Progress report on the UK 5 year antimicrobial resistance strategy

The third annual progress report on the UK 5 year antimicrobial resistance (AMR) strategy, including future plans | Department of Health

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The third annual progress report describes the activities and achievements in the third year of implementation of the UK 5 year antimicrobial resistance (AMR) strategy 2013 to 2018, including significant international achievements.

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.

Full report: UK 5 Year Antimicrobial Resistance (AMR) Strategy 2013-2018. Annual progress report, 2016

 

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Preventing infections and reducing AMR

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.

Full detail at Public Health England

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Image source: http://www.gov.uk

 

Antibiotic awareness resources

Public Health England have published a series of antibiotic awareness resources to support the Antibiotic Guardian campaign and local initiatives.

Antibiotic awareness: toolkit for healthcare professionals in England
Guidance to help the NHS, local authorities and others support European Antibiotic Awareness Day and the Antibiotic Guardian campaign, to encourage responsible use of antibiotics.

Antibiotic awareness: quizzes and crosswords
Quizzes and crosswords about antibiotic resistance for the public, healthcare prescribers and pharmacists.

Antibiotics: secondary care prescriber’s checklist
Prescribers in secondary healthcare can use this checklist to help make decisions about prescribing antibiotics.

Antibiotic awareness: posters and leaflets
Posters and leaflets (in 11 languages) for the public and healthcare professionals to support antibiotic awareness campaigns in the UK.

PHE have also produced a short video to help explain the issue of antibiotic resistance:

Carbapenem-resistant Enterobacteriaceae in patients admitted to the Emergency Department

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.

Full reference: Salomão, M.C. et al. (2017) Carbapenem-resistant Enterobacteriaceae in patients admitted to the Emergency Department: new risk factors and occurrence in patients coming directly from the community. Journal of Hospital Infection. Published online: 18 August 2017

The association between infection control interventions and CRE incidence

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

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Image source: NIAID – FLickr // CC BY 2.0

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.

Full reference: Hussein, K. et al. (2017) The association between infection control interventions and CRE incidence in an endemic hospital. Journal of Hospital Infection. Published online: 22 July 2017

Scientists stumble across new method of making antibiotics

Cancer researchers may have stumbled across a solution to reverse antibiotic drug resistance and stop infections like MRSA. | Via ScienceDaily

Experts warn we are decades behind in the race against superbugs having already exploited naturally occurring antibiotics, with the creation of new ones requiring time, money and ingenuity.

But a team of scientists at the University of Salford say they may have found a very simple way forward — even though they weren’t even looking for antibiotics.

And they have created and validated several new antibiotics already — many of which are as potent, or more so, than standard antibiotics, such as amoxicillin.

“A little like Alexander Fleming, we weren’t even looking for antibiotics rather researching into new compounds that might be effective against cancer stem cells,” explains Michael P. Lisanti, Chair of Translational Medicine at the University’s Biomedical Research Centre.

“I think we’ve accidentally invented a systemic way of creating new antibiotics which is simple, cheap and could be very significant in the fight against superbugs,” added Dr Federica Sotgia, a co-author on the study.

Full story at ScienceDaily

Full reference:  Bela Ozsvari et al.  Mitoriboscins: Mitochondrial-based therapeutics targeting cancer stem cells (CSCs), bacteria and pathogenic yeast | Oncotarget, Advance Publications | published online July 7th 2017

Antibiotic Therapy for Nearly 1 in 4 Adults with Pneumonia Does Not Work

Approximately 1 in 4 (22.1 percent) adults prescribed an antibiotic in an outpatient setting for community-acquired pneumonia does not respond to treatment, according to a new study presented at the 2017 American Thoracic Society International Conference | Infection Control Today

B0007348 Streptococcus pneumoniae

Image source: Debbie Marshall – Wellcome Images // CC BY 4.0

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae, the species of bacterium that is the commonest cause of pneumonia.

McKinnell and colleagues conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society of America, published in 2007, provide some direction, but large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.

The researchers examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia.  The scientists defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription.  The total antibiotic failure rate was 22.1 percent, while patients with certain characteristics — such as older age, or having certain other diseases in addition to pneumonia — had higher rates of drug failure.  After adjusting for patient characteristics, the failure rates by class of antibiotic were:  beta-lactams (25.7 percent), macrolides (22.9 percent), tetracyclines (22.5 percent), and fluoroquinolones (20.8 percent).