Antibiotiques : réponse à la résistance aux antimicrobiens par l'OMS - analyse mondiale de la situation dans les pays
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2016
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Réponse à la résistance aux antimicrobiens par l'OMS.
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Worldwide country situation analysis: response to antimicrobial resistance
April 2015
Worldwide country situation analysis: response to antimicrobial resistance
April 2015
WHO Library CataloguinginPublication Data
Worldwide country situation analysis: response to antimicrobial resistance.
1.AntiInfective Agents. 2.Drug Resistance, Microbial. 3.Infection Control. 4.Population Surveillance. I.World Health Organization.
ISBN 978 92 4 156494 6
© World Health Organization 2015
(NLM classification: QV 250)
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Design and layout:JeanClaude Fattier
Contents
Acronyms and abbreviations
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Country strategies to control antimicrobial resistance
WHO African Region
WHO Region of the Americas
WHO Eastern Mediterranean Region
WHO European Region
WHO SouthEast Asia Region
WHO Western Pacific Region
Conclusions
Annex 1
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AMR ANTIMICROBIAL RESISTANCE
Acknowledgements
WHO woud îke o express îs graîude and apprecîaîon o a Member Saes (Annex 1.) a provîded înormaîon o e WHO survey on poîcîes and acîvîîes a e naîona eve în e area o anîmîcrobîa resîsance.
he conrîbuîon o saf în WHO Regîona and Counry OIces as been învauabe: în gaer-îng orîgîna daa and înormaîon rom Member Saes, în supporîng e process o aggregaîon o ese daa; and în revîewîng e regîona anaysîs o e indîngs a relec e counry sîua-îon a e poîn wen e survey was conduced. he suppor and commîmen o e members o e WHO Task Force on Anîmîcrobîa Resîsance, comprîsîng WHO saf rom Headquarers and Regîona OIces as, îs aso acknowedged.
WHO aso acknowedges e conrîbuîon o Bîoex, Ausraîa, în conrîbuîng o e ex în e capers on e regîona and goba indîngs and în deveopîng e grapîcs and abes based on e daa coeced and e conrîbuîon o Eîzabe Heseîne wo provîded edîorîa servîces.
he projec was managed by Mr Tejînder Cowdary o e Pandemîc and Epîdemîc Dîseases Deparmen, WHO Headquarers and overseen by Dr Carmem L. Pessoa da Sîva, Team Lead, and Dr Cares Penn, Coordînaor, Anîmîcrobîa Resîsance Unî, Pandemîc and Epîdemîc Dîs-eases Deparmen.
Fînancîa suppor was provîded by e Mînîsry o Hea and Weare, Repubîc o Korea.
WORLDWIDE COUNTRY SITUATION ANALYSIS: RESPONSE TO ANTIMICROBIAL RESISTANCE
Acronyms and abbreviations
AMR CAESAR
EARS-Ne ïPC MDR PAHO TB WePARS
anîmîcrobîa resîsance
Cenra Asîan and Easern European Surveîance o Anîmîcrobîa Resîsance nework
European Anîmîcrobîa Resîsance Surveîance Nework
înecîon prevenîon and conro
muîdrug-resîsan
Pan Amerîcan Hea Organîzaîon
ubercuosîs
Wesern Pacîic Anîmîcrobîa Resîsance Surveîance
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WORLDWIDE COUNTRY SITUATION ANALYSIS: RESPONSE TO ANTIMICROBIAL RESISTANCE
Country strategies to control antimicrobial resistance
Global overview
Antîmîcrobîa resîstance has been detected în a parts o the word; ît îs one o the greatest chaenges to goba pubîc heath today, and the probem îs încreasîng. Athough antîmîcro-bîa resîstance îs a natura phenomenon, ît îs beîng propagated by mîsuse o antîmîcrobîa medîcînes, înadequate or înexîstent programmes or înectîon preventîon and contro (ïPC), poor-quaîty medîcînes, weak aboratory capacîty, înadequate surveîance and însuIcîent reguatîon o the use o antîmîcrobîa medîcînes.
