How AMRCO implements the NSAP on AMR

Education

Public education is a cornerstone in the fight against antimicrobial resistance (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, these efforts could lead to individual- and societal-level impact on the sustainable and responsible use of antimicrobials. The Antimicrobial Resistance Coordinating Office (AMRCO) organises and coordinates activities to promote awareness on AMR among public and professionals.

World AMR Awareness Week social media campaigns

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

During WAAW, AMRCO regularly runs a campaign on social media to highlight AMR as a global public health concern, why the One Health approach matters, and how the public can help.

Professional training

Healthcare professionals are kept up to date about AMR issues and appropriate prescribing of antimicrobials through continuing professional education (CPE) events.

Find upcoming training events here.

Surveillance

Surveillance of AMR and antimicrobial utilisation is essential to understand the magnitude, distribution, and impact of resistant organisms and antimicrobial use. Regular monitoring of resistance trends, associations between usage and resistance, and outcomes of policies and initiatives to combat AMR can enable a timely and appropriate response to AMR.

AMRCO coordinates the publication of the biennial One Health Report on Antimicrobial Utilisation and Resistance, drives Primary Care Antimicrobial Utilisation Surveillance Initiative and collates Singapore’s data for global reporting. More information on these initiatives can be found below.

One Health Report on Antimicrobial Utilisation and Resistance

AMR surveillance programmes need a One Health approach, considering how AMR develops and transmits across the human, animal, food and environment sectors, e.g.  through the movement of people, animals, food, and water contamination.

The biennial One Health Report on Antimicrobial Utilisation and Resistance is a collaboration between Ministry of Health (MOH), National Environment Agency (NEA), National Parks Board (NParks), Public Utilities Board (PUB), Singapore Food Agency (SFA), and AMRCO. The multi-sectoral surveillance report provides key findings of national AMR surveillance programmes, including surveillance on the utilisation and sales of antimicrobials in the human and animal health sectors, and incidence and resistance proportions (%R) of priority AMR organisms found in humans, animals, food, and the environment.

Read previous One Health Reports below:

• One Health Report About Antimicrobial Utilisation and Resistance, 2021

• One Health Report About Antimicrobial Utilisation and Resistance, 2019

• One Health Report About Antimicrobial Utilisation and Resistance, 2017

Find more information about One Health initiatives here.

Primary Care Antimicrobial Utilisation Surveillance Initiative

Launched in 2021, the Primary Care Antimicrobial Utilisation Surveillance Initiative (GP-AMU) monitors antimicrobial utilisation (AMU) trends in communities through analysing and reviewing AMU data contributed by participating general practitioner (GP) clinics. In turn, GP-AMU facilitates data-driven feedback annually for participating GP clinics' internal monitoring.

Learn more about GP-AMU here.

Contact amrco@cda.gov.sg if you are interested to participate in this initiative.

Contributing data to WHO GLASS

Singapore enrolled in the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), the first global collaborative effort to standardise AMR surveillance in 2019. Singapore has been contributing AMR data from sentinel healthcare facilities through AMRCO, the appointed GLASS National Coordinating Centre.

Learn more about WHO GLASS here.

The GLASS dashboard presents global AMR data for countries, territories, and areas (CTAs) enrolled in GLASS. View the GLASS dashboard here.

Research

Research helps to fill knowledge gaps, improve understanding of the AMR situation, and enhance tools and measures needed to help control this complex problem. 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 MOH, NEA, NParks, PUB, and SFA. National Centre for Infectious Diseases (NCID) is the appointed grant intermediary, providing 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.

One Health AMR research in Singapore

Along with improving our understanding of resistance development, it is necessary to be informed of the gaps in evidence so that resources for research could be allocated appropriately.

AMRCO regularly conducts the review of the AMR research landscape in Singapore to understand the current research trends and topics in AMR, as well as the AMR research expertise in Singapore.

The ongoing review also identifies opportunities for research to foster collaborations among scientists across sectors, and develop novel tools, strategies, and methods to address AMR.

The first comprehensive review of AMR research articles published by Singapore's research community from 2009 to 2019 has been completed. Findings from the review provided important insights to prioritise One Health AMR research efforts.

The charts below show information on the trends of AMR research published:

Overall annual publication trend, 2009–2019

Annual publication trend by research domain, 2009–2019

Overall Distribution of Research Publications by Research Domains

Distribution of research publications by the One Health sectors

Annual publication trend by the One Health sectors

Distribution of institutional research output by research domain

Antimicrobial use optimisation

Inappropriate use of antimicrobials is the largest driver of AMR. Infections from organisms resistant against last-line antimicrobials have already been observed in patients in Singapore. Measures must be taken to conserve existing antimicrobials.

The implementation of antimicrobial stewardship programmes promotes rational prescribing practices, slows the emergence of resistance, and reduces risks to the healthcare system.

Antimicrobial Stewardship Programmes (ASPs)

The ASPs 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 to hospital management and ASP teams.

The Training and Education Division in CDA coordinates the organisation of the Singapore Antimicrobial Stewardship Training Course annually. It aims to empower individuals with the knowledge and skills needed to establish and operationalise effective ASPs.

Find the latest events here.

National Surgical Antibiotic Prophylaxis Guideline (Singapore)

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.

It aims to align best practices nationally and provide a framework for audit and surveillance, so that the rate of surgical site infections and adverse events from prolonged duration of surgical prophylaxis might be reduced.

The guideline was developed through a multidisciplinary collaborative effort by the National Antimicrobial Stewardship Expert Panel (NASEP) National SAP Guideline Development Workgroup, comprising infectious diseases (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 of the SAP Guideline here.

Find more information on AMR research trends in Singapore and the recommended areas of research across sectors here.