Antimicrobial resistance presents an “apocalyptic” threat similar to that of climate change, CMO warnsBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1597 (Published 11 March 2013) Cite this as: BMJ 2013;346:f1597
Action is needed at both a national and international level to avert the “ticking time bomb” of antimicrobial resistance, which presents a threat as grave as climate change, the chief medical officer for England has warned.
In the second volume of her annual report for 2011, Infections and the rise of antimicrobial resistance,1 Sally Davies spelt out the threat—overuse of existing antibiotics and increasing resistance to them, a “discovery void” of new antibiotics, a change in the types of organism presenting the greatest threat, and the need for better training of NHS staff in hygiene and infection control.
“If we don’t get this right we will find ourselves in a health system not dissimilar to the early 19th century,” where deaths from infections will be commonplace because of a lack of effective treatments, Davies told a press briefing at the Department of Health. The department would publish a five year strategy for action in the next couple of weeks, she said.
At the chief medical officer’s recommendation, the Department of Health and the Department for Environment, Food, and Rural Affairs have added antimicrobial resistance to their strategic risk registers. Davies has also requested that it be added to the National Security Risk Assessment, alongside pandemic flu and terrorism, to ensure cross government action and to help push antimicrobial resistance onto the international agenda.
“Governments and organisations across the world, including the World Health Organization and G8, need to take this seriously,” she said. This included finding some way of incentivising the pharmaceutical industry to develop new antibiotics. No new antibiotic classes have been discovered since 1987, and Davies said that no pharmaceutical companies had any new antibiotic classes in their pipeline, and that there were few new antibiotics of existing classes in development.
With the pipeline drying up, stewardship of antibiotics in health, fisheries, and farming had become increasingly important, she said. In health, that meant prescribing antibiotics only when appropriate and ensuring that the patient completed their course. Davies added: “We need more and rapid diagnostics for infection in order to stop empirical treatment and move to much more targeted treatment.”
A zero tolerance strategy towards meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile has seen peak rates of infection in England and Wales fall by 85% and 60%, respectively; Gram negative bacteria Klebsiella and Escherichia coli are now the most frequent cause of healthcare acquired infection. Davies said that European data suggested 30% mortality for multiresistant E coli infections versus 15% from non-resistant strains. “Up to 5000 patients are dying each year in the United Kingdom of Gram negative sepsis, half with a resistant organism. That greatly exceeds mortality from MRSA and C difficile,” she said.
Mike Sharland, professor of paediatric infectious diseases at St George’s Healthcare NHS Trust in London, said that bloodstream infections from Gram negative bacteria had risen by about 60% over the past five years in England and Wales, taking the number of infections per year from around 25 000 to 35 000. As a result, many large acute hospitals would now only see two to three cases per year of bloodstream infections caused by MRSA, and for each of these cases there would be 50-100 infections caused by Gram negative bacteria, he said.
However, Davies told the BMJ that there were no current plans to introduce a dedicated programme with specific targets to drive down infections caused by Gram negative bacteria. “If we get good surveillance and improve that then we will know where we are, and if we continue to deteriorate we will clearly have to think about that,” she said.
Cite this as: BMJ 2013;346:f1597