A strong, coaboratîve approach wî be requîred to combat antîmîcrobîa resîstance, învov-îng countrîes în a regîons and actors în many sectors. Over a 2-year perîod, rom 2013 to 2014, WHO undertook an înîtîa “country sîtuatîon anaysîs” în order to determîne the extent to whîch efectîve practîces and structures to address antîmîcrobîa resîstance were aready în pace and where gaps remaîned. The survey was conducted în countrîes în each o the sîx WHO regîons.
A mutî-stage anaytîca too was deveoped to assess the sîtuatîon at the natîona eve. The too was based on exîstîng WHO assessment toos and relected the eements contaîned în the poîcy package to address antîmîcrobîa resîstance that was îssued on Word Heath Day 2011. Country authorîtîes were asked to compete a questîonnaîre on theîr exîstîng strategîes, systems and actîvîtîes. The questîonnaîres were competed eîther by the authorîtîes them-seves through se-assessment or at an întervîew wîth a WHO oIcer on the occasîon o a country vîsît.
Thîs report presents the overa indîngs o the survey. ït provîdes an anaysîs, by regîon and gobay, o the înîtîatîves under way to address antîmîcrobîa resîstance and îdentîies areas în whîch more work îs needed. The survey ocused on the buîdîng bocks that are consîdered prerequîsîtes to combat antîmîcrobîa resîstance: a comprehensîve natîona pan, aboratory capacîty to undertake surveîance or resîstant mîcroorganîsms, access to sae, efectîve antî-mîcrobîa medîcînes, contro o the mîsuse o these medîcînes, awareness and understandîng among the genera pubîc and efectîve înectîon preventîon and contro programmes. Sînce the survey was conducted, some countrîes have made urther advances and addîtîona înîtîa-tîves have been aunched. No reerence thereore îs made to îndîvîdua countrîes, and the resuts relect the sîtuatîon at the tîme the questîonnaîres were competed.
Comprehensîve natîona pans, based on a mutîsectora approach and wîth sustaînabe i-nancîng, are regarded as one o the maîn ways to ight antîmîcrobîa resîstance gobay (WHO, 2011); however, ew countrîes reported havîng such a pan. Some countrîes dîd report that a natîona oca poînt or antîmîcrobîa resîstance had been îdentîied and had a natîona coordînatîon mechanîsm în pace. Others had întroduced natîona strategîes and poîcîes to address antîmîcrobîa resîstance.
A natîona surveîance mechanîsm and the necessary aboratory capacîty are essentîa to detect, anayse and track resîstant mîcroorganîsms. Surveîance can revea the presence o patterns o resîstant mîcroorganîsms and îdentîy trends and outbreaks. ïn many regîons, however, poor aboratory capacîty, înrastructure and data management prevented efectîve surveîance. Athough aboratory capacîty varîed by country în a regîons, at east one coun-try în each o the sîx regîons had a natîona reerence aboratory capabe o testîng or antîbî-otîc sensîtîvîty and subject to externa quaîty assessment. The same countrîes aso reported monîtorîng o antîmîcrobîa resîstance în humans.
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Regîons în whîch there are many hîgh-încome countrîes, such as the European and the West-ern Pacîic regîons, reported hîgher rates o access to hîgh-quaîty medîcînes than other re-gîons.
The survey aso reveaed that the sae o antîmîcrobîa medîcînes wîthout prescrîptîon was wîdespread în many countrîes. Furthermore, many countrîes acked standard treatment guîdeînes or heath care. Thus, the potentîa or overuse o antîmîcrobîa medîcînes by the pubîc and by the medîca proessîon was common în countrîes în a regîons. Few countrîes reported a system or monîtorîng the use o antîmîcrobîa medîcînes. Thus, trackîng prescrîb-îng patterns and over-the-counter saes remaîns a sîgnîicant chaenge.
