#WorldAntimicrobialAwarenessWeek

Antimicrobial Awareness Week 2021

A Resource for Health Service Organisations
Insert your organisation’s name here

Insert presenter’s name here

Different types of antimicrobials and the microorganisms
they are active against
Overview

•Antibiotics are vital life-saving medicines

•Antimicrobial resistance is a universal healthcare problem

•The link between antibiotic use and resistance

•Addressing antimicrobial resistance in Australia

•Antimicrobial stewardship (AMS)

•Antimicrobial Awareness Week

Antimicrobial Awareness Week in Australia
18 – 24 November
Fixed dates regardless of the first day of the week

Aims to encourage best practice in relation to antibiotic

use, among the general public, health workers and policy
makers to prevent and contain the spread of antimicrobial
resistance.
Broad and Narrow Spectrum Antibiotics
• Narrow-spectrum antibiotics work against a limited
group of bacteria
⎻Lower resistance potential
• Broad-spectrum antibiotics work against a larger group of
bacteria
• Overuse of unnecessarily broad-spectrum antibiotics can
drive antimicrobial resistance

Bacteria A Bacteria B Bacteria C Bacteria D Bacteria E Bacteria F Bacteria G

  Antibiotic 1    
 
 
Antibiotic 2
Antibiotic 3
 
 
It is preferable to
Antibiotic 4  
narrow spectrum
Antibiotic 5   antibiotics wherever
  Antibiotic 6   possible
Antibiotic 7  
  Antibiotic 8
Antibiotic 9  
Antibiotic 10
 Priority Antibacterial List for
Antimicrobial Resistance Containment
(PAL)
The primary purpose of the PAL is to promote improved
prescribing by reducing the total quantity of antibacterial
use. The PAL can be used to describe reductions in a way
that identifies preferred or quality use in terms of AMR and
AMS
 Priority Antibacterial List for
Antimicrobial Resistance Containment
Access
amoxicillin, ampicillin
benzathine benzylpenicillin
benzylpenicillin
Review - Curb Review - Contain
amoxicillin–clavulanic acid amikacin
azithromycin, clarithromycin, erythromycin,
aztreonam
roxithromycin
Cefaclor, cefalexin , cefalothin, cefazolin cefepime, ceftaroline

ceftazidime, ceftazidime–
chloramphenicol cefotaxime, ceftriaxone
avibactam

dicloxacillin, flucloxacillin cefoxitin ceftolozane–tazobactam

doxycycline cefuroxime colistin
gentamicin, tobramycin ciprofloxacin, norfloxacin daptomycin

ertapenem, meropenem,
metronidazole, tinidazole clindamycin, lincomycin imipenem–cilastatin

minocycline fidaxomicin fosfomycin

nitrofurantoin piperacillin–tazobactam linezolid
phenoxymethylpenicillin rifampicin  

procaine benzyl penicillin rifaximin moxifloxacin

streptomycin   pivmecillinam
sulfamethoxazole– sodium fusidate polymixin B
trimethoprim
tetracycline spiramycin pristinamycin
trimethoprim vancomycin, teicoplanin tigecycline
 What is antimicrobial resistance
(AMR)?
• Antimicrobial resistance (AMR) occurs when bacteria,
parasites, viruses or fungi change to protect themselves from
the effects of antimicrobial drugs designed to destroy them.
• This means previously effective antimicrobial medicines (e.g.
antibiotics) used to treat or prevent infections may no longer
work.
• The World Health Organization (WHO) has identified AMR as
‘one of the biggest threats to global health’.
• The Australia’s National Antimicrobial Resistance Strategy -
2020 and Beyond is Australia’s national AMR strategy.
 Why are antibiotics and antimicrobial
resistance important?
• Antibiotics treat infections caused by bacteria

• Modern medicine, especially surgery and cancer treatments,

depends on effective antibiotics to minimise the risk of
infection
− Currently, antibiotics reduce post-operative infection rates to below
2%
− Without effective antibiotics, this could increase to around 40% to
50%. Up to 30% of these patients could die from resistant bacterial
infections
− The risk of mortality without access to effective antibiotics may make
some treatments and surgical procedures too risky to continue
• In addition to the impact on a patient’s health, AMR results in
substantial financial cost for patients and healthcare systems.
Antimicrobial Resistance

