Antimicrobial resistance: a real threat to the future of healthcare

Since the publication of this blog Dr Mike Durkin has left NHS England.

On European Antibiotic Awareness Day, Dr Mike Durkin, NHS England Director of Patient Safety, writes about the threat of antimicrobial resistance and what needs to be done to respond to this threat to the future of global healthcare.

Each year, 18 November marks European Antibiotic Awareness Day, an annual European-wide initiative to raise awareness of how to use antibiotics in a responsible way that will help keep them effective into the future.

Evidence of the use of antibiotics can be dated back to ancient Greek and Egyptian societies. However, in the modern era of mass medicine we are facing a very real threat to the effectiveness of these important drugs. As bacteria adapt and find ways to survive the effects of an antibiotic the bacteria become ‘antibiotic resistant’, and the drug no longer works. The more an antibiotic is used, the more bacteria become resistant to it.

This is a major threat to the delivery of healthcare across the globe and requires us to act now to ensure these wonderful elements of medical science can be preserved, not just for generations to come but for use in our own lifetimes.

A major part of this year’s European Antibiotic Awareness Day is the Antibiotic Guardian Campaign, which calls on everyone in the UK, the public and medical community, to choose one simple pledge about how they’ll make better use of antibiotics and help save this vital medicine from becoming obsolete. I’ve made my own pledge ‘to incorporate antimicrobial stewardship and resistance as a quality measure within my commissioning pathways’, and strongly encourage others to choose their own via the Antibiotic Guardian website.

The awareness day is used to promote important messages to patients, healthcare professionals and commissioners about the responsible and appropriate use of antibiotics and the need to prevent the spread of infections. It is also part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance.

Antimicrobial resistance (AMR) to antibiotics is spreading, and there are few prospects for new antibiotics to be developed in the short term. Some bacteria have now developed such high levels of resistance that antibiotics of last resort are the only choice of treatment available.

Without effective antibiotics to prevent or treat associated infections, some routine surgical operations and cancer chemotherapy will become very high-risk procedures or even be unavailable due to the increased likelihood of resistant infection.

Healthcare workers have a vital role to play in preserving the power of antimicrobials and in controlling and preventing the spread of infections that require antibiotic treatment. The more we can do to prevent infections and control their spread, the more we will reduce the need for antibiotics and can limit the opportunity for antimicrobial resistant strains to develop.

Antibiotic prescribing and antibiotic resistance are inextricably linked; overuse and incorrect use of antibiotics are major drivers of resistance. However, where infections do occur we need to diagnose them quickly and use the antibiotics we have appropriately, particularly in the urgent treatment of life threatening conditions such as sepsis. There are a range of tools and guidance available to assist healthcare providers and their staff around infection prevention and control and antibiotic prescribing. Links can be found below and on our AMR web page.

For commissioners, such as NHS England, it is essential that we are doing all that we can to drive improvement in infection prevention and control practices and antimicrobial stewardship programmes that reduce health care associated infection and antimicrobial resistance.

Commissioners must ensure that they have access to specialist infection prevention and control advice and that they work closely with local authorities and Public Health England centres which provide a wealth of local intelligence on services, such as timeliness and completeness of mandatory surveillance and voluntary reporting of antibiotic susceptibility data.

Again, details of resources to support commissioners can be found at the end of this blog and on the AMR web page.

And for patients, it is important that antibiotics are only taken as prescribed, never saved for later or shared with others. Antibiotics should be used in the right way, the right drug, at the right dose, at the right time, for the right duration. It is also important never to demand antibiotics from your doctor. Many antibiotics are prescribed and used for mild infections when they don’t need to be. All colds and most coughs, sinusitis, otitis media (earache) and sore throats often get better without antibiotics

Antimicrobial resistance is an issue that affects us all and we all have a part to play. To repeat my earlier plea, please do take the time to contribute to this year’s European Antibiotic Awareness Day by making a pledge via the Antibiotic Guardian Campaign website.

More information can be found on the NHS England antimicrobial resistance patient safety web page, and via the links below to a number of resources and tools.

Antimicrobial resistance resources

A range of resources have been developed to support healthcare providers, staff and commissioners to prevent AMR.

General resources:

  • English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2014 – This data should be used by commissioners, individual organisations and health economies to benchmark against national and regional antibiotic resistance and prescribing, and thereby determine appropriate local action.
  • Epic3 National Evidence Based Guidelines for Preventing HCAI – National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals
  • Infection Prevention and Control Commissioning Toolkit – jointly produced by the Royal College of Nursing and the Infection Prevention Society, this toolkit provides an overarching framework to support commissioning and provider organisations in England to meet the challenge of reducing health care acquired infections (HCAIs).

Resources for healthcare providers and staff:

Resources for commissioners:

Dr Mike Durkin was previously Director of Patient Safety, since the publication of these blogs he has left NHS England.