Pubîc awareness o antîmîcrobîa resîstance was ow în a regîons. Even în some countrîes în whîch natîona pubîc awareness campaîgns had been conducted, there was stî wîdespread beîe that antîbîotîcs are efectîve agaînst vîra înectîons. More educatîon and coaboratîve awareness-raîsîng campaîgns în sectors such as heath care, poîtîcs and the medîa may there-ore be requîred.
Programmes to prevent and contro the spread o antîmîcrobîa-resîstant înectîons are aso essentîa. Wîthout efectîve hygîene and sanîtatîon measures, înectîons can spread rapîdy through heath care acîîtîes and between countrîes and regîons by trave and trade. Ha o the countrîes în the European, South-East Asîa and Western Pacîic regîons that responded to the survey reported havîng a natîona ïPC programme în pace; ewer had comparabe pro-grammes în a tertîary hospîtas. ïPC thus tended to be înadequate.
Overa, the indîngs o thîs survey revea that much îs under way and îndîcate that countrîes are commîtted to addressîng thîs compex probem. Some countrîes aready have a number o actîvîtîes în pace, whîe others are embarkîng on the work and ace chaenges. Thîs înîtîa country sîtuatîon anaysîs provîdes an overvîew and can serve as a reerence agaînst whîch countrîes and WHO can monîtor progress în împementîng actîons to address the chaenge o antîmîcrobîa resîstance în comîng years.
1.1 Introduction Anîmîcrobîa resîsance îs recognîzed as one o e prîncîpa reas o pubîc ea roug-ou e word: îs împac îs e a areas o ea, and î afecs e woe o socîey. Aoug anîmîcrobîa resîsance îs a naura penomenon, î îs exacerbaed by e mîsuse o anîmîcro-bîa medîcînes, poor or non-exîsen ïPC programmes, poor-quaîy medîcînes, weak aboraory capacîy, înadequae surveîance and poor reguaîon or enorcemen o reguaîons o assure access o îg-quaîy anîmîcrobîa medîcînes and eîr approprîae use.
1 On 7 Aprî 2011, on e occasîon o Word Hea Day , WHO înroduced a poîcy package o comba anîmîcrobîa resîsance, wîc îss crîîca acîons by a sakeoders o sîmuae cange.
Aoug wîdey recognîzed as an urgen probem by many înernaîona organîzaîons and mînîsrîes o ea, no a counrîes ave a response pan o acke anîmîcrobîa resîsance. Some regîons ace oer, more pressîng probems, and many ow- o mîdde-încome counrîes do no ave e resources o împemen response mecanîsms. A “counry sîuaîon anaysîs” was subsequeny conduced în counrîes în eac o e sîx WHO regîons o assess curren pracîces and o deermîne e srucures a were în pace o conro anîmîcrobîa resîsance. he resus o a anaysîs are summarîzed în îs repor.
1 Word Heath Day 2011: Poîcy brîes.http://www.who.înt/word-heath-day/2011/poîcybrîes/en/
WORLDWIDE COUNTRY SITUATION ANALYSIS: RESPONSE TO ANTIMICROBIAL RESISTANCE
A e Sîxy-seven Word Hea Assemby, în May 2014, Member Saes approved a resouîon, WHA67.25, requesîng WHO o drat a gLobaL acTîon pLan on anTîmîcrobîaL resîsTance. he drat 2 pLan wîLL be revîewed aT Te SîxTy-eîgT WorLd HeaLT AssembLy . IT îs based on înpuT receîved durîng broad muLTîsecToraL consuLTaTîons wîT counTrîes, înTernaTîonaL organîzaTîons, nongov-ernmenTaL organîzaTîons and oTer sTakeoLders and seTs ouT ive sTraTegîc objecTîves: To împrove awareness and undersTandîng of anTîmîcrobîaL resîsTance, To gaîn knowLedge Troug surveîL-Lance and researc, To reduce Te încîdence of înfecTîon, To opTîmîze Te use of anTîmîcrobîaL medîcînes and To ensure susTaînabLe învesTmenT în counTerîng anTîmîcrobîaL resîsTance.
