E.coli strains that are resistant to the very last antibiotic available to treat such infections.

Against that background, it is clear that we need to take action. Now that Canada has an Action Plan, the time has come to commit to that action.

Putting the Pieces Together: a National Action Plan on Antimicrobial Stewardship can be found at healthcarecan.ca.

 

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