In a guest blog to mark World Antimicrobial Awareness Week, Julie Harris, Consultant Antimicrobial Pharmacist at Swansea Bay University Health Board, explores the impact of antimicrobial resistance, how primary and secondary care in Wales is addressing it, and what innovators can do to support healthcare.
Antimicrobial resistance is one of the biggest challenges that our global population faces this century. When pathogens adapt to the drugs used to treat infections, they become increasingly difficult or even impossible to treat.
No new class of antibiotics have been released to the market since 1987, while the number of pathogens resistant to antibiotics continues to rise, including in Welsh hospitals.
This will have a significant impact on patient care. The impact is already serious: the most recent statistics put the number of worldwide deaths directly caused by antimicrobial resistance at 1.27 million per annum, with 4.95 million dying from illnesses where antimicrobial resistance played a role.
The impact of antimicrobial resistance on healthcare in Wales
Beyond the immediate effects of people becoming unwell due to contracting resistant strains, it can also place a significant strain on healthcare – impacting service delivery and resource. If a patient becomes infected with an antimicrobial resistant strain, then surgeries or treatment might need to be delayed or cancelled.
Patients infected with resistant strains will often require input from specialist teams who need to implement strict infection control and have limited treatment options, therefore becoming infected with resistant strains also alters the quality of life and care that patients receive.
Common infections may become untreatable and routine surgeries such as caesarean sections may be too dangerous to be performed routinely. Patients who are more prone to infections are at particular risk, such as those undergoing cancer therapy or people with co-morbidities.
Dr Richard Evans, Executive Medical Director and Deputy Chief Executive at Swansea Bay University Health Board, summarises the importance of highlighting antimicrobial resistance:
“The threat of antimicrobial resistance needs to reach the same level of awareness as climate change. The threat from multi-drug resistant organisms is not theoretical – it is very real and is likely to become an increasing problem. Although we often discuss antimicrobial resistance and the importance of good antimicrobial governance in a local context, trying to reduce Healthcare Associated Infections in our hospitals and communities, it is essential to remember that this is also helping to combat a global challenge.”
The world has become a small place and resistant strains from other countries can end up spreading quickly. We’ve recently seen researchers raising concerns about how the humanitarian conditions in Ukraine could be leading to the development of resistance.
Of course, local antimicrobial use can also drive resistance: we have seen the number of resistant strains increasing in our hospitals in Wales. We therefore we need global and local solutions developed in tandem.
What is currently being done to tackle antimicrobial resistance?
Organisations and governments are working at a global, national and regional Welsh level, including the World Health Organisation’s Global Action Plan on Antimicrobial Resistance (2015). This has focus on areas such as providing sustainable investment in research and the development of new medicines and diagnostic tools, reducing the risk of infection through improved prevention and hygiene measures, and optimising the use of antimicrobial medicines in animal and human health.
The UK Government’s Five-Year National Action Plan (2019) highlights how we will contribute to the global effort through reducing the burden of infection, optimising the use of antimicrobials and providing effective stewardship, and driving research of new diagnostics, therapies and interventions.
The Welsh healthcare perspective
There are numerous initiatives in Wales to help meet some of these goals, including in Swansea Bay University Health Board in both primary and secondary care.
One example is a move to configure local GP systems to align default prescription settings to the dose and course length recommended within the antibiotic guidelines. This helps us move more towards evidenced-based shorter courses, which can improve patient adherence and lower the risk of acquiring a resistant strain.
To help optimise antimicrobial use, we are also auditing antibiotics that are on a repeat prescription across all practices. This audit data will be fed back to prescribers with best practice advice to help practitioners effectively monitor and discontinue these antibiotics when they are no longer needed.
We are currently focussing on improving the management of urinary tract infections in primary care by optimising antimicrobial treatment, through audit, feedback and education. We are also in the process of developing an electronic template for GP systems to accurately capture and guide consultations for UTIs.
In secondary care, we are using the ‘Antibiotic Review Kit for Hospitals’ (ARK) across all acute sites for paper medication chart and e-prescribing. This aims to reduce antimicrobial use through regular review of all antibiotics, which has been supported by a study published in The Lancet Infectious Diseases.
How can industry help NHS Wales?
The incredible effort being undertaken across our healthcare systems to tackle antimicrobial resistance can be further improved with support from companies working in life sciences and digital innovation. Our work is often constrained by digital systems that aren’t configured to fully support antimicrobial stewardship.
Fully developing our point of care testing and diagnostic services will also help us in addressing antimicrobial resistance. One example is the use of C-reactive protein (CRP) testing in equivocal cases to support diagnosis of active bacterial respiratory infections and prevent unnecessary antibiotic prescribing.
It is essential that solutions are accessible for our NHS – we need to strike a fine balance between the effective use of resources whilst making our services more prudent and efficient.
If you have an innovative product or service that you think could help our healthcare systems in addressing antimicrobial resistance, then please get in touch by emailing firstname.lastname@example.org