Antimicrobial resistance poses “catastrophic threat” to mankind

Professor Dame Sally Davies said:

Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in twenty years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.
That’s why governments and organizations across the world, including the World Health Organization and G8, need to take this seriously.
This is not just about government action. We need to encourage more innovation in the development of antibiotics — over the past two decades there has been a discovery void around antibiotics, meaning diseases have evolved faster than the drugs to treat them.
In some areas, like cutting rates of drug resistant MRSA, the NHS is already making good progress so it’s important that we use that knowledge across the system and I hope my recommendations will prompt people to do that.

The Department of Health will soon publish the U.K. Antimicrobial Resistance Strategy setting out how it will meet the challenge that the Chief Medical Officer has outlined (see a British Medical Journal preview of the plan).

The five-year U.K. Antimicrobial Resistance Strategy and Action Plan will:

  • Champion the responsible use of antibiotics — by ensuring NHS staff have the skills, knowledge and training to prescribe and administer antibiotics appropriately.  Part of this will include reviewing and updating the curricula for medical undergraduates
  • Strengthen surveillance — by improving the recording of data on the numbers of antibiotics prescribed and trends in antibiotic resistance, this information can used by clinicians to change patterns of prescribing.  This will help reduce the level of resistance and help ensure patients respond to treatments
  • Encourage the development of new diagnostics, therapeutics and antibiotics, for example by continuing to support the Innovative Medicines Initiative (IMI) and other initiatives that encourage scientific research.

The Chief Medical Officer’s wide-ranging report makes several further recommendations on tackling antimicrobial resistance, including:

  • New infection control measures should go beyond hospitals and be applied to home and community care settings
  • The national approach to tackling antimicrobial resistance should not just focus on humans and the risk of antimicrobial resistance in animals should be managed closely by the Department for Food, Environment and Rural Affairs
  • Public Health England should work closely with the NHS Commissioning Board to make sure that advanced testing facilities are available to treat infections brought into the country from abroad
  • Further promotion of the benefits of vaccination and encouragement of vaccine uptake during pregnancy to prevent diseases such as flu and whooping cough should be undertaken
  • Directors of Public Health should work with schools to ensure the school nursing system is well-placed to deliver new immunization programs

Note that the U.S. Centers for Disease Control and Prevention (CDC) last Tuesday also sounded the alarm about the growing threat of antibiotic-resistant superbugs. Addressing the cost implications of the antibiotic-resistant superbug threat, Richard Smith and Joanna Coast write in Monday’s British Medical Journal:

…The costs of resistance could be much higher than (existing) estimates (of $55 billion per year in the US) suggest. As an example we estimated the consequences of having no antibiotics for patients having a total hip replacement. Because antibiotics have been used as prophylaxis and treatment for hospital-acquired infection since hip replacements were first performed, we looked at information relating to limb amputation, as a proxy for what infection rates might have been with and without antimicrobials.
…Currently, prophylaxis is standard practice, and infection rates are about 0.5-2%, so most patients recover without infection, and those who get an infection have it successfully treated. We estimate that without antimicrobials, the rate of postoperative infection is 40-50% and about 30% of those with an infection will die. Thus, removal of antibiotics would increase postoperative infection by 1-50% and deaths by 0-30%.

— Read more in U.K. Department of Health,  Annual Report of the Chief Medical Officer, vol. 2, Infections and the rise of antimicrobial resistance; Anthony S. Kessel and Mike Sharland, “The new UK antimicrobial resistance strategy and action plan: A major societal, political, clinical, and research challenge,” British Medical Journal (11 March 2013) (doi: 10.1136/bmj.f1601);and Richard Smith and Joanna Coast, “The true cost of antimicrobial resistance,” British Medical Journal (11 March 2013) (doi: 10.1136/bmj.f1493)