Pennsylvanias Response to the Threat of Resistance Dr.

Pennsylvanias Response to the Threat of Resistance Dr.

Pennsylvanias Response to the Threat of Resistance Dr. Rachel Levine Pennsylvania Physician General Antimicrobial Resistance (AMR) Antimicrobial resistance (AMR) is the change in microbes (e.g. bacteria, parasites and fungi) which enable them to withstand treatment by antimicrobial drugs, meaning that the drugs no longer work, or work less effectively Source: CDC Source: Imperial College

Antimicrobial Resistance (AMR) The recent discovery of a plasmid-borne colistin resistance gene, mcr-1, heralds the emergence of truly pan-drug resistant bacteria Colistin-resistant E. Coli infection; female 46 yrs old Pa. patient in 2016 McGann P, et al. Antimicrob Agents Chemother. 2016. pii: AAC.01103 What drives AMR?

National Prescription Rates 262.5 million courses of antibiotics prescribed by health care providers in 2011 842 prescriptions per 1000 persons Overuse of Abx in animals 60% of medically important antimicrobials are used in animals* Source: Hicks L, et al. US Outpatient Antibiotic Prescribing Variation

According to Geography, Patient Population, and Provider Specialty in 2011. Clinical Infectious Diseases. 2015; 60(9):1308-16 Source: *FDA Report on antimicrobials sold in 2014 What drives AMR? Overview of Commonwealth Response Overview of Commonwealth Response Pennsylvania Get Smart Program Antimicrobial stewardship Program for monitoring antimicrobial

resistance Get Smart Program Objectives Promote guidelines for antimicrobial stewardship Estimate antibiotic prescriptions Decrease consumer demand for unnecessary antibiotics Increase prevention activities (vaccination and hygiene) CDC Image Library Get Smart Program Initiatives

LTCFs* Communications Pediatrics Decreased Abx, BSAs prescriptions Get Smart App Mobile-ready site Pa. Get Smart Initiatives 2016 Pharmacy

* Long Term Care Facilities Pediatric Initiative Pediatric settings Pediatric clinics Abx stewardship Promote Get Smart guidelines Reduce parental expectations for Abxs Collaborations Penn State Hershey Pediatrics Childrens Hospital of Pittsburgh Focus Childcare facilities

~7907 facilities ~242,324 children in childcare facilities3 3. Pennsylvania Department of Human Services Source: Get Smart Pediatric Initiative (continued) Primary prevention Hand hygiene demonstrations are held in child care centers and schools Dr. Levine reading Katie Caught a Cold to children at a child care

center in State College, Pa. November 17, 2015 Get Smart Pharmacy Initiative Objectives Engage faculty and students in antimicrobial stewardship Outreach in community pharmacies Research on antibiotic prescribing trends Collaborator: University of Pittsburgh School of Pharmacy

Get Smart Pharmacy Initiative (contd) Examples of activities Annual Get Smart workshop Get Smart CDC and State perspective, since 2014 Online course Community Pharmacists Tip the Scales4 ~110 students outreach in ~75 com. pharmacies in Allegheny county each year Over 2000 encounters since 2014 Community outreach Abx quiz, feedback and Get

Smart brochures 4. CDC: Weighing in on Antibiotic Resistance (available at Josh Krise and Melanie Beers: Class of 2018 and Christine Murphy, DOH; Source: NM Get Smart Communication Initiative Objectives Disseminate guidelines and training materials Get Smart Web portal Social media Facebook, Twitter Monthly newsletter

Conduct behavioral research on drivers of abx use Coordinate Get Smart Week and One Health forums Get Smart Communication Initiative Examples of activities and outcomes Get Smart Week Governors Proclamation, 2015 First seminar at Penn State Nov 300 participants, Student Health Services Get Smart Award Ceremony 18 award recipients March 2016 100 participantsparents, kids,

legislators Lydia Glick- Penn State Student Tracking Antimicrobial Resistance (continued) Tracking antimicrobial resistant foodborne bacteria e.g., Salmonella Clinical isolates analyzed in collaboration with CDC and Pa. Vet Lab Enteric bacteria in retail meat in collaboration with FDA Next generation whole genome sequencing (WGS)

An advance over PFGE WGS is a more precise method to identify related bacterial strainsimportant for outbreak tracing Collaborative initiatives: DOH and Penn State College of Ag Sciences Tracking Carbapenem-Resistant Enterobacteriaceae (CREs) in collaboration Un. Pennsylvania and CDC Call to Action Prevent spread of pathogens within healthcare settings Ensure

staff ALWAYS clean their hands, instruments & environment at key junctures during care Major administrative and clinical leadership investment needed to improve infection prevention practices Promote antimicrobial stewardship programs Conduct surveillance for antibiotic-resistance pathogens-timely, actionable data

Call to Action For Providers Prevent infections by ensuring clean environment, hands, stethescopes, and other medical equipment Judiciously prescribe antibiotics. Prescribe ABX only when they are needed Narrow-spectrum ABX whenever possible The appropriate dose for the appropriate duration Keep patient vaccinations up to date Credit: NIH 2016 Get Smart Art Competition Winners

Age Group <4 First place Second place Third place Kailee Park Landon Moran Kendal Rank

Age 4 Age 4 Age 3 Palmyra, PA Dillsburg, PA Lorton, VA Age Group 5-6

First place Second place Third place Wyatt Lentz Aanya Govil Alexa Park Age 5

Age 6 Age 6 Camp Hill, PA Mechanicsburg, Dillsburg, PA PA Age Group 7-8

First place Second place Avery Moran Romello Torres Age 8 Age 8 Palmyra, PA

York, PA Third place Naila Nicholson Age 8 Lancaster, PA Age Group 9-10 First place Second place

Third place Sarah Watson Ian Lentz Alyson Park Age 9 Age 9 Age 9

Camp Hill, PA Lorton, VA Atglen, PA Age Group 11-12 First place Second place Courtney Keller

Madyson Isenhour Age 11 Age 11 Kennett Square, PA Harrisburg, PA Third place Keegan Carter Tilley Age 12 Harrisburg, PA

Acknowledgment PCAS Team Acknowledgements PCAS Team Shelley Heffner, Nicole Hackman, Abby Kraus, Bonnie Falcione and Tabitha Reefer CDC Get Smart Program- Lurie Hicks and Sanchez, Guillermo Vincent FDA NARMS Patrick McDermott, Heather Tate, Claudine Kabira and Emily Cracrey PA Bureau Epidemiology Sharon Watkins, Ram Nambiar, Kirsten Waller PA Bureau of Labs, James Lute, Lisa Dettinger and Bridgette Husband

Allegheny County Health Department Karen Hacker and Jenn Fidnner Childrens Hospital of Pittsburgh Marian Michals and Michael Green Acknowledgement Get Smart Week Speakers Michael Katzman, George McSherry, Jeffery Gerber, Andrew Read, Marian Michaels, David Wolfgang and Robin Oliver 2016 Annual Get Smart Week Antibiotic Stewardship in Pennsylvania University of Pittsburgh OHara Student Center

Friday, Nov. 18, 2016 Noon 1:30 p.m.

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