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Volume: 23S7 - November 1997
CONTROLLING ANTIMICROBIAL RESISTANCE
An Integrated Action Plan for Canadians
EXECUTIVE SUMMARY
In response to the growing concern about antimicrobial resistance in
Canada and worldwide, the Laboratory Centre for Disease Control (LCDC),
Health Canada, and the Canadian Infectious Disease Society organized a
consensus conference, Controlling Antimicrobial Resistance: An Integrated
Action Plan for Canadians, which was held in Montreal from May 28 to 30,
1997. The aim of the conference was to develop an action plan to limit
the development and transmission of antimicrobial-resistant organisms
in Canada and to recommend ways to assess the effectiveness of the action
plan.
Presentations by various guest speakers highlighted current knowledge
on the problem of resistance from a number of perspectives. Conference
participants were then assigned to working groups, which developed objectives
that formed the basis of the recommendations in the action plan. The issues
covered by the working groups included antimicrobial usage in various
settings, detection of antimicrobial resistance and the role of surveillance,
creation of partnerships to limit resistance, and communication and implementation
of the action plan.
The working groups' proposals were considered in small groups, and then
in the group of participants as a whole, in order to reach consensus.
The following is a summary of the proposed action plan.
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A multidisciplinary Canadian Coordinating Committee on Antimicrobial
Resistance (CCCAR) will be established, whose mandate is to provide
leadership in promoting a national program to limit the development
and transmission of antimicrobial resistance. This will be achieved
by facilitating the communication, implementation and evaluation of
the recommendations of the conference - either by setting up working
groups to deal with specific issues or by coordinating the efforts
of existing stakeholder groups.
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Detection and surveillance of antimicrobial use and resistance will
be achieved through the establishment of a national surveillance system
for antimicrobial-resistant organisms; an expert working group to
establish national laboratory standards; a surveillance system for
antimicrobial use and resistance in the animal food and agriculture
industry; initiation of studies to determine the scope of antimicrobial
use and resistance in long-term care facilities; and mandatory reporting
of certain infections caused by antimicrobial-resistant organisms.
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Prevention of antimicrobial resistance will be addressed through
the recommendations to reduce antibiotic prescriptions by 25% within
3 years (focusing on community-acquired respiratory infections); establish
expert panels on antimicrobial use in all health care settings; develop
a system in hospitals for identifying patients at risk of harbouring
antimicrobial-resistant organisms; and urgently review current infection
control guidelines and the resources necessary for implementing them.
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Promotion of attitude and behaviour change will best be accomplished
by recognizing that the transfer of knowledge alone is not enough,
and that the individuals targeted must identify their own need for
change and select their own methods. The CCCAR must ensure that representatives
of the groups targeted for change as well as experts in communications
have input into communications strategies.
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