Deaths attributable to AMR annually,

and by 2050 [O’Neill Review 2016]
Antibiotics are a unique medicine

In general, the impact

of medications are
limited to the patient
taking them

Use of antibiotics has

an impact not just for
the patient using
them but the global
community as well
How has antimicrobial resistance
developed?
• AMR is a natural phenomenon accelerated by overuse,
misuse and inappropriate use of antibiotics
• Through the delivery of increasingly complex health care,
often accompanied by extended durations of antibiotics
• The potential impact of surgery undertaken overseas
where AMR may be more prevalent
• Resistant pathogens are spreading
− during hospitalisation, impacted by infection, prevention, and
control practices and antimicrobial use
− with increased overseas travel
 Where do we use antibiotics?

Humans Animals Agriculture

• Community • Pets • Crops

• Hospital • Livestock • Aquaculture

USA
N Engl J Med 2013; 369:2474-
2476

UK
Resistance is not new
 Some resistance is getting worse
Carbapenem-resistant Enterobacteriaceae Carbapenem-resistant Enterobacteriaceae
2013 2018
 Antibiotic use is related to
antimicrobial resistance

Relationship between
total antibiotic
consumption and
Streptococcus
pneumoniae resistance
to penicillin in 20
industrialised countries
Antibiotic use in Australia
Figure 3.15: Annual total-hospital antibiotic usage rates (DDD/1,000 OBD) in Principal Referral
Hospitals contributing to NAUSP, 2017

Source: AURA Report 2019

 Antibiotic use in Australia
• This figure illustrates aggregate
hospital antibiotic usage
(DDD/1,000 OBD) rates by state
and territory in 2018 and 2019
• Aggregate usage rates for 2019
were higher than rates in 2018
for every state and territory
• The greatest increases occurred
in South Australia (SA; 4.2%),
Western Australia (WA; 3.9%)
and Tasmania (3.8%)
Source: AURA Report 2021
Antibiotic use in Australia, 2019

Community antimicrobial use in Australia, European countries (2019) and Canada (2018)

Source: AURA Report 2021

 Decline in antibiotic production

Very few antibiotics

have been developed
in the last 20 years

Most ‘new’ antibiotics

are variations of
existing antibiotics

Only 5 novel classes

have been developed
in the last 20 years.
Decline in antibiotic production
• Trends in sales of recently launched antibiotics
discourage pharmaceutical companies to invest in
research and development
 Antimicrobial Resistance – Global
Response
The WHO global action plan
(GAP) on antimicrobial resistance
(AMR) have been designed to
identify key achievements and
persisting gaps across human,
animal, plant, food, and
environment sectors leading to
AMR.
Robust monitoring and
evaluation, are needed to achieve
GAP objectives and measure GAP
progress
 Australia’s response to antimicrobial
resistance
In March 2020, the Australian Government released the second
antimicrobial resistance strategy Australia’s National Antimicrobial
Resistance Strategy - 2020 and Beyond to guide the response to the
threat of antimicrobial misuse and resistance.
Objectives:
Surveillance of Antimicrobial Use and
Resistance in Australia (AURA)

