Current Status
Antimicrobial resistance (AMR) has become a major global crisis. In response to the increasingly serious threat posed by AMR, Taiwan CDC implemented the National Antimicrobial Stewardship Program, established multi-channel surveillance on multidrug-resistant organisms (MDROs), conducted hospital accreditation and hospital infection control inspection related to the antimicrobial stewardship, carried out coordinated infection control interventions, and implemented appropriate use of antimicrobials to alleviate the AMR crisis. Furthermore, Taiwan CDC proactively create relevant guidelines, e-learning materials and hand hygiene and antimicrobial awareness campaigns to engage all people to curb AMR.

Our goals are:

1. To strengthen surveillance of antimicrobial resistant pathogens and to control the spread of carbapenem-resistant Enterobacteriaceae.
2. To conduct hospital accreditation and hospital infection control inspection to require or encourage all hospitals to implement antimicrobial stewardship.
3. To provide a series of e-learning courses for the antimicrobial stewardship to strengthen understanding and awareness among healthcare workers.
4. To hold national campaigns to raise awareness of the public and healthcare workers.
5. To cooperate with human health and animal sectors to combat AMR.

Accomplishment

1. Surveillance of Antimicrobial Resistant Pathogens
   • Taiwan CDC has conducted AMR surveillance via National Notifiable Disease Surveillance System (NNDSS) and Taiwan Nosocomial Infection Surveillance (TNIS) system for years. To further improve the AMR surveillance efficacy, Taiwan CDC has added a new reporting function, namely the Antimicrobial Resistance Management and Surveillance System, to the TNIS system to collect laboratory testing data of clinical isolates since March 2017. Hospitals are encouraged to report cases through Electronic Data Interchange mechanism. More than 100 hospitals enrolled in this module in 2018.
2. Hospital accreditation and hospital infection control inspection related to antimicrobial stewardship
   • Three indicators have been identified to evaluate the antimicrobial stewardship through the hospital accreditation and hospital infection control inspection system, namely leadership and accountability of antimicrobial stewardship program, surveillance and management mechanism of antimicrobial use, and surveillance and precaution measure of MDROs. A total of 242 hospitals were assessed through hospital infection control inspection in 2018. The percentage of criteria being graded as “meeting or superior to” the minimum requirement were 95.9% (232/242), 95.9% (231/241), and 97.3% (214/220), respectively.
3. E-learning for the management of AMR
   • Taiwan CDC continued to provide a series of e-learning courses for the antimicrobial stewardship to strengthen understanding and awareness among healthcare workers.
4. National campaigns
   • To raise awareness of hand hygiene and AMR, Taiwan CDC continued to support the WHO’s World Hand Hygiene Day (May 5) and the World Antibiotic Awareness Week (November). Taiwan CDC invited delegates from several relevant government agencies, health professional associations, leaders and healthcare workers from hospitals to attend the launch ceremony and to show the public their commitment to hand hygiene and antimicrobial resistance. Campaign information was also distributed to all healthcare facilities and healthcare workers were encouraged to display their engagements in practicing hand hygiene and tackling AMR.
5. 'One Health’ Strategy
   • In response to first action package of Global Health Security Agenda (GHSA), AMR, Taiwan CDC cooperates with the BAPHIQ, Ministry of Science and Technology and Academia Sinica to implement a 4-year research project since 2017 to work together in a ‘One Health’ approach to promote antimicrobial stewardship to reduce the emergence and spread of antimicrobial resistant pathogens in both humans and animals. In addition, BAPHIQ and Taiwan CDC had compiled National Action Plan on AMR 2019-2022 (draft).
6. International cooperation
   • To exchange Taiwan’s experiences in implementing antimicrobial stewardship with the world, Taiwan CDC held the APEC Conference on “Strategies Against the Evolving Threats from Antimicrobial Resistance: From Awareness to Concrete Action” in Taipei on September 20 and 21, 2018. Domestic and foreign AMR experts, scholars, and decision makers from various governmental departments shared insights and practical experiences on the topics of strengthening surveillance and laboratory capacity to combat AMR, policies to promote ASP, and infection control strategies to contain AMR. In addition, posters showcasing APEC member economies’ research findings had been displayed and a site visit to Linkou Chang Gung Memorial Hospital had been arranged.

Future Prospects

1. Promote hospital participation in the Antimicrobial Resistance Management and Surveillance System while strengthening surveillance of AMR.
2. Continue to require or encourage all hospitals to implement the antimicrobial stewardship.
3. Continue to strengthen surveillance of antimicrobial resistant pathogens and promote cooperation between human health and animal sector to combat antimicrobial resistance.