• Question: What's changed in the last 12 months in the fight against antimicrobial infection?

    Asked by to Adam, Alastair, Andrew, Chris, Cliodna, Elizabeth, Jeroen, , , Martin, Michael, Paul, Rose, Susan, Thamarai, Wendy on 11 Nov 2016. This question was also asked by .
    • Photo: Elizabeth Beech

      Elizabeth Beech answered on 11 Nov 2016:


      So much has happened in the past 12 months. The good news story is that during 2015-16 NHS primary care prescribing of antibiotics in England reduced by 7.3%, that’s 2.7 million fewer antibiotics, and 600,000 fewer broad spectrum antibiotics; a 16% reduction. Well done to primary care clinicians. The other good news is global. In September the UNGA agreed global action for AMR. For the first time, Heads of State committed to taking a broad, coordinated approach to address the root causes of AMR across multiple sectors, especially human health, animal health and agriculture. This is only the fourth time a health issue has been taken up by the UN General Assembly (the others were HIV, noncommunicable diseases, and Ebola). This global collaboration is vital as resistant organisms travel quite well on planes and in animal food products.
      In July Jim O’Neil reported on his global AMR Review and the impact on health and wealth. Following this the UK have announced an aspiration to reduce inappropriate antimicrobial prescribing by 50% by 2020, as well as a 50% reduction in Gram negative blood stream infections. This is what England will now be focussing on delivering. National incentives for the NHS will help all health economies start to tackle these challenges fast. This will include improving the management of UTIs, and sepsis, and improving infection prevention. Starting with better handwashing for all. Rose is the expert who can tell us more about how to achieve this.

    • Photo: Marco

      Marco answered on 14 Nov 2016:


      I fully agree with Elizabeth. In 2016 AMR has been in the spotlight in the news – with cases of drug resistant infections on patients in the US and Europe – in public health and practitioners and in the academic world.
      As a lecturer in Queen’s University, I realized how the academic world looks at this problem studying it from a more and more multidisciplinary standpoint. Social scientists are starting to look at AMR to understand why the problem exists in the first place (why do people not consider antibiotics and developing resistance a big deal yet), how to increase the public involvement and how to incentivate the production of either new drugs or alternative approaches.

      Another change is in terminology. We will have to start thinking about AMR in terms of Drug-resistant infections as redefined by Wellcome trust who, Since January 2016 has been exploring whether this should become one of Wellcome’s strategic priorities (https://wellcome.ac.uk/what-we-do/our-work/drug-resistant-infections). As Elizabeth highlighted, the problem is definitely much higher in the agenda that it was a couple of years ago and attention will grow in the next few years

    • Photo: Adam Roberts

      Adam Roberts answered on 14 Nov 2016:


      I think there is more awarness of the issue and there has been a number of highly reported stories which have contributed to this.
      One is colistin resistance in E. coli which was reported about a year ago and this was pretty major for a couple of reasons; A. colistin is used as a drug of last resort for CPE infections and B, and more worryingly, the gene responsible for the resistance (MCR-1) was found on a transferable plasmid. This means that it had the potential to transfer from the bacterial strains in which it was found (isolated from pigs in China which were fed colistin) to human strains causing disease. Previous colistin resistance was conferred by mutations and was not transferable and therefore less important clinically.

      It wasnt long before everybody checked back in their archived strains and found this gene in older isolates from all over the world. It had already spread globally and we had missed it.

      Some good came out of this story; China agreed to stop using antibiotics of human clinical importance in agriculture and (most) of the press engaged with it relatively well. This got people discussing the issues and engaging with them.

    • Photo: Cliodna McNulty

      Cliodna McNulty answered on 15 Nov 2016:


      1. The number of organisms reported to the reference lab with carbepenamase enzymes and therefore multi resistance has increased.
      2. All the societies and different professions are working together to fight AMR
      3. There are even more resources available on the TARGET antibiotics website

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