Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine (2022) / Chapter Skim
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7 The National Action Plan for Combating Antibiotic-Resistant Bacteria
7 The National Action Plan for Combating Antibiotic-Resistant Bacteria
Pages 301-320
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Next, it will review the Government Accountability Office (GAO) report on progress made with regard to antibiotic resistance and human health.
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2.1 Create a regional public health laboratory network to strengthen national capacity to detect resistant bacterial strains and a specimen repository to facilitate development and evaluation of diagnostic tests and treatments. 2.2 Expand and strengthen the national infrastructure for public health surveil lance and data reporting, and provide incentives for timely reporting of antibiotic resistance and antibiotic use in all health care settings.
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5.3 Develop a mechanism for international communication of critical events that may signify new resistance trends with global public and animal health implications. 5.4 Promote the generation and dissemination of information needed to ef fectively address antibiotic resistance.
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. These quantitative targets were intended to reduce the incidence of threats to both human and animal health, particularly for carbapenem-resistant Enterobacterales, methicillin-resistant Staphylococcus aureus, and Clostridioides difficile.
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For example, subobjective 4.1.2 states that within 1 year "FDA, USDA, CDC, and NIH will bring together experts in food production, agriculture, and public health to encourage collaborative research -- from basic research to clinical testing -- on antibiotic resistance" (The White House, 2015, p.
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In response to the 2015 action plan, the CDC has established several new networks to assess the scope of antimicrobial resistance such as the Antibiotic Resistance Laboratory Network in 2016, the Emerging Infections Program, and the Enhanced Gonococcal Isolate Surveillance Program. Nevertheless, hospital participation in the National Healthcare Safety
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. GAO found that despite supporting important research and reducing duplicative research funding, HHS had not given sufficient attention to the managing of clinical outcomes research, something "important for encouraging the use of diagnostic tests for antibiotic resistance, among other things, because such studies can demonstrate the benefits of those tests" (GAO, 2020, p.
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. Key Findings from the Government Accountability Office 2017 Report The 2017 GAO report on the use of pharmaceuticals in animals found that since the agency's previous report in 2011 FDA had increased veterinary oversight of antimicrobials and was engaged in promising work on label changes for veterinary antimicrobials, though these changes were BOX 7-3 GAO Recommendations for Improving Progress on the National Action Plan 1.
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To a similar end, the report reiterated a 2011 recommendation that HHS and USDA monitor antimicrobial use and resistance on farms, noting that neither FDA nor USDA's Animal and Plant Health Inspection Service "have metrics to assess the impact of actions they have taken, which is inconsistent with leading practices for performance measurement" (GAO, 2017)
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government research resources are focused on high-priority antibiotic resistance issues (including basic research on the emergence and spread of resistance genes) and facilitate use of advanced technologies in research on antibiotic resistance (e.g., whole genome sequencing, proteomics, metagenomics, structural biology, bioinformatics)
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It is likely that a disinterested observer could reach different conclusions regarding how well agencies had implemented the TABLE 7-2 Summary of Federal Agencies Progress and Challenges Implementing the National Action Plan for Combating Antimicrobial-Resistant Bacteria 2015–2020 Agency Selected Agency Accomplishments for 2015–2020 HHS • Assistant Secretary for Planning and Evaluation has coordinated the federal CARB Task Force • Implemented Global Action Plan on Antimicrobial Resistance • Released the AHRQ Safety Program for Long-Term Care: Preventing Catheter-Associated Urinary Tract Infections and Other Hospital-Associated Infections BARDA • Cosponsored Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) ; success of CARB-X demonstrated by FDA approval of three antibiotics whose development was supported by BARDA CDC • Antibiotic Resistance Laboratory Network has expanded testing for pathogens, colonization testing, and use of whole genome sequencing • CDC and FDA Antibiotic Resistance Isolate Bank • New communication activities such as the "Be Antibiotics Aware" national awareness program for health care providers and public • Increased support for laboratory and response capacities to health departments across the nation CMS • Published a final rule in 2016, "Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities" (81 FR 68688)
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and initiating the cecum sampling program • Provided National Veterinary Accreditation Program modules for veterinarians • USDA National Institute of Food and Agriculture funded research, extension, and education activities through the USDA Agriculture and Food Research Initiative Programs and Hatch Multistate projects • Conducting whole genome sequencing for National Antibiotic Resistance Monitoring System and published data in National Database of Antibiotic-Resistant Organisms in near real time VA • Implemented functional stewardship programs at all VA centers • All VA facilities are reporting antibiotic use data to CDC NOTE: AHRQ = Agency for Healthcare Research and Quality; BARDA = Biomedical Advanced Research and Development Authority; CDC = Centers for Disease Control and Prevention; CMS = Centers for Medicare & Medicaid Services; DOD = U.S. Department of Defense; EPA = U.S.
