Hey, welcome to another episode of our podcast,
The Canadian Breakpoint. So as everybody knows,
we're live here today at the AMR Symposium in
Toronto. We've had some great talks on AMR, antibiotic
stewardship, diagnostic stewardship, and really
lots going on in the area. And so today I have
a very special guest with me and I will have
you do your introduction and we are going to
talk more about AMR. Well, thank you for having
me. I'm excited to be here. So my name is Dr.
Kanchana Maruchanga. I'm an infectious disease
physician and work in the public health realm.
So I currently work at the Public Health Agency
of Canada and specifically in our AMR task force.
So I am the director of stewardship, but also
the medical advisor for the task force. And I
do part -time clinical work at the Ottawa Hospital.
Okay. So lots going on. Yeah. And so what brought
you to the symposium this year? So this is my
second time attending this symposium, and it's
mainly related to some of our work. It was to
provide an update in terms of what the Government
of Canada is doing when it comes to AMR, which
is a priority for us, but also to give an update
on one really special project that we're working
on that we've launched with some of our partners,
which I'll talk about. So that's really the main
reason I'm here. Awesome. So yeah, why don't
we dive into some of the work that you guys have
been doing? Obviously, I think the goal being...
for everyone is to really fight the AMR increases
that we've seen and kind of work together with
collaborative partners to do this. So what has
been kind of the experience or what's been going
on over the last year? Yeah. So, I mean, AMR
is so dynamic, right? And the landscape continuously
changes. And I've been in this field for the
past decade or so from the government side. And
as was discussed at my... presentation, but also
from the government end, we did develop a pan
-Canadian action plan. So WHO has their own global
action plan, and most countries now are developing
their own national action plan. So this was Canada's
effort to coordinate efforts, both nationally
and with provinces and territories. So the PCAP,
as we affectionately call it, was put out in
June 2023. So currently we're in a phase of really
looking at gaps and strengthening governance
in terms of within, as you know, Canada is a
federated system. So healthcare delivery is done
at the provincial level. So at the national federal
level, it's always a... tough position, but really
our goal, our work is to really bring people
together and say that this is a priority and
we need to continue to fight that fight. And
within that PCAP, we have five major pillars
which fall within AMR. So we have surveillance,
which is really keeping a pulse on what's happening
on a domestic as well as global level. We have
research and innovation, which it comes to when
it comes to delivery of new therapeutics, antimicrobials,
vaccines, diagnostics, which was discussed even
at the meeting here. We have infection prevention
control. We have leadership, which is the governance
aspect, and then stewardship, which is really
the focus of the symposium this year. And so
there's multiple different projects happening
on that, both at the federal level. We have 13
different federal departments that are involved
because PCAP is really, it's not just human,
it's a one health focus. So it's human, animals,
and the environment, and it's interesting. And
there's a lot of work happening on the human
and animal front. Environment is coming along.
It's an area that's still, you know, very much
research in the research involvement. And so
there's, you know, there's progress reports that
are published every year. There was a progress
report last year. This year's report is imminently
going to be published. And some of the highlights
include, so this year we published the Canadian
priority. pathogen list, which is the MR pathogens.
There was a list published in 2015. So it took
us about 10 years to update this one. And it
was done. with external and internal consultations.
And so that was released in earlier this year,
and it was also published in a scientific journal.
And really that's to help us with guidance, not
just guidance, but surveillance and to really
identify some of the, what are the priority pathogens.
There's also the... One Health research strategy
that was discussed last year here at this symposium.
And then they did a survey over the last year.
And now from that survey, they're putting a list
together of the sort of the priority areas of
research when it comes to One Health and AMR.
And that's coming out in the next few weeks.
I've had a few people come up to me asking, do
I have any further insight? Yeah. And then the
other aspect is stewardship. And one of the major
aspects of stewardship was development of guidelines.
