AMR Global
Situationand Strategy

Disease Control and Prevention Center
National Center for Global Health and Medicine(WHO Collaboration Center)

Shinichiro Morioka, M.D.

Alexander Fleming (1881-1955)

It is not difficult to make microbes resistant to penicillinin the laboratory by exposing them to concentrations not
sufficient to kill them, and the same thing has
occasionally happened in the body.
Nobel Lecture, December 11, 1945
http://www.time.com/time/specials/2007/article/0,28804,1677329_1677708_1677828,00.html

Resistance: Tackling a crisis for the health and wealth of nations
The Review on Antimicrobial Resistance Chaired by Jim O’Neill (December 2014)

Resistance: Tackling a crisis for the health and wealth of nations
The Review on Antimicrobial Resistance Chaired by Jim O’Neill (December 2014)

Antibiotic Use in Medical CareAntibiotic use and AMR from 1990-2000
in selected countries

WHO: The evolving threat of antimicrobial resistance, Options for action (2012)

The more antibiotics,
the more resistant bacteria.

Global antibiotic
use by class,
2000-2010

State of the World’s Antibiotics, 2015.
CDDEP: Washington, D.C.

Percentage change in antibiotic consumption
per capita 2000–2010, by country

State of the World’s Antibiotics, 2015. CDDEP: Washington, D.C.

Carbapenem retail sales in selected countries,2005–2010 (per 1,000 population)
Pakistan
Egypt
India

Lancet Infect Dis 2013;13:1057-98

Antibiotic pipeline

WHO “The evolving threat of antimicrobial resistance Options for action” (2012)

(https://www.cdc.gov/drugresistance/pdf/11-2013-508.pdf)

http://www.theweek.in/features/lifestyle/India-war-against-over-the-counter-antibiotic-abuse.html

Antibiotic Use in LivestockEstimated Annual Antibiotic Usein the United States.

N Engl J Med 2013; 369:2474-2476

Antibiotic consumption in livestock,
ten top countries 2010-2030

State of the World’s Antibiotics, 2015. CDDEP: Washington, D.C.

Resistant bacteria in environment

Dissemination of NDM-1 positive bacteria
in the New Delhi environment

Walsh TR et al. Lancet Infect Dis. 2011;11:355-62.

2015

Collaboration under
One Health Approach

National Action Plan on Antimicrobial resistance (AMR) 2016-2020

Field
１

Public awareness/education

２

Surveillance/monitoring

３

Infection prevention/control

４

Proper use of antimicrobial agents５

Research & development/drug development

６International cooperation
National Action Plan on Antimicrobial resistance (AMR) 2016-2020

Numeral targets

Human

Proportion of resistant isolates of specific indicator microorganisms
Indicator

2014

2020 (target)

Proportion of penicillin-resistance inStreptococcus pneumoniae

48%

15% or less

Proportion of fluoroquinolone resistance in
Escherichia coli

45%

25% or less

Proportion of methicillin resistance in
Staphylococcus aureus

51%

20% or less

Proportion of carbapenem resistance inPseudomonas aeruginosa

17%

10% or less

Proportion of carbapenem resistance in
Escherichia coli/Klebsiella pneumoniae

0.10.2%

0.2% or less(same level as of 2014)

National Action Plan on Antimicrobial resistance (AMR) 2016-2020

Surveillance is important.
No measurement, no management.

AMR Clinical Reference Center• Established in National Center for Global Health andMedicine Hospital in April 2017
• Working on projects and researches based on National
Action Plan on Antimicrobial Resistance in Japan– Clinical Surveillance Division– Information and Education Divisionhttp://amr.ncgm.go.jp/