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Abstracts of FIS/HIS 2016
–
Oral Presentations
Topic: Antimicrobials and antimicrobial resistance
ID: 4815
Controlling AMR in Scotland: the One Health approach
Morag Christie
1
, Eleanor Anderson
1
, Pauline Dunlop
1
, Scott Hanley
1
,
Alistair Leanord
2
, DominicMellor
1
, Jacqui Reilly
1
, Christopher Sullivan
1
.
1
Health Protection Scotland,
2
University of Glasgow
Background:
Antimicrobial resistance (AMR) is a major global public
health issue. Recognising the complex ecological factors which drive
and sustain AMR, among humans, animals and the environment, the
Controlling Antimicrobial Resistance in Scotland (CARS) programme
has adopted a
‘
One Health
’
approach.
Aim(s)/Objective(s):
The CARS programme aims to deliver a long-term
sustainable approach to control of AMR within Scotland.
Method(s):
This will be achieved by establishing national infrastruc-
ture including:
•
National AMR Research Centre
•
Scottish Animal Health and AMR Stakeholder Group
•
AMR Intelligence and Epidemiological Research Hub
•
Behavioural Insights Team
Results:
Early achievements include critical contribtuion to the
‘
UK
One Health
’
report, the formation of the Scottish Animal Health
and AMR group, reviews on veterinary prescribing guidance and
biosecurity/disease avoidance, and a stock take on AMR human and
animal data submitted to Electronic Communication of Surveillance in
Scotland (ECOSS).
Discussion and/or Conclusion(s):
Future, planned work includes:
•
Concise collation of national guidance for veterinary prescribing of
antimicrobials and avoidance of disease transmission, with
development of a website for animal keepers and veterinarians.
•
Development of a
‘
One Health
’
AMR intelligence resource
including data from humans, animals, and the environment, and
use these data explore evidence for any relationship(s) between
AMR in these settings.
•
Improve AMR data quality.
•
Workwith partners to influence public and professionals
’
attitudes
and behaviours in relation to prescribing and AMR in all
‘
One
Health
’
spheres.
•
With partners, prioritise and co-ordinate AMR research in
Scotland.
•
Development of an environmental group to ensure involvement of
this aspect in the AMR
‘
One Health
’
approach.
ID: 4822
Risk factors associatedwith antibiotic resistance in urinary isolates
in the community: an exemplar of NHS Scotland
’
s Infection
Intelligence Platform
William Malcolm
1
, Kim Kavanagh
2
, Camilla Wiuff
3
, Nicholas Reid
4
,
Ashutosh Deshpande
5
, Charis Marwick
6
, Jean Sneddon
7
,
Marion Bennie
7
.
1
NHS National Services Scotland: Health Protection
Scotland,
2
Department of Mathematics and Statistics, University of
Strathclyde,
3
Health Protection Scotland, NHS National Services Scotland,
4
Pharmacy Department, NHS Ayrshire & Arran,
5
Microbiology
Department, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde,
6
Population Health Sciences, School of Medicine, University of Dundee,
7
Information Services Division, NHS National Services Scotland
Background:
Urinary tract infections (UTIs) are amongst the most
common infections treated in primary care. Initial antibiotic treatment
of UTI is usually empirical. There are concerns that antimicrobial
resistance is increasing, particularly for antibiotics commonly used for
UTI.
Aim(s)/Objective(s):
Using individual level linked data to characterise
factors associated with antibiotic resistance in urine samples.
Method(s):
All positive community urine samples included in the
“
Surveillance of Antimicrobial Resistance in Urinary Isolates in
Scotland
”
dataset in the period from January 2012 to June 2015 were
analysed. Cases were assigned a resistance status of Fully Susceptible,
Single Resistance or Multiple Resistance based on antibiotic suscep-
tibility data.
Using the NHS Scotland Infection Intelligence Platform all cases
were linked to national hospital activity data and patient-level com-
munity prescribing data. Risk factors associated with antibiotic
susceptibility were assessed using multivariable multinomial logistic
regression.
Results:
Age, care home residence and increasing comorbidity were
significantly associated with both categories of resistance after
adjustment for other factors.
Cumulative antibiotic exposure had a dose-response effect. Thosewith
1-7DDDs were 1.12 times (95% CI: 1.04
–
1.22) more likely to have
Multiple Resistance (compared to a Fully Susceptible infection) rising
to 5.53 times (95% CI:4.98
–
6.14) for 29+ DDDs.
Discussion and/or Conclusion(s):
Data linkage has allowed charac-
terisation of risk factors for antibiotic resistance in urine samples.
Such quantification will form the evidence base for development
of prescribing decision support tools for more patient centred
treatment of UTI and support robust antimicrobial stewardship
policy.
ID: 4836
Increasing trend of vancomycin resistant enterococci (VRE) within
Scotland
Christopher Sullivan, Julie Wilson, Edward McArdle,
Eleanor Anderson, Michael Lockhart.
Health Protection Scotland
Background:
Enterococci are important hospital-acquired pathogens.
They are a common cause of urinary tract infections but can also lead
to more serious types of infections. Enterococci have intrinsic
resistance to several antimicrobial classes and the ability to acquire
additional resistance limiting the number of treatment options.
Enterococci can easily disseminate within healthcare facilities if
standard infection control precautions and transmission based
precaution are not followed. Of particular concern within enterococci
is resistance to glycopeptides antibiotics such as vancomycin.
Aim(s)/Objective(s):
To describe the epidemiology of vancomycin
resistant enterococci (VRE) within Scotland.
Method(s):
VRE data were obtained from all diagnostic laboratories
within Scotland. The most recent EUCAST clinical breakpoints were
applied to all data and the trends were analysed.
Results:
In Scotland there has been an increasing trend observed in
VREs since 2012. Despite VRE bacteraemias remaining relatively low in
Scotland and subsequently the burden of disease, it is of public health
concern that the vancomycin proportion of resistance in Scotland is
one of the highest in Europe.
Discussion and/or Conclusion(s):
A change in the epidemiology of
VREs across Europe has been reported, with an increasing number
of countries demonstrating a significantly increasing trend. There
is also the potential that the genes that confer resistance to
vancomycin can be transferred to Staphylococcus aureus. More
recently strains of VRE resistant to linezolid and tigecycline, which
are both used to treat VRE, have emerged, limiting available
therapeutic options and leading to prolonged hospital stay.
Therefore it is essential that we fully understand the drivers for the
change in epidemiology of VRE.
0195-6701/© 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.