So both for animal, and I can speak to the human
side. So one area was to have part of that availability
of information, education for prescribers, was
to have national guidance. We don't have national
guidance, right? A lot of the times, even as
a clinician, we go to IDSA or we go to other
global... resources and so this was a first of
its kind noting that a lot of regions and provinces
have have their own guidance so this is more
at a high level national level for regions to
adapt as needed or for areas that don't have
guidance in areas for prescribers frontline family
doctors, nurse practitioners, pharmacists, and
really targeting the current focus is primary
care. So primary care syndromes. And this is
the initial launch, which is really focused on
the respiratory syndromes given the season we're
in. And so we worked with our partners, AMI Canada.
who spearheaded developing the guidance. And
then Firstline, the company that has helped implement
and disseminate it. And we're really excited.
We're now working on promoting it so that people
get to know what it is. There were QR codes in
our presentation that people use it. And I know
Ami and Firstline are working on other venues
to really get the word out. And it's, yeah, it's
really exciting. That's awesome. And then in
terms of the guidelines, just because I'm interested,
because I'm a pediatric infectious disease physician,
and you probably realize that there's very limited
guidelines and consensus. I mean, we have Canadian
Pediatric Society, which I serve on the committee
too, and we always have consensus guidelines.
But it's kind of nice to have something more
national or at least, you know, framework for
it. So are these going to be more aligned with
clinical syndromes and antibiotic durations,
that type of thing? Or is it... more from like
a different angle with like um lab and diagnostic
stages it's more clinical syndromes and and really
treatment focused there is a bit of a diagnostics
and laboratory or primary pathogens of concern
so for example the respiratory guidelines we've
released focus on both adults and pediatrics.
And so community -acquired pneumonia, pharyngitis,
sinusitis, so the syndromes of interest. And
then we're going to continue to work on others
like UTI, skin and soft tissue infections. And
so really the focus is once you have a patient
and you think that that is what you've diagnosed,
here's your guidelines in terms of treatment
and duration and if an antibiotic is not needed.
Right. And that's also in there. And we've connected
to other groups like Choosing Wisely Canada.
So they have their viral prescription pad. So
it's all available on that app so that clinicians
can easily access it. Also NACI guidelines for
vaccines. So for chronic pneumonia, for strep
pneumonia, what are the guidelines? And I know
it's varied across the provinces, but it's there
for clinicians to access in terms of sort of
hopefully a one -stop shop. Because it's overwhelming.
There's so many resources out there. So the goal
is to have everything sort of there at your fingertip
to be able to. to access to at the bedside. Awesome.
Yeah. So it's really centralized and, and kind
of creates that consistency. I think that's the
other thing, even with, I always see like if
there's a bunch of ID docs in the room, sometimes
the consensus could be so different. So this
is helpful because you can centralize these and,
and really have like a focus there. And obviously
everything's case by case and guidelines are
guidelines, but I think it's good framework for
especially community care physicians who don't
have accessibility or don't have day -to -day
follow -up with their patients. I think inpatient
medicine can sometimes be a little bit easier
in that sense because you can have your day -to
-day follow -up with that patient and round,
but community physicians, I think, would benefit
from this infrastructure. Yeah, 100%. And, you
know, Deb and the other panelists can really
speak to the amount of work and effort. And as
you mentioned, you have... 10 ID physicians in
the room and sometimes we have 11 different opinions,
right? So really getting down to those recommendations,
there was a lot of work put in and really keeping
into not just the evidence, but I think Dana
described this really well. treatment is not
just the evidence it's directed by patients.
So keeping in mind the patient population and
all the factors that come into that. And there's
other tools in there in terms of like allergies,
like pen allergy and how to work, navigate that.
