AMR occurs when microorganisms such as bacteria, viruses, fungi and some parasites develop mechanisms to resist being killed by antimicrobial agents such as antibiotics¹. Infections thus persist and may spread to others².

Find facts on AMR here.

Why is AMR a concern?

AMR presents a major threat to global health. With the gradual and increasing development of resistance to antimicrobial agents, crucial medicines lose their ability to effectively treat infections and this threatens to reverse the benefits achieved as a result of the advancements in science and medicine³. 

The United Nation’s (UN) Interagency Coordinating Group on Antimicrobial Resistance (IACG) warns that drug-resistant diseases could lead to a projected 10 million deaths globally each year by 2050⁴ and highlights the projected economic strain from the impact of dealing with prolonged hospitalisation stays and increased morbidity as a result of ineffective medicines.

A study published in The Lancet in 2022 estimated that in 2019, 4.95 million global deaths were already associated with bacterial AMR⁵. AMR can affect anyone, at any stage of life² and it is evolving at a rate that outpaces the development of new antimicrobial agents. With increased global connectivity through trade and travel, AMR has the potential to spread and pose a threat to all countries.

References:

[1] Joint External Evaluation of IHR Core Capabilities, Singapore

[2] Centers for Disease Control and Prevention (CDC)

[3] National Strategic Action Plan (NSAP) on Antimicrobial Resistance, Singapore

[4] World Health Organisation (WHO) No Time to Wait: Securing the Future from Drug-Resistant Infections. Report to the Secretary General of the United Nations

[5] Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Antimicrobial Resistance Collaborators. Lancet 2022; https://doi.org/10.1016/ S0140-6736(21)02724-0

​Judicious prescribing of antimicrobials plays a key role in minimising the risk of misuse. Ensure the 4 Rights when prescribing, dispensing or administering antimicrobials to patients: Time, Dose, Duration and Antimicrobial Agent. Healthcare professionals (HCPs) should prioritise educating their patients on the importance of appropriate antimicrobial use, to receive recommended vaccines, and maintain good hygiene habits to prevent the spread of infections.

Appropriate infection prevention and control measures will further reduce the risk of the spread of antimicrobial-resistant organisms. HCPs should also stay equipped with updated knowledge and keep abreast of resistance patterns in their respective institutions and community to improve antimicrobial use in clinical practice. Lastly, supporting institutional and national AMR surveillance programmes, and promptly reporting any AMR outbreaks to the appropriate authority is essential for the formulation of interventions and policies to prevent the spread and emergence of AMR.

Download AMR material to display at your institution:

• Poster for Prescribers
• Poster for Pharmacists
• Screensaver A for HCPs
• Screensaver B for HCPs

Source: World Health Organization

Infection Control Guidelines for Healthcare Facilities can be found here.

There is a need to tackle the drivers of AMR and reduce the emergence and prevent the spread of drug-resistant organisms. AMR is accelerated by human activities such as the overuse and misuse of antimicrobials in humans, plants and animals, and the contamination of the environment⁶.

In May 2015, the World Health Assembly endorsed a Global Action Plan to set out key priority areas to combat AMR. The objectives of the Global Action Plan include improving AMR awareness, optimising the use of antimicrobials, strengthening surveillance and research, and reducing infections.

Read more about the WHO Global Action Plan on AMR here.

The UN Inter-Agency Coordinating Group (IACG) recommends urgent action by all stakeholders in recognition of the interlinked human, animal, food and environment sectors. A 'One Health' approach in combating AMR through cross-sectorial collaboration is crucial in addressing challenges posed by AMR⁷ and is highlighted in Singapore's National Strategic Action Plan (NSAP) on AMR. The NSAP brings together the Health Promotion Board, Ministry of Health (MOH), National Parks Board (NParks), National Environment Agency (NEA), Singapore Food Agency (SFA) and PUB, Singapore's National Water Agency, to coordinate and drive AMR efforts across the human, environmental, food and animal sectors.

