Chair and spokesperson for MRSA Action UK Derek Butler was invited on BBC 2’s Victoria Derbyshire current affairs program to discuss the release of Lord O’Neill’s report commissioned by the Prime Minister David Cameron on Antimicrobial Resistance (AMR). The report and the lack of the pharmaceutical companies’ ability or incentive to develop new treatments for the ever growing resistance to antibiotics were featured in the report. Lord O’Neill’s report highlighted concern regarding the growing threat to human health from AMR for future generations. The report cites reducing unnecessary use of antimicrobial drugs in healthcare settings; monitoring and reducing superfluous use of the drugs in farming; banning or restricting antibiotics that are vital for human health from being used in animals; using diagnostic tools to reduce inappropriate prescribing; a global public awareness campaign about the problem of drug resistance and increasing the supply of new antibiotic drugs.
Whilst on the program, Professor Paul Cosford from Public Health England said that MRSA rates in our hospitals had been halved over the last ten years. However he failed to mention that progress had slowed and there are now signs of a rising trend. He also referred to the success in reducing Clostridium difficile, the position on Clostridium difficile reductions has also halted, and this is linked to the over-use of antibiotics that contribute to AMR, which he failed to mention. In 2014/15 Clostridium difficile rose by 4% on the previous year in hospital care and 6% in primary care with over 19,000 patients being affected.
Although progress has been made since mandatory reporting of the resistant bacteria MRSA has been introduced, this bacteria continues to show resilience and despite best efforts trends for the last 5 years show an increase in Staphylococcal related infections. Public Health England’s own figures show that in 2011/12 there were 472 hospital reported bloodstream infections, this reduced by 16% the following year to 398, however the trend is turning, and 5 years on there is an overall increase of 11% compared to 2011/12, with the most significant increase seen in 2015/16, a 21% increase over the year with 520 cases. The rise in numbers coincides with the Department of Health’s change in policy on screening for MRSA, from universal screening to targeted screening, it may be early to say if this is a blip, but in our opinion should not be ruled out as a contributing factor.
Professor Cosford was right to highlight that the risk of infection can be significantly reduced with simple hand hygiene, however we would like to point out that hand hygiene compliance in our hospitals is woefully inadequate. Whilst many hospital audits proclaim to be meeting hand hygiene compliance at around 90-100% in reality after over 10 years of having this subject at the top of everyone’s agenda, hand hygiene compliance is more or less at the same level as it was when the World Health Organisation promoted “Cleanyourhands” in 2004, that being around 20-40%.
What we do know in relation to infection levels in our hospitals and healthcare facilities, is that there is a need for everyone to grasp the importance of this keystone procedure in preventing the transmission of microbes that cause infection, and whilst the O’Neill review looks for answers to rising infection rates and AMR, all we have at this moment is hand hygiene, “It really is the here and now” and it works.
Overall we welcome Lord O’Neill’s report, but with some reservation. 50 years ago another report warned of AMR, the Swann Report (1969) in which it was recommended that antibiotics used in human medicine should not be used as growth promoters. Swann also recommended that a committee with authority to review and recommend antibiotic use in man, animals and horticulture be set up. Such a committee was not established until the House of Lords Science and Technology Sub-committee on ‘Resistance to antibiotics and other antimicrobial agents’ in 1998 reminded the Government of the serious situation with respect to resistance and pressed for the long awaited (30 years!) ‘Swann Committee’. The Specialist Advisory Committee on Antimicrobial Resistance was the result.
Since the Review on Antimicrobial Resistance started in mid-2014, more than one million people have died from infections. And in that time doctors discovered bacteria that can resist the drug of last resort - Colistin - leading to warnings that the world was teetering on the cusp of a "post-antibiotic era".
The review says the situation will get only worse with 10 million people predicted to die every year from resistant infections by 2050.
We cannot afford to wait another 30-50 years before action is taken. This issue is the biggest threat to human health over this coming century and unless we can galvanise world leaders to see this problem in its proper perspective then (where the 20th century will be known for the eradication of smallpox and other terrible diseases), the 21st century will go down in history in which mankind lost the battle against bacteria and we are the masters of our own disaster taking us back to the beginning of the 20th century in terms of our decline and inability to treat infections and provide life-saving surgery.
MRSA Action UK