Antimicrobial agents are unique in that their activities vary inversely with time. Today, the efficacy of antimicrobial agents is seriously threatened by an alarming increase in microbial resistance. In 2016, the United Nations General Assembly adopted a political declaration giving full attention to antimicrobial resistance, following a call for global action by the World Health Organization. In Hong Kong, owning to the high population density and lack of hospital space for implementation of infection control measures, it has long been recognized that rates of antibiotic resistance among bacteria are higher than in many other regions. It is for this reason that our medical profession has taken many actions and strategies ahead of time. A web-based platform has been established by the Hospital Authority for surveillance of multidrug-resistant bacteria and audit of big gun antibiotic usage. MRSA infection has been made a key performance indicator for the organization. There is a pledge that the first dose of life-saving antibiotic should be administered within one hour of the patient’s arrival. Protocols for hospital admission screening of carbapenemase-producing Enterobacteriaceae (CPE), vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are now widely implemented in both public and private hospitals. Among the frontline doctors, there is now a broad consensus that proper use of antibiotics should be given high priority and that unfounded patient requests for antibiotics should be resisted.
IMPACT is a coordinated and multifaceted effort that aims to support prudent use of antimicrobial agents. The content has been extensively reviewed and recommendations carefully considered after a review of the evidence base. The focus is on clinical situations in which the local epidemiology is unique; highlighting the antimicrobial agents with a strong link to development of multidrug-resistant organisms or situations where dosing is complicated. Where appropriate, comments are provided to indicate the situations where the advice of a specialist should be sought. This edition of IMPACT involved and is supported by the Hospital Authority, Centre for Health Protection, University of Hong Kong, Chinese University of Hong Kong, Hong Kong Medical Association, and Hong Kong Private Hospital Association. The publication is freely available at the homepages of the partner organizations and made accessible as an app (Android and iOS) and website for mobile PC and phones. Features that are only available in the app version include medical calculators and up-to-date antibiograms from the Hospital authority, private hospitals and Department of Health.
I am grateful to the members of the Editorial Board for their contributions. We thank the Centre for Health Protection for providing secretarial support and resources for printing and production of the app and website; as well as the Hospital Authority for granting access to the data and figures.
PL Ho, JP
Chairman, IMPACT Editorial Board