References:

[6] World Health Organisation (WHO) Framework for Accelerating Action to Fight Antimicrobial Resistance in the Western Pacific Region

[7] National Food Institute, Technical University of Denmark (DTU) One Health Integration in Surveillance

In September 2018, the Antimicrobial Resistance Coordinating Office (AMRCO) was established as a coordinating body to facilitate the implementation and monitoring of the NSAP, coordinate AMR efforts across different sectors and serve as secretariat for national committees.

Learn more about AMR efforts undertaken by AMRCO in education, surveillance and risk assessment, research and optimisation of antimicrobial use in the subsequent sections.

​​Public education is a cornerstone in the fight against AMR. Raising awareness and understanding of AMR will prevent the misuse and overuse of antimicrobials and help to reduce the spread of infections. Coupled with professional education and training for healthcare professionals in the areas of infection prevention and control, antimicrobial stewardship practices and guidance for clinical practice, this will lead to individual- and societal- level impact to the sustainable and responsible use of antimicrobials.

World Antimicrobial Awareness Week social media campaigns

Held annually from 18 to 24 November, World Antimicrobial Awareness Week (WAAW) aims to increase awareness of global AMR and encourage best practices among the public, healthcare workers and policy makers to prevent further emergence and spread of AMR.

For the third year running, the 2021 AMR social media campaign developed messages relating to why AMR is a global public health concern, what the public can do to play their part, and the importance of vaccination. The campaign consisted of six posts which were shared on the National Healthcare Group, Tan Tock Seng Hospital, Health Promotion Board and Pharmaceutical Society of Singapore social media pages. This included the winning animation video, Penicillin’s Call for Help, from the Antimicrobials: Handle with Care Competition 2021 for students.

Download this year's AMR graphics for sharing on social media:

• What is Antimicrobial Resistance?

• AMR, A Global Public Health Problem

• Go Bue Campaign - Handle Antimicrobials With Care

• Spread Awareness, Stop Resistance

• Singapore's One Health Approach

• Preventing Misuse and Overuse of Antibiotics
  

Professional training for healthcare professionals

Healthcare professionals (HCPs) are kept up-to-date on AMR issues and appropriate prescribing of antimicrobials through regularly organised continuing professional education (CPE) events.

For upcoming training events, click here.

Past AMR training events include:

Continuing nursing education webinar on AMR 2021

• Held in collaboration with the Infectious Disease Research and Training Office and NCID Nursing

• Consisted of four talks on the understanding of AMR; importance of antimicrobial stewardship and infection prevention; and nurses' role in antimicrobial stewardship

• The online webinar was attended by more than 350 participants

WAAW inter-hospital webinar series 2021

• Seven lunch-time webinars were held in collaboration with seven public hospitals – Alexandra Hospital, Changi General Hospital, Khoo Teck Puat Hospital, National University Hospital, Ng Teng Fong General Hospital, Singapore General Hospital and Tan Tock Seng Hospital

• The webinars covered a variety of topics on AMR including multi-drug resistance infections, appropriate prescribing practices and antimicrobial stewardship

• A total of 2370 participants attended the webinars that were held in November 2021

​Surveillance of AMR and antimicrobial utilisation is essential to understand the magnitude, distribution and impact of resistant organisms and antimicrobial use. Regular monitoring and surveillance of emerging resistance trends, analyses of associations between usage and resistance, and outcomes of policies and initiatives to combat AMR will help enable a timely and appropriate response, and prioritise resources required to combat AMR.

