BD solutions to combat antimicrobial resistance

What is antimicrobial resistance (AMR)?

Antimicrobial resistance is the ability of microorganisms (such as bacteria, fungi, viruses, or protozoa) to nullify the effects of antimicrobial drugs, resulting in these drugs becoming ineffective1,2 AMR can affect anyone, of any age, in any country.

How does it happen?

There is usually a small number of bacteria that are resistant to antibiotics

When taken,
antibiotics kill bacteria causing the illness - but they also kill the good bacteria that protects the body from

The drug-resistant bacteria survive and multiply

Eventually, the drug-resistant bacteria becomes dominant and spreads

SOURCE: The Center for Disease Control (CDC)

1. Antimicrobial Resistance Fact Sheet. WHO.
2. About Antimicrobial Resistance. CDC.

In Canada...

It is estimated that one billion dollars in medical care costs are associated with antimicrobial resistant infections (1)

In 2013, 293 million diagnoses were made by community physicians of which 8% involved an antimicrobial recommendation (1)

For the six most common organisms, resistance rates in Canada can be up to 31% (2)

Each year 18,000 Canadians acquire drug-resistant infections in hospitals (2)

Canada's use of human outpatient antimicrobials was 1.6 times higher than the country with the lowest use (1)

1. Public Health Agency of Canada. Canadian Antimicrobial Resistance Surveillance System Report. 2015.
2. Office of the Auditor General of Canada. Report of the Auditor General of Canada — Spring 2015: Report 1: Antimicrobial Resistance. 2015.


700,000 preventable deaths worldwide annually

Source: O’Neill (2014) ‘Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations.


1 out of 6 infections in OECD countries is caused by a resistant organism.

Source: OECD (2018), Stemming the Superbug Tide: Just A Few Dollars More, OECD Publishing, Paris.


A continued rise in resistance by 2050 would lead to 10 million deaths and a reduction of 2% to 3.5% in GDP.

Source: O’Neill (2014) ‘Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations

Healthcare environment

Healthcare settings are high-risk environments for the spread of organisms that cause infections.

  • 7% to 10% of hospitalized patients and 33% of patients in intensive care units contract at least one healthcare-associated infection.1,2
  • 25% of healthcare-associated infections in long-term acute care settings are caused by antibiotic-resistant bacteria.1

All healthcare facilities need to implement sufficient cleaning and disinfection protocols and properly dispose of biohazardous waste in order to reduce the potential for spreading healthcareassociated infections. Improving the quality of these practices and use of advanced decontamination technologies are needed.3

1 Review on Antimicrobial Resistance. Infection prevention, control, and surveillance: Limiting the development and spread of drug-resistance. London, England: Wellcome Trust and HM Government; 2016.
2 World Health Organization. Report on the burden of endemic health care-associated infection worldwide. Geneva, Switzerland: World Health Organization; 2011.
3 Boyce JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control. 2016;5:10.


Healthcare workers and other caregivers can be a source of infection when appropriate prevention and control measures are not taken.

  • Only 40% of healthcare workers adhere to recommended handwashing practices, although self-reported rates are nearly 100%.1

Consistent hand hygiene is the single most important infection prevention and control intervention in the healthcare setting.4 Antimicrobial hand sanitization products are effective means of hand hygiene that decrease the risk of infection in healthcare settings.5

1 Review on Antimicrobial Resistance. Infection prevention, control, and surveillance: Limiting the development and spread of drug-resistance. London, England: Wellcome Trust and HM Government; 2016.
4 Pittet D, Allegranzi B, Sax H, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis. 2006;6(10):641–652.
5 Weinstein RA. Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics. Emerg Infect Dis. 2001;7(2):188–192.


Medical devices and surgical procedures are potential sources of infection.

  • 17% of central-line, 14% of surgical-site and 10% of catheter-associated infections are caused by antibiotic-resistant bacteria.6
  • Catheter-related bloodstream infections account for 10% to 20% of hospital-acquired infections in the UK and are associated with extended intensive care unit stay and increased mortality.7

Training guidelines for proper central-line and intravenous catheter use need to be followed.6 Appropriate antiseptic agents, skin preparation and sterile dressings minimize the risk of surgical-site infections.8 Closed needleless intravenous access ports reduce the risk of microbes entering the patient’s bloodstream.9

6 Centers for Disease Control and Prevention. Making health care safer: Protect patients from antibiotic resistance. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2016.
7 Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014;4(2):162–167.
8 Centers for Disease Control and Prevention. Basic Infection Control and Prevention Plan for Outpatient Oncology Settings. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2011.
9 Blake M. Update: Catheter-related bloodstream infection rates in relation to clinical practice and needleless device type. Can J Infect Control. 2008;23(3):156–160, 162.


Patients can be a source of transmission of infectious bacteria to caregivers, to other patients and often, to themselves.

