The UK risks the spread of antibiotic-resistant and other infectious diseases if it leaves the European Union’s (EU) early warning system after Brexit without an effective replacement, the Brexit Health Alliance has warned.
This briefing from the Brexit Health Alliance (BHA) and the Faculty of Public Health, a sets out how people across Europe currently benefit from the close collaboration between the UK and EU on public health, and proposes solutions to maintain and improve a high level of public health protection after the UK leaves the European Union.
The Alliance is calling for:
Both the EU Commission and UK government to prioritise the public’s health in negotiations on the future relationship between the UK and the EU.
A security partnership based on strong coordination between the UK and EU in dealing with serious cross-border health threats, such as pandemics, infectious diseases, safety of medicines (pharmacovigilance) and contamination of the food chain. Ideally, this would be by continuing access to the European Centre for Disease Prevention and Control and other relevant EU agencies, systems and databases.
Alignment with current and future EU regulatory and health and safety standards relating to (for example) food, medicines, transplant organs and the environment, to avoid the need for replication of inspections and non-tariff barriers at the UK/EU border.
The UK government to commit to a high level of human health protection when negotiating future free trade and investment agreements.
Department of Health and Social Care, Innovate UK & Steven Brine | March 2018 | UK-China collaboration to tackle antimicrobial resistance
The Department of Health and Social Care (DHSC) will invest up to £10 million in UK businesses and academics who work in conjunction with Chinese scientists to advance work on antimicrobial resistance (AMR). The fund is to support the development and, where appropriate, clinical evaluation of new products or services, which must be of value in addressing the threat from AMR.
Innovate UK will deliver the funding to UK researchers (£750,000) and The Chinese Ministry of Science and Technology will invest up to 60 million Renminbi (RMB) to fund the project. Projects can last up to 3 years.
UK applicants must demonstrate that projects are primarily and directly relevant to the needs of people in low and middle income countries (LMICs), including China, as defined by the Organisation for Economic Co-operation and Development (OECD). There must be a clear economic and societal benefit to LMICs from their proposed project. The competition will open on 3 April 2018 (Innovation Funding Service)
Projects must address the specified criteria at DHSC here
Full details including eligibility criteria are available from DHSC
The UK AMR strategy represents an ambitious programme to slow the development and spread of AMR, taking a ‘One Health’ approach spanning people, animals, agriculture and the wider environment.
The report sets out progress made in 2016, and notes that for the remaining 2 years of the strategy, the programme will focus on delivery of the government’s ambitions set out in response to the review on AMR led by Lord O’Neill. These include ambitions to halve certain types of infection and the inappropriate use of antibiotics.
This professional resource outlines the importance of infection prevention and control and how it can contribute to reducing antimicrobial resistance (AMR) | Public Health England
Every infection prevented reduces the need for and use of antimicrobials, which in turn lessens the potential for development of resistance. In the UK, the current rising threat from drug resistant organisms is from Gram-negative bacteria. Infections caused by Gram-negative organisms are increasing. This professional resource outlines the importance of infection prevention and control and how it can contribute to reducing antimicrobial resistance.
New risk factors and occurrence in patients coming directly from the community | Journal of Hospital Infection
Aim: To investigate the prevalence of patients harboring CRE on hospital admission, risk factors associated and the acquisition rate within the emergency department (ED).
Methods: We conducted a cross-sectional with 676 patients consecutively admitted to the ED study during the months of May to July 2016. A questionnaire was performed and rectal swabs were collected from patients on admission, for culture and for multiplex real-time polymerase chain-reaction (RT-PCR). If the patient was hospitalized for more than one week in the ED, samples were taken again to determine the acquisition rate of CRE.
Findings: Forty-six patients were colonized, all positive RT-PCR were KPC. The acquisition rate was 18%. Patients CRE colonized presented a higher mortality rate. Previous exposure to healthcare in the last year, liver disease and use of antibiotics in the last month were risk factors for colonization. Six patients with no previous exposure to healthcare were CRE-colonized on admission, suggesting transmission of CRE within the community.
Conclusion: Screening of high-risk patients on admission to the ED is a strategy to early identify CRE carriage and may contribute to control CRE dissemination.
The aim of this study was to assess the association between infection control (IC) interventions implemented in a referral hospital in Israel and (CRE) incidence | Journal of Hospital Infection
Image shows a human neutrophil interacting with Klebsiella pneumoniae (pink).
Background: Israel experienced a national outbreak of carbapenem-resistant Enterobacteriaceaee (CRE) starting in 2006.
Methods: Retrospective quasi-experimental study of prospectively collected data. CRE incidence, defined as the number of patients newly acquiring CRE in surveillance or clinical samples per 100,000 hospitals days (HD), was plotted quarterly between 2005 to 2016. IC interventions were applied at different time-points throughout this period. We collected data on IC staffing, number of rectal surveillance cultures and carbapenem consumption. We used auto-correlated segmented linear regression analysis to assess the time-points where a significant change in the CRE incidence trend occurred and assessed the relationship between the timing of IC intervention implementation and observed CRE trends. Trends between time-points are expressed as quarterly percent change (QPC) with 95% confidence intervals.
Findings: Between 2005-2008, CRE incidence increased significantly, QPC 19.7% (11.5-28.4%), reaching a peak of 186.6 new acquisitions/100,000 HD. From mid-2011 until the end of follow-up, there was a significant decreasing incidence trend, QPC -4.5 (-6.4 to -2.5). Cohorting of patients, screening of contacts and high-risk patients on admission were insufficient to control the epidemic. Improved hand hygiene compliance, cohorting with dedicated nursing staff, addition of regular screening in high-risk departments and carbapenem restriction were required. Decreasing CRE incidence was observed with an ID/IC staffing of 1.2-1.5/100 beds and 20,000-36,000 yearly CRE surveillance samples.
Conclusions: A multifaceted hospital-wide intervention program is required to control CRE in hospital settings.