The AURA Surveillance

System:
• Integrates data from a range of
sources on antimicrobial use
and antimicrobial resistance
• Contributes significantly to the
development and
implementation of health
strategies to respond to,
monitor and prevent
antimicrobial resistance in
Australia
Australia’s response to antimicrobial
resistance
• AMR affects hospitals, aged care homes and the
community more broadly
• Australia is better placed than many countries to respond
to antimicrobial resistance through improved information
and data:
- The Antimicrobial Use and Resistance in Australia (AURA) Surveillance
System
- The National Alert System for Critical Antimicrobial Resistances – CARAlert
(as part of AURA)
- The Australian Government’s National Antimicrobial Resistance Strategy -
2020 and beyond)
- A large range of initiatives developed and implemented by states and
territories, and the private sector
 Surveillance of Antimicrobial Use and
Resistance in Australia (AURA)
• The Commission’s AURA team collates data for the AURA Surveillance
System, and coordinates 2 AMR surveillance programs (CARAlert and
APAS).
• Funding for AURA is provided by the Australian Government, and
state and territory health departments.
• Multiple partners contribute data.
 AURA 2021 Key Findings
• Increase in antibiotic use in Australian hospitals observed through the
NAUSP in 2019:
⎻Antibiotic use increased by 2.8% in comparison with the previous
year
⎻The usage rate increased from 848.2 to 883.0 DDDs per 1,000 OBDs
from 2015 to 2019
• In the community setting, between 2015 and 2019, there was a gradual
annual decline in the rate of antibiotic dispensing
⎻14.8% decrease in the age-standardised rate of PBS/RPBS
prescriptions per 1,000 people
 AURA 2021 Key Findings –
Antibiotic use in the Community
• Australia has very high usage of antibiotics in the community
• For the first time since the late 1990s, the rate of antibiotic dispensing
under the PBS/RPBS has declined
⎻40.3% of Australians received an antibiotic in 2019
⎻Australia remains in the top 25% of countries with the highest
community usage compared with European countries and Canada
• High levels of inappropriate prescribing were found for conditions
where there is no evidence of benefit including:
⎻Acute bronchitis (81.5% of patients with this condition recorded)
⎻Sinusitis (80.1% of patients with this condition recorded)
Aged Care Prescribing in Australia,
2019

Aged care homes are

recognised
nationally and
internationally as an
important
community setting
for monitoring
infections

LINK to report
Antimicrobial Resistance in Australia
E. coli

A. Methicillin
Percentage of patients
with bacteraemia with
aureus

resistance to antibiotic,
as defined by EUCAST,
S

Australia, 2019
 Patient impact of antimicrobial
resistant infections
Preventing infections is everybody's business

• Treatment failures
• Recurring infections
• Longer hospital stays
• Longer recovery times
• A higher risk of
mortality or long term
implications
• Significant financial
cost of treatment

Watch Glen’s Story here

Antimicrobial resistance locally –
What is happening in our health
service?
• Which infections are we seeing? [Insert surveillance data,
i.e. what is the most common cause of bacteraemia in your
facility]
• What are our susceptibility and resistance patterns?
⎻[Insert hospital data]
⎻[Numbers of cases]
⎻[Examples of cases]
• Are there local antimicrobial resistance issues?
• What are local rates of MRSA, C diff?
• Do you have access to a local antibiogram?
Patient story

• This is a placeholder for a local example of a patient who

experienced a resistant bacterial infection at your
healthcare facility

• Insert a case study (optional)

• You may want to detail the:

− diagnosis and the method of diagnosis
− bacterium that was resistant to the preferred antibiotic
− medications used to treat the bacterial infection
− time, resources and people involved to treat the infection
− impact on the patient, the patient’s life and patient’s family
− immediate, medium or long-term health implications (if any).
 Monitoring of Critical Antimicrobial
Resistance (CARAlert)
Shigella species Acinetobacter baumannii complex
Carbapenemase-
Multidrug resistant Pseudomonas
producing
Enterococcus species aeruginosa
Carbapenemase-
Linezolid resistant producing
Salmonella species Enterobacterales
Ceftriaxone
Mycobacterium Carbapenemase-producing,
non-susceptible and/or
tuberculosis
Neisseria gonorrhoeae Enterobacterales
Multidrug-resistant
Ceftriaxone non-susceptible or (resistant to at least Ribosomal methyltransferase-
azithromycin non-susceptible rifampicin and producing
isoniazid)
Candida auris Enterobacterales
Mechanism of resistance Transmissible colistin
is not well known resistance