  • Up to 30% of individuals carry Staphylococcus aureus, a potentially harmful bacterium.10
  • Up to 7.2% of hospitalized patients can carry methicillin-resistant Staphylococcus aureus (MRSA), a strain of the bacteria resistant to commonly used antibiotics.11
  • Patients' own bacteria cause the majority of catheter-related bloodstream infections and a large proportion of surgical-site infections.12,13

Health systems and healthcare facilities need to establish protocols to screen patients for harmful bacteria using diagnostic tests where available. If patients are found positive for harmful bacteria, then actions need to be taken by healthcare facilities and providers. The spread of infections can be reduced through awareness of outbreaks, appropriate treatment, isolation of patients with resistant microorganisms, adherence to recommended infection control practices and use of personal protective devices and equipment.14

10 Wertheim HF, Melles DC, Vos MC, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005;5(12):751–762.
11 Davis KA, Stewart JJ, Crouch HK, Florez CE, Hospenthal DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis. 2004;39(6):776–782.
12 Maki DG. Infections caused by intravascular devices used for infusion therapy: Pathogenesis, prevention, and management. In: Bisno AL, Waldvogel FA, eds. Infections Associated with Indwelling Medical Devices. 2nd ed. Washington, DC: American Society for Microbiology; 1994:151–212.
13 Wenzel RP. Minimizing surgical-site infections. N Engl J Med. 2010;362(1):75–77.
14 Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2007.

Patient evaluation and initial diagnosis

Upon initial examination, patients are commonly prescribed antibiotics that are either unnecessary or ineffective.

  • At least 30% of antibiotics prescribed in the United States are unnecessary.15
  • Most infections in developing countries are treated empirically without the benefit of diagnostic tests, leading to even higher rates of unnecessary antibiotic use.16

When assessing the need for antibiotic therapy, clinicians need to combine the observed symptoms and signs with diagnostic tests for direct or indirect evidence of an infection and adherence to clinical practice guidelines for diagnosis and treatment.17 Countries and healthcare facilities with low resources will need support to increase access to and use of cost-effective diagnostic tests.

15 Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. 2016;315(17):1864–1873.
16 Sosa AJ, Byarugaba DK, Amábile-Cuevas CF, et al, eds. Antimicrobial Resistance in Developing Countries. New York, NY: Springer; 2010.
17 Boyles TH, Wasserman S. Diagnosis of bacterial infection. S Afr Med J. 2015;105(5):419–421.

Microorganism identification

Patients with viral infections are commonly treated with antibiotics, even though viruses do not respond to antibiotic therapy. Diagnostic tests that can distinguish between viral and bacterial infections are either unavailable or not widely used, especially in developing countries.16

  • Most upper respiratory tract infections are caused by viruses, yet 50% of patients with these infections receive antibiotics.18

Use of diagnostic tests that enable evidence-based prescribing practices needs to become the standard of care. Point-of-care diagnostics that rapidly confirm the type and source of infection can reduce inappropriate over-prescription of antibiotics.16

16 Sosa AJ, Byarugaba DK, Amábile-Cuevas CF, et al, eds. Antimicrobial Resistance in Developing Countries. New York, NY: Springer; 2010.
18 Caliendo AM, Gilbert DN, Ginocchio CC, et al. Better tests, better care: Improved diagnostics for infectious diseases. Clin Infect Dis. 2013;57(suppl 3):S139–S170.

Drug effectiveness

Antibiotic susceptibility testing is important to confirm whether the selected antimicrobial agent is effective or is associated with resistance,19,20 but this testing is uncommon in many developing countries.20

  • In the poorest countries, < 1% of patients are treated at clinical facilities that have diagnostic microbiology laboratories.16

Susceptibility testing is recommended to determine whether a patient will respond to antibiotic therapy. All countries, including developing countries, need to improve access to basic microbiology laboratory testing and facilities. New automated diagnostics that provide rapid and cost-effective results are needed.19

16 Sosa AJ, Byarugaba DK, Amábile-Cuevas CF, et al, eds. Antimicrobial Resistance in Developing Countries. New York, NY: Springer; 2010.
19 Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: A review of general principles and contemporary practices. Clin Infect Dis. 2009;49(11):1749–1755.
20 Laxminarayan R, Bhutta Z, Duse A, et al. Drug Resistance. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2006:1031–1051.

Prescription and treatment

Access to antibiotics for patients who need them is essential, yet prescribing practices vary globally, including over-the-counter access in some countries.

  • In developing countries patients often present with advanced infections, requiring urgent treatment with antibiotics. Expanded access is needed in certain populations, such as treating children for pneumonia. Health systems need to balance these essential access needs with reducing the excessive overuse of antibiotics that occurs in all countries.

