Antimicrobial resistance (AMR) is the ability of micro-organisms to withstand antimicrobial treatments such as antibiotics. This resistance occurs as bacteria, for example, adapt and find ways to survive the effects of an antibiotic, meaning the drug no longer works to fight the infection it was previously used to treat. The more an antibiotic is used, the more bacteria become resistant to it.
The consequences of AMR include increasing treatment failure for the most commonplace infections, such as urinary tract infections and decreasing the treatment options available where antibiotics are vital, such as during cancer treatment when patients are prone to infection.
The Chief Medical Officer for England highlighted the problem of antimicrobial resistance in her 2013 annual report and this subsequently led to the UK cross-government five-year (2013-2018) antimicrobial resistance strategy.
National programme to combat antibiotic overusage
The World Health Organisation has estimated that antimicrobial-resistant infections currently claim at least 50,000 lives each year across Europe and the US. A review by Jim O’Neil last year found that unless action is taken then there could be 10 million worldwide deaths each year attributable to antimicrobial resistance in coming decades.
NHS England has launched the world’s largest healthcare incentive scheme for hospitals, family doctors and other health service providers to prevent the growing problem of antibiotic resistance. The programme offers hospitals incentive funding worth up to £150 million to support expert pharmacists and clinicians review and reduce inappropriate prescribing.
Clinical commissioning groups are being supported to reduce the number of antibiotics prescribed in primary care by 4%, or to the average performance levels of 2013/14. Hospital trusts will also receive payments for gathering and sharing evidence of antibiotic consumption and review within 72 hours of the beginning of treatment.
European Antibiotic Awareness Day
We are a proud supporter of both European Antibiotic Awareness Day (EAAD) and World Antibiotic Awareness Week. EAAD is held annually on 18 November as a European-wide event to raise awareness on how to use antibiotics in a responsible way that will help keep them effective for the future.
Infection prevention and control and antimicrobial stewardship
Healthcare workers have a vital role in preserving the power of antimicrobials.
Antibiotic prescribing and antibiotic resistance are inextricably linked. Overuse and incorrect use of antibiotics are major drivers of resistance. Inadequate hygiene and infection prevention and control measures help to spread infections.
The more we can do to prevent infections and control their spread, the more we will reduce the need for antibiotics and limit opportunities for antimicrobial resistant strains to develop. Where infections do occur we need to diagnose them quickly and use the antibiotics we have appropriately.
A range of resources have been developed to support healthcare providers, staff and commissioners to prevent AMR.
- The antimicrobial prescribing competencies were developed by the Professional Education sub-group of the Expert Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI) and Public Health England (PHE).
They are designed to complement the NICE National Prescribing Centre’s generic competency framework.
Regulators, education providers and professional bodies can also use them to inform the development of standards, guidance and training.
- 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).
- Review on antimicrobial resistance website – Responding to mounting international concern about the rise of drug-resistant infections, the UK Prime Minister, The Rt Hon David Cameron MP, commissioned Jim O’Neill in July 2014 to chair this review on antimicrobial resistance. The Review has published its first paper, Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations which explains why failing to tackle drug-resistant infections will cause 10 million deaths a year and cost up to US$ 100 trillion by 2050.
- The NHS England healthcare associated infection (HCAI) web page
Resources for healthcare providers and staff
- Start Smart – Then Focus – Department of Health’s guidance is to provide an outline of evidence-based antimicrobial stewardship in the secondary healthcare setting
- TARGET – The Royal College of General Practitioners’ antibiotics toolkit for general practitioners
- Public Health England Carbapenemase-producing Enterobacteriaceae: early detection, management and control toolkit for acute trusts
Resources for commissioners
- NICE QS61 Infection prevention and control: support for commissioning report – this report highlights the key actions local authorities, commissioners and their partners should take to improve the quality of care for infection prevention and control.
- Antibiotic QIPP indicator data for primary care – NHS BSA Information Services Portal provides access to a variety of information reports on key prescribing areas including antibiotics, and this data can be used by both commissioners and prescribers to monitor antibiotic prescribing in primary care.
Commissioners guide to the prevention of antimicrobial resistance (AMR)
The presentations delivered at the NHS England workshops are available below and will guide commissioners towards existing resources and best practice that will help to reduce inappropriate prescribing and use of antimicrobials in primary and secondary care and support effective antimicrobial stewardship activity.