Streptococcus pyogenes Staphylococcus aureus

Link to latest Penicillin reduced Vancomycin, linezolid or
CARAlert Report susceptibility daptomycin non-susceptible
 Critical Antimicrobial Resistances
(CAR) (2020 CARAlert)
Resistance mechanisms to ‘last-line’ antibiotics
• Excluding new CARs introduced in 2019, there was an overall
decrease of 21% in CARs reported in 2020 compared to 2019 (n =
1,904 in 2019; n = 1,499 in 2020)
• Carbapenemase-producing Enterobacterales (CPE) pose the highest
risk to patient safety, as they are becoming more resistant to
important classes of antibiotics including β-lactams, β-lactamase
inhibitor combinations, fluoroquinolones and aminoglycosides, they
are also the most frequently reported CAR (n = 646, 41%) in 2020
• There was a decrease in the number of ceftriaxone non-susceptible
Salmonella species (n = 30, down 33%)
• Most often in 2020, CARs were reported from public hospitals
(764/1,177, 65%). There were 274 from community settings, 90
from private hospitals, and 49 from aged care homes.
 Aggregate Hospital Antibiotic Use
2015-2019 (NAUSP)
The National Antimicrobial
Utilisation Surveillance
Program (NAUSP) is a partner
in AURA and collects data on
antimicrobial use.
Factors that are likely to have
contributed to reduced use
include:
• Increased capacity of local,
state and territory, and
national AMS programs
• Changes in clinical practice
• More effective adoption of
recommendations in
Therapeutic Guidelines:
Antibiotic.
Local Antibiotic Use

• Insert local antibiotic use data (if available)

• Include information about your contributions to National

Antimicrobial Usage Surveillance Program (NAUSP)

• Insert NAUSP data.

 Utilisation vs Appropriateness
Utilisation: how much we use?
Whilst antimicrobial
utilisation is a good
measure for the INCREASED
success of BY
antimicrobial
prescribing X%
interventions
It does not assess
why or how well the

BAD CHOICE
antimicrobial was
used
Appropriateness: was it GOOD CHOICE
(appropriateness) a good choice?
 Appropriateness of prescribing in
Australia
National Antimicrobial
Prescribing Survey (NAPS)
In 2017,
• 22.4% of all prescriptions
from all participants were
deemed “inappropriate”
(n= 24,987 prescriptions)
The rate of inappropriateness
for ceftriaxone prescribing
was the most notable change
between 2018 and 2019
Hospital NAPS data,
• increasing from 24.9% to
29.0%.
 Appropriateness of prescribing at
our hospital
• Does your healthcare facility audit appropriateness of prescribing?
• What tools are used (e.g.. National Antimicrobial Prescribing Survey
[NAPS], jurisdictional audit tools)

• If participating in NAPS, insert your healthcare facilities results here:

• Consider
− results compared to national results
− Time series data
− how the your facility’s NAPS results have contributed to your AMS
program.
Why is inappropriate use important?

May increase risk of

adverse effects, including:
 AMR (current and future
patients)
 Antimicrobial allergy
 Treatment failure
 Toxicity (e.g. ototoxicity)
 Clostridioides difficile
(formely called Clostridium difficile)
 Increased health care
costs (i.e. length of stay)
JAMA Intern Med. 2017;177(9):1308-1315. doi:10.1001/jamainternmed.2017.1938
 Antibiotics in primary care –
Pharmaceutical Benefit Scheme (PBS)

In 2019, a large
proportion of the
Australian
population had at
least one
antimicrobial
dispensed under
the PBS, 40.3% (n =
10,227,693)
Quantity of antibacterials dispensed under the PBS/RPBS
(DDD/1,000 people/day), 2015–2019
Antibiotics in Primary Care

• Australia’s antimicrobial prescription rate remains high

by international standards, and is double that of
comparable OECD countries such as The Netherlands and
Sweden
Antibiotics in primary care –
NPS MedicineWise Medicine Insight
• In 2019, 31.2% of patients from participating
MedicineInsight practices were prescribed systemic
antimicrobials.
• Approximately 50% of all antibiotic prescriptions were
ordered with repeats; of those repeats, approximately half
were filled within 10 days of the original prescription
• Very high proportions of patients still received antibiotic
prescriptions for influenza/upper respiratory tract
infections
⎻Antimicrobials are not generally recommended for these
conditions
 Understanding Variation
• Variation raises concerns about equity and safety
and appropriateness of care
• There is marked variation in use of antibiotics that
is not well understood:
− between states
− between hospitals
 different sizes / within the same size

