- Anthony S Kessel, honorary professor1,
- Mike Sharland, professor in paediatric infectious diseases2
- 1Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- 2Paediatric Infectious Diseases Research Group, St George’s University London, London SW17 0RE, UK
This week the chief medical officer highlighted in her report how the rise of antimicrobial resistance (AMR) poses a threat to healthcare delivery in the United Kingdom.1 This will be followed shortly by the Department of Health’s new UK Five Year Antimicrobial Resistance Strategy and Action Plan, which will reflect the need for a clear change in the understanding and response to AMR by the public, the NHS, and the government in the UK. The rise of AMR as a serious health threat is due to the international spread of multidrug resistant (MDR) Gram negative bacteria, the global overuse of antibiotics in humans and animals, and the almost complete lack of new antibiotic development.2 All of these are now of direct concern to the NHS.
The 85% reduction in rates of meticillin resistant Staphylococcus aureus (MRSA) bloodstream infections seen in England between 2003 and 2011 has been remarkable. MRSA is now responsible for less than 2% of all bloodstream infections in England. Less remarked on has been the inexorable rise in the number of bloodstream infections attributable to Gram negative organisms (particularly Escherichia coli), which now comprise more than half of the around 100 000 of these infections reported in England annually.3 Most large NHS hospitals now identify 50-100 times more patients with Gram negative bloodstream infections than those with MRSA, with antibiotic resistance rates of 10-20% and mortality rates of 30% reported for MDR forms.4 In England the successful introduction of conjugate pneumococcal vaccine means that the number of reported Klebsiella pneumoniae bloodstream infections …