Antimicrobial resistance
Continuing challenges with antimicrobial resistance
Kate Woodhead RGN DMS provides an insight into the highlights from the Infection 360 conference. High on the agenda was the threat posed by antimicrobial resistance, with a major focus on MRSA.
Infection 360 conference saw the delegates enjoy two days of presentations from a wide range of experts, in early November in Manchester. The first day focused on antimicrobial stewardship and some of the challenging infections affecting patients both in primary and secondary care. Antimicrobial resistance (AMR) has been identified as one of the most pressing global challenges we face in this era. The World Health Organization has identified AMR as one of the top ten global health threats. In 2019 there were 4.95 million deaths associated with bacterial AMR across 204 countries and 1.27 million of those were directly attributable. In 2022, 52,224 people had an antibiotic resistant infection, a rise of 4%, deaths due to severe antibiotic resistant infections also increased from 2021 to 2022.1
It is widely recognised that, in order to
tackle antimicrobial resistance, we need to take specific actions to reduce our reliance on antibiotics or they will become less and less useful in the fight against infections. Many antibiotics currently in use are already resistant to a range of micro-organisms. It is identified that what is required to tackle resistance is: l Early prevention of infections. l Timely, accurate diagnosis. l Appropriate prescribing and use of antimicrobials only where there is an infection for which they are the most appropriate treatment.
l Effective management of infections. l Development of alternatives to current antimicrobials.
The UK government has recently called for expert contributions to the next five-year strategy document, which is due in 2024 to support the twenty-year vision on managing resistance and developing stewardship of the antibiotics we have. At Infection 360, a presentation by Neil Wigglesworth focused on MRSA, which has
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been the cause of many serious infections over the last thirty years. MRSA is a type of Staphylococcus aureus that is resistant to most beta-lactam antibiotics, anti-staphylococcal penicillins (eg methicillin, oxacillin) and cephalosporins. Methicillin is still used to describe resistance due to its historical role. MRSA infections can include syndromes of bacteraemia, pneumonia, endocarditis, joint infections and skin or soft tissue infections. MRSA was an intractable issue particularly for acute care, with many specialties routinely screening patients, particularly pre-surgically. However, after a great deal of effort and hard work by healthcare professionals across primary and acute care, the numbers of infections fell, although there are signs that an increase occurred during the pandemic. Many of the infections were defined as co/secondary infections to COVID-19.
Guidelines for the prevention and control of MRSA During the height of the pandemic, when most IPC professionals were busy with more immediate problems, the Healthcare Infection Society and the Infection Prevention Society published updated guidance for the
management of MRSA.2
There were a number
of significant changes from the previous guidance, which was published in 2006, with the updated recommendations being less prescriptive than before. Thus, at Infection 360, Neil Wigglesworth had been asked to present on the guidance, in case it had escaped notice. He described his role in the guideline development as a minor one, but he was pleased to re-visit the recommendations. He took us gently through the important aspects of the new guidance ensuring that we were informed about what had changed. The whole document includes areas
on screening, management of colonised healthcare staff, environmental screening and cleaning/ disinfection, surveillance, IPC precautions (including isolation and movement of patients and equipment) and patient information. The guidelines review the evidence in
accordance with NICE approved methodology and critical appraisal followed SIGN and other standard checklists. Questions for review were derived from a stakeholder meeting, which included lay representatives in accordance with a PICO framework.
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