• Also marked variation in community dispensing of

antibiotics in 2016-17
− Variation magnitude of 4.5 times
− A reduction in the rate of antimicrobial prescriptions
nationally by 9% compared to 2013-14
• 2021- Paediatric variation
⎻ uncertain whether grommets were more effective than
antibiotics (assess risk of surgery vs reducing the risk of
side effects and AMR
• 2021 - variation in preventable hospitalisation of
chronic infectious diseases
⎻Variation was greatest in COPD (Variation magnitude
18 times)
 Antimicrobial Stewardship (AMS)
Antimicrobial Stewardship isn’t about “not using antimicrobials” but
rather “identify that small group of patients who really need antibiotic
treatment and then explain, reassure and educate the large group of
patients who don’t”
• Stewardship means to protect something
• AMS is a systematic approach to optimising the use of antimicrobials
• Goals of AMS are to:
‒ improve patient outcomes / patient safety
‒ reduce antimicrobial resistance
‒ reduce costs.
• AMS works hand-in-hand with infection prevention and control, and
environmental cleaning strategies
 Antimicrobial Stewardship (AMS) –
Safety, Quality and Equity dimensions

Does your organisation keep up to

Quality – aspiring to the best
date with the latest evidence and
possible quality and effectiveness
strive to innovate and implement
of care
that standard of care?

Equity – ensuring every patient Is there a systematic approach to

regardless of their cultural or ensure each patient using
linguistic background has the same antimicrobials is managed with the
experience of care principles of AMS?

Has the right patient received the

Safety – bring up to the minimum right antibiotic, at the right time, at
acceptable and sustainable the right dose, via the right route
standard for the right duration?
A Critical Balance

Risk of toxicity and adverse drug

reactions
Antimicrobial Stewardship
Right
antimicrobials

Right
Right patient
documentation

Antimicrobial
stewardship

Right duration Right time

Right route Right dose

= least harm to current/future patients

AMS – putting the pieces together
Auditing
and Training
Governance Restriction Surveillance and
Education

Policies
• Government Antibiograms Resources
• District • Know your local
• Local • International - WHO
Access pathogens
• Government
Clinical • District
Guidelines CARAlert • Local

NSQHS
Standards Restrict
• Review NAUSP Workshops
• Contain
AMS Clinical
NAPS Seminars
Care Standard
 Enablers for effective for AMS
Programs - Hospitals
• Clear organisational structure and governance
• Executive and clinical leadership
• AMS advisory committee
• Multidisciplinary clinical AMS team
• Expert advice from
− infectious diseases experts
− microbiologists
− pharmacists
• Education and training
− prescribers, pharmacists, nurses
− consumers
• Information technology resources.
 Essential strategies for AMS
Programs - Hospitals
Pre-prescription
Formulary management
Restriction System
Guidelines
Education
Antibiograms (susceptibility of
microogranisms to antimicrobials)
Selective reporting of susceptibility
testing
Confirming patient’s allergy status
Post-prescription
Direct patient input e.g. AMS Round
Audit and Feedback
Monitor appropriateness – National
Antimicrobial Prescribing Survey (NAPS)
Monitor utilisation – National Antimicrobial
Utilisation Surveillance Program (NAUSP)
Education
Electronic solutions - eMeds – automatic stops
IV to Oral switch
 Antimicrobial Stewardship in our
healthcare facility
Insert information on
your AMS service:
⎻Structure, governance
– who is responsible?
⎻Who leads AMS
activities?
⎻Who is on your local
AMS team?
⎻What AMS activities
are undertaken?
⎻What AMS activities
are you / your
department involved
in?
 Antimicrobial Stewardship – not just
for hospitals

• In the community
⎻General Practice
 Not prescribing antibiotics for colds and flu
 Delayed prescribing
 Shared decision making
 Public declarations in the practice about
conserving antibiotics
⎻Pharmacies
 Offering symptomatic support for cold and flu
 Antimicrobial Stewardship – not just
for hospitals

• In the home
⎻Not taking antibiotics that haven’t been
prescribed for you
⎻Discarding old antibiotic medicines
appropriately
• In industry
⎻Investing in research and development
for antimicrobials
 AMS during COVID-19
• COVID-19 pandemic has
presented many
additional challenges
(including antimicrobial
shortages) for managing
patients with infections
• Key message:
Antibiotics do not prevent or treat
COVID-19 but can cause adverse
effects, allergic reactions, drug
interactions and increase risk of
future resistant infections

