Foreword

Antimicrobial resistance (AMR) is a formidable challenge that continues to threaten global public health. The World Health Organization (WHO) identified AMR as one of the top ten global public health threats in 2019. The health impact of AMR is far-reaching — an estimated 1.14 million deaths were attributable to bacterial AMR globally in 2021. In Hong Kong, the WHO projected over 18,000 AMR-related deaths in 2020 to 2030. The rise of AMR not only compromises the effectiveness of treatments but also jeopardises the sustainability of our healthcare system.

The first Hong Kong Strategy and Action Plan on Antimicrobial Resistance, launched in 2017, called for coordinated efforts across sectors and laid a solid foundation for a multi-faceted approach to halt AMR. Building on this foundation, the second Action Plan was launched in 2022, mapping out priority interventions and target indicators. One of the key strategic interventions was to review, update and promote evidence-based guidelines for antimicrobial prescription among healthcare professionals.

The sixth edition of these guidelines is a testament to the Government’s commitment to ensuring that antibiotics are prescribed judiciously to preserve their efficacy, in an effort to curb AMR. I would like to express my gratitude to all the experts and professionals who have generously contributed their time and insights to this important initiative.

The IMPACT guidelines provide a strong foundation for antimicrobial stewardship in Hong Kong and are integral to our larger initiatives against AMR. Their success, however, rests on widespread adoption and sustained commitment by both the public and private healthcare sectors. I encourage all healthcare practitioners to fully utilise this invaluable resource and integrate it in their daily medical practice.

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My heartfelt congratulations to the Interhospital Multi-disciplinary Programme on Antimicrobial ChemoTherapy (IMPACT) Editorial Board on the publication of the sixth edition of IMPACT. With the ever-rising global threat of antimicrobial resistance (AMR), the issuance of the new edition could not be more opportune.

In recent years, not only do we encounter a sustained high level of methicillin-resistant Staphylococcus aureus (MRSA), but also an uprising trend of carbapenem-resistant Escherichia coli (CRE) and a re-emergence of vancomycin-resistant enterococcus (VRE). Outbreak of Candida auris in hospitals, an emerging multidrug-resistant fungus, has further increased overwhelming burdens to our hospitals. The local threat of AMR is dire in which the necessity for antibiotic stewardship is greater than ever. The sixth edition of IMPACT reflects the most recent local statistics on antibiotic resistance, along with guidelines for selected antimicrobial use, as well as treatment recommendations for specific infections and pathogens. The content has been revised, taking reference from international guidelines and up-to-date scientific research, as well as local disease epidemiology and the latest susceptibility data from local surveillance network. Besides, a new part on Outpatient Parenteral Antimicrobial Therapy (OPAT) has been developed highlighting key issues for this treatment modality. I am confident that the sixth edition of IMPACT would contribute profound values to the management of various infections.

I would like to express sincere gratitude to all those who worked tirelessly to bring the sixth edition of IMPACT to fruition, especially the Editors and Members of the Editorial Board. The Editorial Board truly encompassed a multifaceted spectrum with leading experts and representatives from hospitals of the private and public sector, universities, professional bodies, the Hospital Authority, and the Department of Health. I am also grateful to the continuing contribution of the Infection Control Branch of the Centre for Health Protection (CHP) in analysing the local epidemiology of AMR, coordinating the editing work, and developing an e-Book and a mobile app, both equipped with clinical calculators and antibiograms, to optimise usability for healthcare professionals. Through close collaboration with local experts across sectors, the CHP will continue to dedicate its utmost to stave off the advance of AMR.

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It gives me a great pleasure to write the foreword for the sixth edition of the Interhospital Multi-disciplinary Programme on Antimicrobial ChemoTherapy (IMPACT).

Antimicrobial resistance (AMR) is a major and rising global challenge across healthcare spectrum as a result of inappropriate use of antimicrobials which accelerates the emergence of newer resistant strains of microorganisms. AMR jeopardises the effectiveness and limits the choices of treatment, attributes to prolonged illness and hospitalisation, increases mortality among vulnerable patients as well as healthcare and social costs.

Collaborative effort from all stakeholders is critical in combating AMR, as underlined and advocated by the Hong Kong Strategy and Action Plan on AMR (2023–2027). With this, the Hospital Authority (HA) is working in partnership with the Government to turn the tide against AMR.

Since 2005, the HA has introduced the Antibiotic Stewardship Programme (ASP) to promote appropriate use of antimicrobials in hospitals. Seizing the opportunity arising from technological development, the HA brings ASP to a next level and progressively launched the SmartASP beginning from early 2024 onward, which is a protocol-driven tool sending reminder prompts on potentially inappropriate use of broad-spectrum antibiotic.

The IMPACT guideline is a cornerstone and reference tool to guide health professionals on appropriate choices of antimicrobials for treating various types of infections based on the latest clinical and scientific evidence. The IMPACT and SmartASP programme are complementary with each other and would achieve synergies.

The IMPACT Editorial Board, comprising leading experts from major medical disciplines, especially in the field of antimicrobial use, has rendered invaluable guidance to this new edition. I wish to express my sincere thanks and congratulations to the successful launching of the sixth edition of IMPACT, which would definitely further safeguard the health of our community.