The threat posed by antibiotic resistant bacteria is all too real

In the second of a series of blogs to mark World Antibiotic Awareness Week, Dr Matthew Fogarty, NHS England Head of Patient Safety Policy and Strategy, and Stuart Brown, an antimicrobial pharmacist and NHS England Healthcare Acquired Infection and Antimicrobial Resistance Lead, explain the need for change:

Dr Matthew Fogarty: Patient safety policy is buzzing at the moment.

Following Mid Staffs, Morecambe Bay and the various reports that followed, a lot of attention is on the safety of healthcare and a lot of work is underway to support the system.

This is a fabulous thing and means we are able to maintain a focus on the safety of everyone who relies on healthcare, even while facing the most intense funding squeeze in generations.

Into that space steps antimicrobial resistance (AMR); a fairly esoteric, remote and long-term threat to the provision of healthcare. When you have patients suffering after medication errors, harm caused by problems in surgery, or incidents where patients deteriorate unnecessarily, it does seem a bit less important to worry about the fact that our usual antibiotics may not be effective in a decade. But then you think about that. The antibiotics don’t work. My kids can’t get treatment for their infections. My mum can’t get help for that chest infection. There goes surgery, transplants, lots of cancer treatment. It’s suddenly pretty terrifying.

So, we are taking a longer term view with this one. Along with our brilliant antimicrobial leads we are using the tools available to us to do what we can to address the problem.

We are highlighting variation in antimicrobial prescribing, incentivising commissioners to work with their providers to reduce the use of antibiotics, and improving the collection of data so we can understand more about what is going on. And we are working across the system – including government and other sectors – to ensure we approach this thing from every angle.

AMR may seem a little remote. But if we don’t tackle it now, it will be all too real.

Stuart Brown: It seems like only yesterday when I started my career as a specialist antimicrobial pharmacist and I still remember those initial days and the huge learning curve ahead of me.

At that time the emphasis was clearly on addressing Clostridium difficile infection (CDI) and MRSA bacteraemias. Large strides were made on reducing antibiotics that were high risk for developing CDI and MRSA selection.

As I look back on those early days, rarely did we discuss the wider picture of gram-negative resistance and I can hardly remember seeing a prescription for Meropenem let alone heard of an ESBL or carbapenemase!

As the years have passed the all too real threat of gram negative resistance has become apparent. There has been a 31% increase in carbapenem prescribing between 2009 and 2013, and an increase in the number of carbapenem resistant enterobacteriacea.

Undoubtedly, AMR has now become a national and international problem.

In the last few years we have had the publication of the Chief Medical Officer’s report on antimicrobial resistance, which clearly identifies the key issue is and potential risks. Following this, the national five year AMR strategy was published in 2013, highlighting seven key areas for improvement, developed with key national stakeholders.

As I reflect on my career and the challenges I have faced while working within the ever changing field of antimicrobials, there is one phrase that always comes back to me: ‘whole health economy’. Working patterns and action plans are often fragmented with clear lines drawn between primary and secondary care.

If there is one change I will be making to address AMR it will be to work much more closely with primary care to ensure that there is a single approach to tackling AMR.

We should no longer consider C diff cases as primary or secondary care attributed, but rather work closer together to understand the whole patient journey and learn collective lessons rather than attribute blame to one sector.

This will be no easy task but one that can be achieved with the right engagement and drive to improve.

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Dr Matthew Fogarty

Dr Matthew Fogarty is currently NHS England’s Head of Patient Safety Policy and Strategy. Prior to this he was Head of Patient Safety Policy in the Department of Health.

Matt held a number of roles as a DH Civil Servant, including as a Private Secretary to the Minister of State for Health, and as policy lead on Emergency Preparedness and Urgent and Emergency Care.

Before joining the Civil Service, Matt was a research scientist and gained his PhD in Developmental Neuroscience at University College London in 2006.

Stuart Brown

Stuart Brown currently works as an antimicrobial pharmacist at County Durham and Darlington NHS Foundation Trust and has spent the last 10 years working within Secondary care.

He is a keen advocate of antimicrobial stewardship, presenting on this at both local and national conferences.

Stuart works closely with his colleagues in primary care and is the current chair of the Antimicrobial Pharmacist Group in the North East of England. He is currently seconded to NHS England as a national project lead for AMR and HCAI’s.