• The average fall in volume supplied between April and December 2020
compared with the same period in 2019 was 39%.
Commission Resources for AMS
AMS in Australian Health Care Book
• New Chapters!
⎻General Practice – Published!
⎻In the Care of Children – Published!
⎻Aboriginal and Torres Strait Islander Populations - Published!
⎻Residential aged care - Published!
⎻Rural and remote hospitals and health services – on its way
Partnering with
consumers

Link
National Safety and Quality Health
Service Standards
AMS
CLINI
CAL
CARE
STAN
DAR
D
Therapeutic Guidelines: Antibiotic

• Always use the most current

version
⎻Currently version 16, 2019
⎻Now only in online format
• Check hospital intranet
• A ‘go to’ reference, especially
where there are limited local
guidelines
• Learn more
⎻www.tg.org.au
⎻click ‘Products’, then ‘Antibiotic’
• Use this slide to highlight any AMS initiatives your
organisation has completed recently
• This may be
⎻A new guideline
⎻A new audit
⎻A new service or multidisciplinary team success
Local Antibiotic Awareness Week
Activities
Insert information on AAW in your
health service:

• Join the conversation on social media:

⎻ Hashtags
 #worldantimicrobialawarenessweek
 #WAAW
 #AntibioticResistance
 #AMR
⎻ @ACSQHC
• Local activities and contact people

• Include information about local

activities
Ideas!
• Get Creative 
• Pick a target area
• Examples
• IV to Oral Switch
• Penicillin Allergy
• Surgical Prophylaxis
Key messages
Antimicrobial resistance:
⎻ occurs when an organism evolves and develops resistance to an
antimicrobial that should inhibit or destroy it
⎻ is reducing the effectiveness of antimicrobials to treat infections

⎻ is happening now

• Few new antimicrobials are being developed

• The misuse, overuse, and inappropriate use of
antimicrobials contributes to antimicrobial resistance
• Antimicrobial stewardship works hand in hand with
prevention and control strategies to help address
antimicrobial resistance.
Online Resources for AMS
• NPS MedicineWise/ACSQHC Antimicrobial Prescribing Modules -
https://learn.nps.org.au/mod/page/view.php?id=4282
• Future Learn -
https://www.futurelearn.com/courses/antimicrobial-stewardship
• Stanford AMS Course -
http://errolozdalga.com/medicine/pages/OtherPages/AntibioticRevi
ew.ChanuRhee.html

• MAD-ID Course - http://mad-idtraining.org/certification/ 

• Infections in Surgery Course -
https://infectionsinsurgery.org/management-of-intra-abdomianl-inf
ections-free-online-course/

• WHO Course - https://openwho.org/courses/AMR-competency

References
Slide Website
Number
4 https://www.reactgroup.org/toolbox/understand/antibiotics/

6&7 https://www.safetyandquality.gov.au/publications-and-resources/resource-library/priority-antibacterial-list-antimicrobial-
resistance-containment

10 Image -
https://www.researchgate.net/figure/Total-deaths-projected-by-2050-attributable-to-antimicrobial-resistance-AMR-ever
y-year_fig2_340990507

11 Image - http://blog.nus.edu.sg/singaporesling/2016/11/16/the-resistible-rise-of-antibiotic-resistance/

13 Image courtesy of CDC / Melissa Brower Centers for Disease Control and Prevention Public Health Image Library
http://phil.cdc.gov/phil/home.asp
Image - http://blog.nus.edu.sg/singaporesling/2016/11/16/the-resistible-rise-of-antibiotic-resistance/
14 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/843129/English_Sur
veillance_Programme_for_Antimicrobial_Utilisation_and_Resistance_2019.pdf

https://www.nejm.org/doi/full/10.1056/nejmp1311479
15 https://www.businessinsider.com.au/alexander-fleming-predicted-post-antibiotic-era-70-years-ago-2015-7
References
Slide Website
Number
16 https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/carbapenem-resistant-enterobac
teriaceae-risk-assessment-april-2016.pdf

https://www.ecdc.europa.eu/sites/default/files/documents/carbapenem-resistant-enterobacteriaceae-risk-ass
essment-rev-2.pdf
17 Source: The Antimicrobial Resistance Standing Committee (2013)
National Surveillance and Reporting of Antimicrobial Resistance and Antibiotic Usage for Human Health in
Australia.

