Without action on antimicrobial resistance, even minor surgery could see a higher risk of mortality.
Photograph: Bisual Studio/Stocksy United
They are one of the most crucial parts of modern healthcare, allowing us to treat infections that might otherwise be deadly and making life-saving surgery and treatments such as organ transplants and chemotherapy possible. But the effectiveness of antibiotics is so threatened by the rise of antimicrobial resistance (AMR) that Dame Sally Davies, England’s chief medical officer, has warned that without action now, even minor surgery could lead to routine deaths within the next 20 years.
“According to the World Health Organization (WHO), AMR is one of the top challenges to continued way of life on Earth, alongside climate change,” says Greg Quinn, director of public policy and advocacy at healthcare company BD. And although the resistance of bacteria to antibiotics was predictable – it was foreseen by Alexander Fleming in his Nobel prize acceptance speech back in the 1940s – today it’s a far more worrying prospect for two reasons, says Dr Nicholas Brown, a consultant microbiologist at Addenbrooke’s hospital in Cambridge and director of the public and professional engagement for the British Society for Antimicrobial Chemotherapy (BSAC), one of the UK’s leading antibiotics charities.
“Whereas in the past, when resistance developed, we could simply turn to an alternative antibiotic, now we don’t have the ready supply of new agents to take over,” Brown says. “At the same time, the rate of emergence of resistance appears to be accelerating.”
It’s encouraging, says Quinn, to see consensus and coalitions at country, regional and global levels – including the UK’s own 20-year vision and five-year national action plan for how the UK will help contain and control AMR – but it’s now time for action. “Nobody argues with the strategy, but everybody has a part to play to mobilise much smarter implementation,” he says.
For him, the role of rapid diagnostics and point-of-care diagnostics is key – and underdeveloped. Broad-spectrum antibiotics are routinely given to patients coming to emergency departments with infection-related problems from chronic conditions such as chronic obstructive pulmonary disease or diabetes complications, he explains, and it can take two or three days to get a more targeted drug. But it’s the overuse of broad-spectrum antibiotics that’s one of the major causes of AMR, and meanwhile the patient is taking a drug that may not be effective.
“Point-of-care and rapid diagnostics enable you to drastically reduce not only the timeline but also the broad-spectrum treatment, which is such a big driver of AMR,” says Quinn. “Diagnostics are critical to ensure that the right treatment is used at the right time.”
The integrated approach taken by BD Life Sciences is essential, says Dr Tracy Ellison, director of medical affairs for Europe at the company’s pre-analytical systems division. “If someone shows up at a hospital emergency department with an infection, think about the journey they go on: it has many, many touchpoints,” she says.
“If you’re poorly, you’re going to have some blood taken. You need to make sure that your arm’s cleaned properly before they stick a needle in, because you can get false positives from the bacteria on your skin.
“You could also have false negatives if you don’t have enough blood in the bottle. The pre-analytical elements associated with how we collect samples are so important. Then there’s the transport, which needs to be done swiftly, keeping samples at the right temperature, and testing at a laboratory with an efficient processing environment – all with the aim of getting an actionable result, and getting the patient the right antibiotics as quickly as possible.”
But while diagnostics are important, so is the stewardship of existing antibiotics. Last year a government-funded study found that GPs were wrongly giving antibiotics to one in five patients who had a cough or sore throat. However, in the past there have been improvements when goals have been set to reduce prescribing antibiotics.
Quinn, however, thinks health professionals may be mistaken in assuming patients won’t be satisfied unless they get antibiotics: “A lot of research shows that what they actually want is an acknowledgement there is a problem and a plan to address it. It could be antibiotics, but it could also be a supportive: ‘Buy an over-the-counter remedy, go to bed for two days, then go back to work.’”
And it’s not enough simply to protect existing antibiotics. “The other side is around the stimulation of the drug development market to encourage the discovery, development, licensing and marketing of new agents,” says Brown. “This is really a multifaceted response.”
In face of the grave threat posed by AMR, partnerships between all stakeholders, including industry competitors, are vital, says Quinn. “With AMR the answer isn’t with one person or group, so we strive to facilitate collaboration between people and organisations who can combine to drive the solution,” he says. “It’s critical to our mission that we do everything we can.”