One Health surveillance report on antimicrobial utilisation and resistance

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​The One Health Report on Antimicrobial Utilisation and Resistance, published two-yearly, is a collaboration between MOH, NEA, NParks, PUB, SFA and AMRCO, NCID. The multi-sectoral surveillance report provides an overview of national surveillance programmes and presents key findings on antimicrobial utilisation and resistant organisms in the human, animal, food and environmental sectors in Singapore. One Health Report on Antimicrobial Utilisation and Resistance, 2017 One Health Report on Antimicrobial Utilisation and Resistance, 2019

WHO GLASS National Coordinating Centre for Singapore

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​ In 2019, Singapore enrolled to the World Health Organization (WHO) Global Antimicrobial Resistance and Use Surveillance System (GLASS). AMRCO is the appointed GLASS National Coordinating Centre to compile national aggregated data for submission to GLASS. Contribution of data to the global platform allows for benchmarking, for Singapore to be better informed of both global and country level antimicrobial resistance trends, and to learn from international best practices in the use of surveillance data to support AMR control efforts. Learn more about WHO GLASS here.

​​Research helps to fill in important gaps in knowledge, improve our understanding of the AMR situation and enhance tools and measures needed to help control this complex problem. The AMRCO serves as the national body to coordinate One Health AMR research across the human, animal, food and environment sectors, and funding of One Health AMR research.

One Health AMR Research Programme

The One Health Antimicrobial Resistance Research Programme (OHARP) is funded by the MOH, NEA, NParks, PUB, and SFA. NCID is the appointed grant intermediary which provides grant administration and management support for OHARP grants.

OHARP supports One Health AMR research in the following research priority areas -  Knowledge, Attitudes and Practices (KAP); Transmission Pathways; and Socioeconomic Impact of AMR.

For more information on OHARP, please click here.

AMR research landscape mapping

The landscape mapping of AMR research in Singapore is an ongoing review conducted by AMRCO, to understand the current research and innovation in this field. This will provide up-to-date information on highly-researched topics and trends in AMR, as well as illustrate the expertise in Singapore. The mapping will also identify opportunities for research, with the goal of fostering collaborations among scientists from different domains, especially across sectors, to develop novel tools, strategies and methods to address AMR.

​Inappropriate use of antimicrobials is the largest driver of AMR. Infections with organisms resistant against last-line antimicrobials have already been observed in patients in Singapore. Measures must therefore be taken to conserve existing antimicrobials. The implementation of antimicrobial stewardship programmes promotes rational prescribing practices, slows the emergence of resistance and minimises healthcare care costs.

Antimicrobial stewardship programme

Antimicrobial stewardship programmes (ASP) have been implemented in all public hospitals since 2011. This includes the establishment of ASP teams consisting of infectious diseases physicians and ASP pharmacists. The tracking of antimicrobial usage, appropriateness of antimicrobial use and ASP intervention acceptance rates are reported regularly and consolidated into a yearly report.

The Infectious Diseases Research and Training Office holds the Singapore Antimicrobial Stewardship Training Course annually with the aim of empowering individuals with the knowledge and skills needed to establish and operationalise effective ASPs. Follow this link to the NCID events page for details of the latest events.

National surgical antibiotic prophylaxis guideline (Singapore)

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​ The National Surgical Antibiotic Prophylaxis (SAP) Guideline (Singapore) provides evidence-based recommendations for the rational use of antibiotic prophylaxis, including recommended agent(s), dose, timing and duration for adult patients undergoing clean or clean-contaminated surgeries. This guideline aims to align best practices nationally and provide a framework for audit and surveillance. The establishment of the national SAP guideline for hospitals in Singapore may reduce the rate of surgical site infections, while also reducing adverse events from prolonged duration of surgical prophylaxis.

The guideline was developed through a multidisciplinary collaborative effort by the National Antimicrobial Stewardship Expert Panel (NASEP) National SAP Guideline Development Workgroup, comprising Infectious Disease (ID) physicians, ID and/or antimicrobial stewardship-trained pharmacists, surgeons, and anaesthesiologists; and endorsed by NCID and the Chapter of ID Physicians, College of Physicians, College of Anaesthesiologists and College of Surgeons under the Academy of Medicine, Singapore. Download a copy here.