Effective antibiotic stewardship and consistent prescribing practices are needed on a global basis. Initiatives to strengthen national laboratory systems, including expansion of laboratory technician workforces and higher access to simple cost-effective rapid diagnostic tests in remote areas, need to be prioritized, funded and supported by governments, public health agencies, foundations and the private sector.16

16 Sosa AJ, Byarugaba DK, Amábile-Cuevas CF, et al, eds. Antimicrobial Resistance in Developing Countries. New York, NY: Springer; 2010.

Infection surveillance and tracking

Surveillance is key to infectious disease management, but it remains underresourced in many countries.

  • Due to the lack of coordination and information sharing, gaps exist in antimicrobial consumption and resistance in many regions of the world.21

Surveillance tools need to be used to assimilate information generated by a variety of sources in order to streamline identification of patients who have acquired an infection and may require antimicrobial therapy. The near real-time availability of these data can enable clinicians to optimize treatment decisions and antimicrobial use.

21 World Health Organization. Antimicrobial resistance: global report on surveillance 2014. Geneva, Switzerland: World Health Organization; 2014.

Automated outbreak detection

Thorough surveillance can reveal the presence of resistant microorganisms and identify trends and outbreaks.

  • In many regions of the world, poor laboratory capacity, infrastructure and data management prevent effective surveillance.22

Effective surveillance efforts need to include an early warning system to detect emergent pathogens, resistant clusters and unusual infectious disease events so action can be taken to prevent or control an outbreak.

22 World Health Organization. Worldwide country situation analysis: response to antimicrobial resistance. Geneva, Switzerland: World Health Organization; 2015.

Optimizing therapy selection and delivery

Many areas of the world have access to laboratory data, but the data are not in a format suitable for optimizing surveillance efforts and timely therapy selection.23

  • Major gaps exist in surveillance data, and treatment guided by such limited data can increase antimicrobial resistance.21

Continuous monitoring of appropriate antimicrobial prescribing is necessary to optimize antimicrobial therapy and patient outcomes. Patient diagnostic information, combined with resistance trends and timely data distribution to healthcare providers, facilitates effective antimicrobial treatment decision-making.23

21 World Health Organization. Antimicrobial resistance: global report on surveillance 2014. Geneva, Switzerland: World Health Organization; 2014.
23 World Health Organization. Surveillance standards for antimicrobial resistance. Geneva, Switzerland: World Health Organization, 2002.

Tracking and reporting antibiotic use and outcomes

Antimicrobial consumption and resistance data can guide local, regional and national interventions.

  • Most developing countries do not have systems for monitoring antimicrobial resistance and consumption or evaluating the effect of interventions.24

Robust and comprehensive infection control practices need to include measuring the impact of interventions and the appropriateness of antimicrobial prescribing. Public health authorities need to support infrastructure that promotes transmission of antimicrobial consumption and infection data to facilitate local, regional and national surveillance efforts.

24 World Health Organization. Community-based surveillance of antimicrobial use and resistance in resource-constrained settings: report on five pilot projects. Geneva, Switzerland: World Health Organization; 2009.


BD possesses important capabilities that are instrumental in containing AMR. We offer a wide range of medical products utilized to reduce the risk of infection in healthcare facilities, diagnostic instruments to screen, test and diagnose infection, including drug-resistant strains, and medication management and surveillance to support the safe and proper administration and tracking of medications.


Support infection control guidelines

Comprehensive product and service offerings from BD help clinicians improve patient outcomes through the standardization of care and adherence to best practices.


Expand diagnostic testing

Diagnostic tests classify infections and guide therapies, enabling clinicians to implement effective antimicrobial stewardship interventions.


Advance medication management

A connected medication management system comprised of technologies, analytics, and surveillance tools can help ensure that medications are available and utilized appropriately.

Our commitment to combating AMR

BD commits to helping slow the spread of antibiotic resistance by improving awareness, surveillance, infection prevention, and stewardship. We commit to:

AMR Fighter

Improve awareness

by mobilizing the Antimicrobial Resistance Fighter Coalition

Support surveillance and research

by collating, in specific projects, MedMined™ data with the CDC to help better understand resistance in the U.S. and track regional differences in important resistant pathogens and antimicrobial use


Advance infection prevention practices

by introducing innovative solutions to support infection control and deploying training programs in collaboration with international organizations and professional societies

Help to extend the useful life of existing medications

through stewardship training and innovative integration of diagnostic testing, microbiology results and medication management workflows

What every person can do to combat AMR

  • Only use antibiotics when prescribed by a certified health professional
  • Always finish antibiotic prescriptions
  • Never share or use leftover antibiotics
  • Don't take antibiotics for viruses, such as the cold or flu (antibiotics only work on bacteria)
  • Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people and keeping vaccinations up to date

Responding to the Threat of Antimicrobial Resistance in Canada

AMR Event — UN General Assembly Meeting, September 21, 2016