1.2collection methods Data WHO îs represenTed TrougouT Te worLd, dîvîded înTo sîx regîons: Te Afrîcan Regîon, Te Re-gîon of Te Amerîcas, Te EasTern MedîTerranean Regîon, Te European Regîon, Te SouT-EasT Asîa Regîon and Te WesTern Pacîic Regîon (Fîgure 1.1). he survey was conducTed în counTrîes în aLL WHO regîons.
Figure 1.1.World Health Organization regions
A muLTî-sTage rapîd assessmenT anaLyTîcaL TooL was devîsed To assess Te sîTuaTîon în counTrîes. he TooL was based on exîsTîng WHO assessmenT TooLs and relecTed Te eLemenTs conTaîned în Te poLîcy package To address anTîmîcrobîaL resîsTance TaT was îssued on WorLd HeaLT Day 2011, wîc buîLT on prevîous recommendaTîons (WHO gLobaL sTraTegy for conTaînmenT of anTî-mîcrobîaL resîsTance, 2001) and resoLuTîon WHA51.17. IT LîsTed Te foLLowîng acTîvîTîes for com-baTTîng anTîmîcrobîaL resîsTance:
l
l
l
l
l
l
Adere To a compreensîve, inanced naTîonaL pLan wîT accounTabîLîTy and cîvîL socîeTy engagemenT. STrengTen surveîLLance and LaboraTory capacîTy. Ensure unînTerrupTed access To essenTîaL medîcînes of assured quaLîTy. ReguLaTe and promoTe raTîonaL use of medîcînes, and ensure proper paTîenT care. Enance înfecTîon prevenTîon and conTroL.
FosTer înnovaTîon, researc and new TooLs.
2 Antîmîcrobîa resîstance: drat goba actîon pan on antîmîcrobîa resîstancehttp://apps.who.înt/gb/ebwha/pd_Iles/WHA68/ A68_20-en.pd
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he quesîonnaîre was pîo-esed în 2012, and a sîmpîied versîon was dîsrîbued o counrîes or compeîon beween 2013 and 2014. Auorîîes în eac counry were învîed o compee e quesîonnaîre emseves or wî WHO saf rom e regîona or counry oIce and o reurn î o e regîona oIce. he daa were compîed, and e resus were recorded as sîmpe requen-cîes. Bank responses were recorded as “unknown”.
he quesîonnaîre addressed e use o anîmîcrobîa medîcînes în bo uman and anîma ea; owever, îs repor îs îmîed o e indîngs în umans. ïn due course, a urer survey wî be conduced, în coaboraîon wî e Organîsaîon or Anîma Hea and e Food and Agrîcuure Organîzaîon o e Unîed Naîons, on îssues reaed o anîmîcrobîa resîsance and anîma ea.
Tabe 1.1 gîves e numbers o Member Saes în eac regîon rom wîc înormaîon was re-ceîved. A oa o 133 o e 194 WHO Member Saes provîded înormaîon.
Table 1.1 –Responses to requests for information for the country situation analysis, by region WHO region No. of Member Total no. of Member States States in region African Region 8 47 Region of the Americas 26 35 Eastern Mediterranean Region 13 21 European Region 49 53 SouthEast Asia Region 11 11 Western Pacific Region 26 27
Percentage
17 74 62 92 100 96
For eac regîon, a daa were anaysed on e basîs o e number o counrîes rom wîc în-ormaîon was receîved.
The aim of this report is to provide an overview of the extent to which effective practices and structures designed to address ant microbial resistance are in place and where gaps remain. Some of the data are more than 1 year old; it is likely that improvements have been made since the original assessment, which will be reflected in future reports. In view of the difference in the proportions of countries in each region that responded, the results should be interpreted with caution, particularly in making any comparisons between countries or regions.