18 & 20 AURA 2019 Report - https://www.safetyandquality.gov.au/aura-2019

19 AURA 2021 Report -

AURA 2021: Fourth Australian report on antimicrobial use and resistance in human health | Australian Commission on Saf
ety and Quality in Health Care
21 Butler M, Blaskovich M, Cooper M. Antibiotics in the clinical pipeline in 2013. J. Antibiot 2013;66: 571-591

22 Lee Ventola C. The Antibiotic Resistance Crisis Part 1: Causes and Threats. P T 2015 Apr; 40(4): 277–283
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/
Fernandes V, Martens E. Antibiotics in late clinical development. Biochemical Pharmacology 2017 June 1; 133: 152-163
https://www.sciencedirect.com/science/article/pii/S0006295216303082

23 https://apps.who.int/iris/handle/10665/325006
References
Slide Website
Number
24 https://www.amr.gov.au/resources/australias-national-antimicrobial-resistance-strategy-2020-and-beyond

25 AURA 2021 Report -

AURA 2021: Fourth Australian report on antimicrobial use and resistance in human health (safetyandquality.gov
.au)
30 https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-survei
llance-system-aura/antimicrobial-prescribing-australian-residential-aged-care

31 https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-syste
m-aura/community-antimicrobial-resistance/australian-group-antimicrobial-resistance

32 YouTube - Glen’s Story - https://www.youtube.com/watch?v=RIsBB6TmZvA

35 https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-syste
m/national-alert-system-critical-antimicrobial-resistances-caralert

36 https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-syste
m/national-alert-system-critical-antimicrobial-resistances-caralert
References
Slide Website
Number
37 NAUSP 2019 Report -
https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-austr
alia-surveillance-system-aura/hospital-antimicrobial-use/antimicrobial-use-australian-hospitals

40 NAPS 2019 Report -

Appropriateness of antimicrobial use | Australian Commission on Safety and Quality in Health Care
42 NAPS 2019 Report -
Appropriateness of antimicrobial use | Australian Commission on Safety and Quality in Health Care
43 Goff D.A, File T.M, The risk of prescribing antibiotics “just-in-case” there is infection, Seminars in Colon and Rectal Surgery
29 (2018), 44-48 https://www.sciencedirect.com/science/article/abs/pii/S1043148917300763
44 & 45 Antibiotics in primary care-
Antimicrobial stewardship in primary care | Australian Commission on Safety and Quality in Health Care
46 Antibiotics in primary care-
Antimicrobial stewardship in primary care | Australian Commission on Safety and Quality in Health Care
47 Australian Atlas of Healthcare Variation Series | Australian Commission on Safety and Quality in Health Care
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48 Verheij TJ. The antibiotic revolution should be more focused. Br J Gen Pract. 2009;59(567):716-717.
doi:10.3399/bjgp09X472557 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751913/

49 Elements of Hospital Antibiotic Stewardship Programs | Antibiotic Use | CDC

56 https://www.health.gov.au/resources/publications/nudge-vs-superbugs?utm_source=health.gov.au&utm_medium=callo
ut-auto-custom&utm_campaign=digital_transformation

59 https://www.tg.org.au/news/antibiotic-summary-table/

60 https://www.safetyandquality.gov.au/our-work/healthcare-associated-infection/antimicrobial-stewardship/

61 https://www.safetyandquality.gov.au/publications-and-resources/resource-library/antimicrobial-stewardship-australian-h
ealth-care-2018

62 https://www.safetyandquality.gov.au/sites/default/files/2019-06/AURA-2019-Consumer-resource-Trifold-Brochure-Do-I-r
eally-need-Content-from-Literally-Inspired.pdf

https://www.nps.org.au/medical-info/consumer-info/antibiotic-resistance-the-facts
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63 https://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-infections-standar
d

64 https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-s
tandard/

65 https://www.tg.org.au/

67 https://thepulse.org.au/2017/11/14/what-is-the-future-of-antibiotics/

68 Acknowledgement: Toronto East Health Network

Safetyandquality.gov.au

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