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Heartbeat: Antibiotic resistance – a silent pandemic

October 13, 2021

The rise and spread of antimicrobial resistance (AMR) is creating a new generation of multi drug resistant organisms or ‘superbugs’ that cannot be treated with existing medicines. Antibiotic resistance is a scary yet very real threat the world is facing – with an ever-increasing number of resistant superbugs emerging and a severe lack of new treatment options.

It is now estimated 700,000 people die each year as a result of antimicrobial resistance, with this number predicted to increase to over 10 million deaths per year by 2050. The current COVID-19 pandemic appears to have accelerated the threat of antimicrobial resistance (AMR), as many patients admitted to hospitals displaying COVID-19 symptoms are treated with antibiotics to reduce their chances of contracting secondary bacterial infections, making resistant bacteria more common.

Everyone needs to get involved to prevent antimicrobial resistance. The small changes that we can make in our daily lives, can add up to large scale change and help to avert this ‘silent pandemic’ – we too have a role, and we can make a difference.

Human actions in the form of overprescribing, overconsumption and a general complacency to use board spectrum antibiotics has got us to a situation where resistance threatens many aspects of our lives. We regularly see outbreaks of resistant bugs here in the Midlands, the UK and wider afield. There are bugs out there that are almost untreatable, and we are failing to keep up with developing new, effective antibiotics. Resistance anywhere threatens people everywhere, due to the ease of movement of people, animals and goods around the world (consider how quickly COVID-19 has spread around the globe). The threat of antibiotic resistance to modern medicine and the economy can directly affect us and our livelihoods, as well as the individual patient harm it can cause.

Again, it is easy to feel overwhelmed and powerless, to criticise the pharmaceutical industry for not doing enough, blame prescribers for writing too many prescriptions and complain about the poor controls on antibiotics in many parts of the world which helps to drive resistance. All these things (and many more) need to be tackled, but like climate change, there is a lot that we as individuals can do and when we do them regularly and consistently, it all adds up.

There is requirement to reduce total antimicrobial consumption as part of the standard contract with the CCG, driven by the National Action Plan for Antimicrobial Resistance. Previous CQUIN targets have focused on reducing antibiotic consumption for key agents such as piperacillin/tazobactam and carbapenems, as well as increasing the proportion of agents used from the WHO ‘Access’ list of antimicrobial agents. Shift in focus from CQUIN targets, which have previously had a value of approx. £160,000 per annum per target, to the standard contract with CCG, where penalties can range from 1-3 per cent of the Trust’s total operating budget.

Data from the Define reporting system has indicated that total antibiotic consumption may be between 11 and 28 per cent above target, driven in the last 12 months by the pandemic; this is a trend across many NHS Trusts and is not unique to SWB.

So, how could we achieve this at SWB? Always:

  • Send microbiology samples in the right container (e.g. red topped bottle for urine)
  • Make a weekend plan for antibiotic treatment
  • Ask the medical team if IV antibiotics are still needed after 48 hours of treatment
  • Check if ultra-broad spectrum antibiotics are approved by microbiology or in line with guidelines
  • Check that the duration of antibiotics on discharge is appropriate
  • Ask if antibiotics are still required after 7 days of treatment
  • Check microbiology results before prescribing antibiotics
  • Check microbiology results to de-escalate board spectrum antibiotics to narrow spectrum antibiotics
  • Use Start Smart, then Focus approach
  • Do not start antimicrobials in the absence of clinical evidence of infection.

Imagine if every day at SWB, nursing colleagues asked the medical team to review if the IV antibiotics were still required for patients who are eating, drinking and taking other medication orally? Many patients could be switched to oral antibiotics, saving nursing time, saving precious money, making patients more comfortable and allowing them to go home sooner. Some patients might need a longer course of IV antibiotics, but no one has been harmed by at least asking the question. Everyone is busy and under pressure, so often we leave things like this for another time or rely on someone else doing it. The end result can be extra unnecessary days of treatment than can be harmful – all because no one thought to ask or question it. Striving for incremental improvement, and asking that question for just one extra patient each day could make a huge difference.