Antimicrobial Resistance

Definitions

  • Methicillin-resistant Staphylococcus aureus (MRSA): A group of gram-positive bacteria which are responsible for several difficult-to-treat infections in humans as they are resistant to many antibiotics.

  • Dosing: Adding antibiotics to animal feed in order to prevent infection in livestock (a farming practice in some countries which is illegal in England).

  • Phage Therapy: Using bacteriophages, a type of virus adapted to infect specific bacteria, to kill bacteria.

Issues of Antimicrobial Resistance

  • In 2019, antibiotic-resistant bacteria were associated with 5 million deaths, and directly caused 1.3 million deaths.

  • MRSA Outbreaks in UK hospitals and care homes are increasing.

  • Colistin-resistant (Colistin is an antibiotic used as a last resort against infection) bacteria have been found. We will, therefore, have no antibiotics to kill these.

  • The United Nations warns “climate change and antimicrobial resistance: are the top two greatest threats to public health.”

If nothing is done, scientists estimate that bacterial resistance will cause 10 million deaths and 14% of transplants will result in death from antibiotic resistance by 2050. Routine surgeries will become deadly.

Causes of Antimicrobial Resistance

  • Increase hospitalisation in developing countries.

  • Inadequate hospital space: high bed density increases the spread of infections.

  • Dosing of livestock in some countries.

  • Public Health England predict 20% of GP antibiotic prescriptions are unnecessary.

  • More pressure on GPs by patients to prescribe antibiotics (40% of people believe that antibiotics can cure viral infections).

  • Many patients prematurely stop their course of antibiotics. This means some bacteria with partial resistance are not killed and can re-infect the patient as well as other people. This adds a selection pressure to less resistant bacteria, slowly increasing the level of resistance bacteria have over time.

Solutions to Antimicrobial Resistance

Global

In 2015 the World Health Assembly adopted a 5 step global action plan on antimicrobial resistance:

  1. Improve awareness and understanding (through education and training).

  2. Strengthen knowledge (through surveillance and research).

  3. Reduce the incidence of infection (through sanitation, hygiene and infection prevention measures).

  4. Optimise the use of antimicrobial medicines.

  5. Develop sustainable investment into medicines, vaccines and other interventions.

Governmental

  • NICE and NHS England have devised a new commissioning method where pharmaceutical companies are paid on the value of the drug to the NHS rather then the quantity of drugs ordered. This will incentivise the development and supply of crucial medications (e.g. new antibiotics) over popular and profitable medications (e.g sleeping pills).

  • Teixobactin is a broad spectrum antibiotic isolated in 2015. It appears to utilise a different method of killing bacteria, creating a whole new class of antibiotics, however it is currently under investigation.

  • Increased antimicrobial resistance surveillance (e.g GLASS Global Antibiotic Resistance Surveillance System). This enables infections to be tracked.

  • Improved antimicrobial resistance diagnosis. For example new AI technologies have been developed to identify likely antibiotic resistant bacteria and calculate combinations of medicines to cure it.

  • Public education campaigns such as the Public Health England ‘antibiotic-resistance advert’ in 2017.

  • The Government’s National Action Plan aimed to decrease antibiotic prescriptions by 15% from 2014 to 2024 which has been met.

  • Decreased antibiotic funding for Integrated Care Systems (ICSs) to disincentivise antibiotic prescriptions.

  • Increased research into phage therapy.

Doctor

  • Encourage and practice good hygiene practices to decrease the chance of infection.

  • Encourage vaccinations.

  • Educate patients on the importance of completing the full course of antibiotics.

  • Report any antimicrobial resistance to surveillance teams.

  • Use combinations of antibiotics in order to treat resistant strains (combination therapy).

Individual

  • Practice safe hygiene.

  • Only use prescribed antibiotics.

  • Vaccinate pets.

  • Reduce pressure on GPs to prescribe antibiotics (some patients refuse to leave practices if they don’t get antibiotics causing delays).