Antimicrobial resistance
Tackling the AMR crisis in healthcare
Experts at the Infection Prevention and Control (IPC) conference discussed the scale of the antimicrobial resistance (AMR) crisis, hidden ways in which healthcare is contributing to the problem, and actions that could be taken. Louise Frampton reports on the issues raised, as part of CSJ’s focus on World AMR Awareness Week, taking place 18-24 November.
The threat posed by antimicrobial resistance (AMR) was high on the agenda at the Infection Prevention and Control (IPC) conference this year. Professor Mark Wilcox, National Director for Antimicrobial Resistance and Infection Prevention and Control, NHS England, highlighted some disturbing epidemiology regarding the rates of acquired carbapenemase-producing Gram-negative episodes, which have shown a worrying rise over the past three years. Samples suggest that the North-West has a particular problem with carbapenemase- producing Gram-negative infections, and the data shows a preponderance of Klebsiella pneumoniae carbapenemase (KPC) positive samples in the North-West – unlike other parts of the country. He went on to highlight some hard-hitting facts – including figures from WHO that suggest that bacterial resistance was directly responsible for 1.27 million global deaths in 2019. Furthermore, this figure is estimated to become 50 million by 2050, if we do not reverse current trends. In addition, these 50 million deaths will outnumber cancer deaths. Prof. Wilcox presented a graph indicating
the predictions for the number of additional deaths per year for various surgical specialties, based on four scenarios of decreased efficacy of antibiotic prophylaxis (a 10%, 30%, 70% and 100% increase in resistance). The projections show that the increase in deaths for specialties where there is a frequent risk of contamination, such as colorectal surgery, will be very marked indeed. “This isn’t just conjecture; we are already seeing increasing levels of resistance to co- amoxiclav – one of the most frequently used antibiotics used for surgical prophylaxis,” he commented. Prof. Wilcox highlighted a new report by the Global Leaders Group on Antimicrobial Resistance1
“If that doesn’t make politicians wake up and carry out the much-needed actions, nothing will. It is not just politicians, of course; all of us need to maximise our efforts,” he asserted. He highlighted the need for “diagnosis not
guesswork”. One of the key recommendations of Jim O’Neil’s AMR review, published in 2026, was the need for rapid diagnostics and to cut the use of unnecessary antibiotics. There has been some progress since the publication of the report – particularly during the pandemic, when “our eyes were opened about how rapid diagnostics can make a real difference”. Nevertheless, Prof. Wilcox added that we
, which states that the average global
life expectancy will fall by 1.8 years over the next decade because of AMR.
have not made enough progress – Jim O’Neil’s recommendation of “No antibiotic without a diagnostic test by 2020” has not been achieved, with the majority of antibiotic prescriptions (80%) currently being issued based on ‘best guess’. A Longitudinal Prize of £10 million was set up in 2014 to develop a new diagnostic test for bacterial infections that is ‘accurate, rapid, affordable and easy to use anywhere in the world.’ The prize had still not been awarded (at
the time of this presentation); the prize was eventually awarded to a rapid UTI diagnostic in June 2024 (
https://amr.longitudeprize.org/ blog/the-long-read-we-must-do-better-for-uti- patients/). “The long delay in making this award reflects the difficulty in developing and then proving that new tests can make a difference,” he commented. He highlighted the need to build on the momentum of the pandemic, adding: “We need to exploit rapid tests that are as accurate as possible to minimise the guesswork.” In April 2022, NICE issued a news story that
it had reached an important milestone in the UK’s efforts to tackle antimicrobial resistance, with two new antimicrobial drugs being “close to becoming the first to be made available as part of the UK’s innovative subscription-style payment model”.2 Sometimes described a ‘Netflix’ style
subscription model, these contracts are not based on the ‘volume of use’; instead, the value of the antibiotics is calculated, and an award made accordingly.
November 2024 I
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