Antimicrobial Resistance (AMR)

Antimicrobials are medicines used to treat infections or disease, and are essential in both human and animal health.

Antimicrobial resistance occurs when an antimicrobial that was previously effective, is no longer effective to treat an infection or disease caused by a microorganism.

The development of resistance is a natural phenomenon that will inevitably occur when antimicrobials are used to treat disease. The problem at present is that the sheer volume of antimicrobials being used globally in humans, animals and in other situations is leading to significant increases in the rate of development of resistance with the result that common infections are becoming more difficult to treat and microorganisms that are resistant to many antimicrobials, so called ‘superbugs’, are emerging.

Whilst the term antimicrobial resistance is used throughout this document, much of the detail and the activities in this, Ireland's first national action plan on AMR, are focused specifically on antibiotic resistance. The Plan was jointly published with the Department of Agriculture, Food and the Marine and you can access their AMR webpage here.

Visit the HSE Healthcare Associated Infection & Antimicrobial Resistance page.

Healthy Ireland Survey 2017 – Antibiotics Infographic

To mark European Antibiotic Awareness Day 2018, the Department of Health, along with the Department of Agriculture, Food and the Marine, the Health Service Executive (HSE) and supported by the Environmental Protection Agency, held a one day event entitled One Health 2018: A Joint Approach for Healthcare and Veterinary Professionals on Tuesday 20th November 2018 in the Convention Centre, Dublin.

The aim was to raise awareness of antimicrobial resistance and facilitate the sharing of learning and exchange of best practice amongst healthcare and veterinary professionals in relation to use, prescribing and management of antibiotics in human and animal health. This One Health approach aligns with and supports the goals of Ireland’s National Action Plan on Antimicrobial Resistance 2017 – 2020.

One Health Event 2018 Programme

One Health Event 2018 Programme Supplement: Selected Biographies

One Health Event 2018 Infographic

Carbapenemase-producing Enterobacteriaceae (CPE), also known as CRE, are bacteria which become resistant to all conventionally used antimicrobials.

• The Minister for Health has activated the Public Health Emergency Plan to address CPE in our health system.
• CPE is a superbug resistant to most or all antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity.
• CPE has been identified throughout the world in recent years. Ireland has seen an increase in the number of cases year on year.
• The number of cases almost doubled in 2016 and is estimated to increase by a further third in 2017. An opportunity remains to halt or reverse the spread of this superbug through our hospital system.
• The spread of this superbug in hospitals can lead to the closure of beds, wards and units removing thereby, essential capacity to provide services, to admit patients from Emergency Departments and to address waiting lists effectively.
• The National Public Health Emergency Team will oversee an enhanced response to this on a weekly basis. These arrangements are in line with standing emergency plans which have been activated in the past in response to pandemic influenza and ebola preparedness.
• Public Health and microbiological advice indicates that the opportunity remains for effective interventions to be taken which can protect our patients, protect our hospital capacity from unplanned closures and ultimately lead to a halting or reduction in the spread of this superbug.
• Activation of the Public Health Emergency Plan and use of the National Public Health Emergency Team allows the system to manage the containment of CPE in a co-ordinated way. This would ensure alignment and appropriate balance in maximising both access and patient safety across the system. Infection prevention and control challenges are resulting in difficulties with patient flow in some hospitals.
• The National Public Health Emergency Team will conduct its work taking into account Ireland’s National Action Plan on Antimicrobial Resistance. This was launched on Wednesday 25th October 2017 by the Minister for Health and the Minister for Agriculture, Food and the Marine.
• The first meeting of the National Public Health Emergency Team took place in the week beginning 30th October 2017.

National Public Health Emergency - Carbapenemase Producing Enterobacterales (CPE)

Ireland’s first One Health Report on Antimicrobial Use and Antimicrobial Resistance provides a snapshot of the antimicrobial use (AMU) and antimicrobial resistance (AMR) in both humans and food-producing animals in Ireland.

Both the Department of Health and the Department of Agriculture, Food and the Marine have adopted the ‘One Health’ approach to AMR and encourage multidisciplinary collaborative efforts across different sectors such as health, agriculture and the environment to achieve the best health outcomes for people and animals.

This Report is an important step forward as we have now commenced cross sectoral surveillance for AMR which will help identify emerging areas of concern and inform joined up solutions to keep antibiotics working for the future.

Read more in the press release.

Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g. antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.

The rise in antimicrobial resistance (AMR) is recognised at global, European and national levels, including Ireland, as one of the greatest potential threats to human and animal health with possible serious consequences for public health, animal welfare and the agriculture and food sectors.

Further details are available from the World Health Organization (WHO) and the Longitude Prize.

In recognition of the serious and increasing threat of antimicrobial resistance and the requirement for a whole-of-Government approach to health issues, the Department of Health’s Chief Medical Officer (CMO) and the Department of Agriculture, Food and the Marine’s Chief Veterinary Officer (CVO) established a high level National Interdepartmental AMR Consultative Committee to address this issue. The Committee meets Ireland’s requirements to have an Intersectoral co-ordinating mechanism for addressing AMR at European level.

The Committee was launched, with Ministerial approval, on European Antibiotic Awareness Day in November 2014 and has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both departments and of the relevant HSE and veterinary specialist agencies, including other relevant bodies with a remit across the two sectors; membership is representative of major stakeholders. The Committee meets bi-annually and its most recent meeting took place this week.

Ireland is fully committed to and engaged in addressing resolution of the problem of AMR and will continue to collaborate at international, EU and national levels to this end. Ireland contributes reporting to the European Antimicrobial Resistance Surveillance System.

Ireland, through membership of the World Health Organisation, is part of the international effort aimed at tackling the global public health threat of AMR, which requires action across human and animal health sectors, agriculture and the wider environment.

In May 2015 at the WHO 68th World Health Assembly the final WHO Global Action Plan was endorsed; it sets out five strategic objectives:

• to improve awareness and understanding of antimicrobial resistance
• to strengthen knowledge through surveillance and research
• to reduce the incidence of infection
• to optimise the use of antimicrobial agents
• to develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions

Through adoption of the Global Action Plan, governments committed to have in place, by May 2017, a national action plan on antimicrobial resistance that is aligned with the global action plan. This national plan needs to cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. WHO will work with countries to support the development and implementation of their national plans, and will report progress to the Health Assembly in 2017.

The National Interdepartmental AMR Consultative Committee held its third meeting on 13 April 2016 and agreed as a key action for 2016 the development of Ireland’s AMR national action plan.

In addition, the prevention and control of healthcare associated infections (HCAIs) and AMR has been a significant, long-standing patient safety and public health priority for the Department of Health for many years.

A wide range of initiatives have been put in place in the Irish health system over several years in response to the rising incidence of AMRs.

These include:

• improved surveillance of infections and prescribing
• infection prevention and control processes
• antimicrobial stewardship initiatives
• public and professional awareness raising, with a significant emphasis on the education and training of healthcare professionals

Further information is available on the Committee meetings.