Cause that's always a challenge. And the goal
is it was following the WHO aware antibiotic
head book. So ideally. it's not to prescribe
if when not needed, but when you do prescribe
to find the most narrowest, most effectively
side effect, shortest duration that's out there
in terms of. therapy based on evidence great
yeah super exciting and you mentioned um obviously
amy and first line are kind of working in that
so kind of what's the best resource tool that
our listeners should be looking out for when
when you're getting all these updates and where
can they go and where can they yeah um so i mean
it's available for free you can go to your if
you have a iPhone, you can go to your app store.
Android, I'm sure, has a similar feature. And
you can download Firstline. Now, Firstline's
been around. They have guidelines across Canada
for institutions, for other global entities.
But you can specifically look for the Canadian
Antibiotic Treatment Guidance. That's the...
canadian specific and it's available for free
for for clinicians and you can sign up for push
notifications so that as we update things you'll
get a notification saying that this has been
updated and that's great yeah perfect so obviously
you guys have been working on a lot and so i
feel a little bit bad asking like what's the
future because it seems like there's a lot going
on but i'm sure my listeners are thinking okay
what's next you know so it's always exciting
yeah you guys have a lot of momentum going and
and there's a lot of work going on I mean even
from I was at last year's symposium and I think
you guys have done fantastic even just in a short
period of time so obviously it's commendable
but what is the future and what are some of the
other future initiatives that you're looking
at yeah in terms of the I mean as I said, AMR
is a priority for the government. And it's an
area that we're going to continue to work in.
Now, funding and budgets get very complicated
over time. But in terms of the guideline project,
the goal is to complete the syndromes that I've
discussed so that there is a comprehensive list
of syndromes for clinicians to access. And we're
in discussion with AMI and Firstline about ongoing
maintenance and perhaps addition of future guidance.
A lot of that is still being discussed based
on available budgets and such. But that is the
hope that it continues to be a flagship resource
for clinicians across Canada. In terms of other
areas, as I mentioned, surveillance is another
area that I'm very involved with in terms of.
targeting up -and -coming concerns. So we know
based on the most recent data, we have Canada
Oris, that's a new kid on the block that was
mentioned. So that's an area where we're trying
to focus carbapenemase -resistant or carbapenemase
-producing organisms, which are more in the healthcare
setting. But we do have programs funded through
BHEC like CNAS that do collect that data. But
the other focus is equity is a big piece that
was included both in the priority pathogen piece,
but it's also an area of interest specifically
for the government because we know that AMR impacts
different populations. And so that's an area
that we struggle with in terms of collecting
data, because we know when we look at like Staph
aureus, MRSA or other STIs, different populations
are impacted differently when it comes to Indigenous
populations or GPMSM. So trying to collect that
information is always a bit of struggle. So that's
an area we're trying to look into so that we
can provide the necessary response and guidance
that's culturally appropriate or appropriate
to that. particular group and continuing to work
on governance and strengthening the the AMR response
now across Canada that's awesome yeah no it's
really great because I think you're bringing
up a really good point in terms of, you know,
it's even though it is a national and Canadian
plan, I think it's really nice to look at the
regional differences that there are certain areas
that are requiring enhanced kind of need in,
for example, like I practice in Saskatchewan.
So our sexually transmitted infections or MRSA
risk factors and population are really high compared
to some of even, you know, really close provinces.
And so I think it's really important because
it isn't like, it's not one answer for everyone.
And so it's really good that you guys are looking
at all the regional references and, and really
excited that, you know, having the support because
I think as a clinician. practicing it's super
nice to know that there's like you know a national
guidance on this and I think that sometimes is
frightening as especially as we're like seeing
all the global threats with AMR we're seeing
all the resistance that's developing the carbon
penemase resistance and then not only that with
immigration and travel there's obviously emerging
infectious diseases as well and so and we we
kind of talk about all this on the podcast and
it's it's frightening I mean it makes for good
conversation, but it's very scary. So thank you
so much for all your work and your effort. And
we look forward to seeing what's up and coming.
Thank you so much. Awesome. Thanks for being
our guest. Thanks.