- What is antimicrobial resistance?
- Tackling antimicrobial resistance
- AMR National Action Plan (NAP)
- What is the NHS doing to tackle AMR?
- AMR – key links
Antimicrobial resistance (AMR) has been identified as one of the most pressing global challenges we face this century. In fact, the World Health Organisation (WHO) has declared AMR as one of the top 10 global public health threats, and AMR is listed on the UK Government’s National Risk Register. In 2019 there were 4.95 million deaths associated with bacterial AMR across 204 countries, and 1.27 million of those were directly attributed, leading the WHO to declare it a top global public health threat.
What is antimicrobial resistance?
AMR occurs when the microorganisms which cause disease (including bacteria, viruses, fungi and parasites) are no longer affected by antimicrobial medicines such as antibiotics, antivirals, antifungals and antiparasitics that we use to kill them, prevent and treat the disease.
While resistance is a natural phenomenon and not just a health issue, from a human healthcare perspective it is accelerated by:
- inappropriate use of antimicrobial drugs
- poor infection prevention and control practices
- a lack of new antimicrobial drugs being developed
- insufficient global surveillance of infection rates.
How important is it that we tackle resistance?
We rely on antibiotics, antifungals, and antiparisites to treat the microorganisms that cause many common diseases, such as tuberculosis (TB), HIV / AIDS, malaria, sexually transmitted infections, urinary tract infections, chest infections, bloodstream infections and food poisoning. These microorganisms, however, can already resist a wide range of antimicrobial medicines.
This isn’t just a problem in treating illness; routine surgical procedures and cancer treatment – such as caesarean sections, hip and knee replacements, cardiac surgery and chemotherapy – also rely on these antimicrobial medicines prior to carrying out surgical procedures to prevent infections.
There are few replacement antibiotics or alternative products in development, and even fewer which target specific super resistant bacterium, virus, or other microorganisms. This is partly due to how new drug development is funded.
As resistance continues to increase, more people will suffer for longer as infections become more difficult to treat – resulting in longer hospital admissions, routine surgical procedures becoming more dangerous to perform, and higher death rates. The impact of AMR therefore has a detrimental effect on the working of modern medicine and can and will affect each and every one of us.
What is needed from a healthcare perspective to tackle resistance?
- early prevention of infections
- timely, accurate diagnosis
- appropriate prescribing and use of antimicrobials only when there is an infection for which they are the most appropriate treatment
- effective management of infections
- development of alternatives to current antimicrobials.
AMR National Action Plan (NAP)
The UK Government has developed an AMR 5 year National Action Plan (NAP), to contain and control AMR by 2040. The action plan covers action across human and veterinary medicine, food production, agriculture and research. It’s overall aims are to:
- optimise the use of antimicrobials
- reduce the need for, and unintentional exposure to, antibiotics; and
- support the development of new antimicrobials.
The NAP contains a number of ambitions, including:
- halving the number of healthcare-associated gram-negative blood stream infections
- reducing UK antimicrobial use in humans by 15%, including:
– a 25% reduction in antibiotic use in the community (from a 2013 baseline)
– a 10% reduction in use of ‘reserve’ and ‘watch’ antibiotics in hospitals (from a 2017 baseline)
- reducing the incidence of specified drug-resistant infections in humans by 10%
Implementation of the NAP is overseen by the UK AMR Board, jointly overseen by Department of Health and Social Care (DHSC) and Department for Environment, Food and Rural Affairs (DEFRA).
What is the NHS doing to tackle AMR?
The NHS Long Term Plan (LTP) details commitments by the NHS to continue supporting implementation and delivery of the NAP. This includes ensuring access to old and new treatments, preventative measures (including vaccines) and appropriate tools (including diagnostics and electronic prescribing in both hospitals and community settings), together with continued support for system-wide improvement, surveillance, infection prevention and control practice, and antimicrobial stewardship, ensuring resources are available for clinical expertise and senior leadership at all levels.
Implementation of the UK NAP is broken down into a number of workstreams, with a senior responsible officer (SRO) for each. Professor Sir Stephen Powis, NHS England’s National Medical Director, is the SRO for the Human Health workstream and chairs the NHS England AMR Board which oversees the work.
NHS England has established a national AMR programme, comprised of a number of workstreams aimed at supporting NHS England’s responsibilities for delivering the Human Health ambitions in the NAP.
The current programme workstreams are:
- Antimicrobial evaluation and payment model pilot project
- antimicrobial prescribing and medicines optimisation
- infection prevention and control (IPC)
- sepsis and acute deterioration
- urinary tract infections.
NHS England also funds AMR leads in each of the seven regions, who drive local implementation, support and advise on antimicrobial stewardship, infection prevention and control and diagnostics. They are available to support integrated care systems to understand what they need to do to address AMR.
To find out more about the above workstreams, please visit the above workstream page or alternatively if you are an NHS professional, please visit the Future NHS Antimicrobial Resistance (AMR) Programme workspace for more information.
Alternatively, please contact firstname.lastname@example.org.
AMR – key links
Resources – WHO and UK Government:
- WHO – Antimicrobial resistance (AMR)
- WHO – AWaRe
- Global report on infection prevention and control – WHO
- Global burden of bacterial AMR paper – The Lancet
- O’Neill AMR Review
- UK 5-year action plan for antimicrobial resistance 2019-2024
- Addendum to the UK 5-year action plan for antimicrobial resistance 2019 to 2024
- UK 20-year vision for antimicrobial resistance
- English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report
- Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection (APRHAI)
Key Wider NHS publications and policy:
- NHS Long Term Plan
- Standard Contract Technical Guidance (22/23)
- Standard Contract Service Conditions (22/23)
- NHS National oversight framework 22/23
- NICE guidance on antimicrobial stewardship
Resources for education:
- e-Bug offers free resources for children aged 3 to 16
- Become an antibiotic guardian
- UKHSA Resources
- Health Education England resources
- TARGET e-learning resources
- Healthier Together – Royal College of Paediatrics and Child Health
- Caring for children with cough
- When should I worry?
Resources – prescribing:
- NICE guideline NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use
- Start smart, then focus: antimicrobial stewardship toolkit for English hospitals
- WHO AWaRe categorisation
- ePACT2 (NHS BSA primary care prescription data)
- PrescQIPP Antimicrobial Stewardship Hub
- Patient group directions
Resources – IPC:
- healthcare associated infections
- Escherichia coli (E. coli) prevention video
- urinary catheter tools
- National infection prevention and control manual for england and associated resources
- Every action counts’ resources
For any queries, please email email@example.com.
Resources – sepsis:
Resources – antimicrobial evaluation and payment model pilot project:
Resources – Diagnostics:
- NHS England: Improving the Blood Culture Pathway Executive Summary
- Diagnostics: Recovery and Renewal – Report of the Independent Review of Diagnostic Services for NHS England