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. The CDC was to establish up to 10 new sites to monitor drug-resistant pathogens as part of its Emerging Infections Program.
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The 2020 action plan builds on the successes of the 2015 action plan and lays out a strategy for combating antibiotic resistance over the next 5 years. The goals of the 2020 action plan mirror the five goals of the 2015 action plan, but with updated targets and objectives to reflect the progress and challenges of the prior plan.
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Addressing the challenges shown in Box 7-6 requires an understanding of what outcomes will be most useful in determining success and how those outcomes will be measured. Many of the action plan's targets already have measurable outcomes for federal agencies, and each agency or department is to report progress on meeting its outcomes on an annual BOX 7-5 Building Off the Previous 5-Year Action Plan The National Action Plan for Combating Antibiotic-Resistant Bacteria 2020– 2025 cites ways it will build off the previous 5-year action plan, including: • Expanding evidence-based activities that have already been shown to reduce antibiotic resistance, such as optimizing the use of antibiotics in human and animal health settings; • Continuing to prioritize infection prevention to slow the spread of resistant infections and reduce the need for antibiotic use; • Supporting innovative approaches to developing and deploying diagnostic tests and treatment strategies; • Emphasizing a One Health approach that recognizes the relationships between the health of humans, animals, plants, and the environment; and • Collecting and using data to better understand where resistance is oc curring, supporting the development of new diagnostics and treatment options, and advancing international coordination.
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316 COMBATING AMR AND PROTECTING THE MIRACLE OF MODERN MEDICINE BOX 7-6 Challenges to Reaching the Goals in the National Action Plan on Combating Antimicrobial-Resistant Bacteria 2020–2025 Goal 1: Reduce the emergence of resistance • Changing behaviors to ensure optimal infection prevention practices and appropriate prescribing of antibiotics • Identifying and scaling up best practices across spectrums of care, ensur ing their continuity, and coordinating these practices across One Health • Engaging all relevant stakeholders for buy-in and support of best practices Goal 2: Strengthen testing, data collection, and data sharing • Maintaining ongoing support for laboratory staff, continuously maintaining their testing equipment, and advancing their testing methodologies • Sharing electronic data on antibiotic use and resistance • Developing and implementing minimum data quality standards of measurement • Ensuring enough resources to support isolate and data repositories • Implementing new federal policies and processes for the secure and con fidential storage and sharing of data Goal 3: Support research, development, and adoption of rapid diagnostics • Addressing the high cost of some components of the diagnostic tests • Overcoming technical difficulties in preparing and obtaining clinical samples • Identifying microbe–drug interactions • Enhancing return on investment for new diagnostics Goal 4: Research and develop new antibiotics, novel therapies, and vaccines • Reducing the high rate of attrition within the antibiotic discovery pipeline • Discovering new classes of antibiotics with activity against gram-negative bacteria • Developing more nonantibiotic therapeutics • Decreasing the lag time between completing and publishing the results of basic and applied research studies Goal 5: Strengthen global collaboration • Developing global consensus around updates to international guidance • Supporting partner countries to better identify the emergence and spread of antibiotic resistance • Addressing the need for substantial and well-aligned resources, including the ability to tap experts to help with the containment of resistance and to establish a well-functioning international network to detect and respond to antibiotic resistance SOURCE: Adapted from FTF CARB, 2020.
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The CDC (2019) Antibiotic Resistance Threats in the United States, 2019 report documented changes in the burden of resistant infections, including drawing attention to areas where targets had not been met.
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Establishing causality might be an ambitious goal, but more attention to data describing the association between public policy and the burden of antimicrobial resistance would be helpful. As part of the evaluation envisioned in this recommendation, implementing agencies could give some attention to defining outcome measures and concrete indicators of progress against the goals of the national strategy, not just the steps outlined in the action plan.
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2020. Antibiotic resistance: Additional federal actions needed to better determine magnitude and reduce impact.
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2019. National action plan for combating antibiotic-resistant bacteria progress report: Year 4.
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