What is Antimicrobial Resistance (AMR)?

Antimicrobial resistance (AMR) arises when the micro-organisms which cause infection survive exposure to a medicine that would normally kill them or stop their growth. This means that the treatments usually used to treat infections caused by a resistant organism will not be effective. 

Many of the medical advances in recent years, for example organ transplantation and cancer chemotherapy, need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. Without effective antibiotics, even minor surgery and routine operations could become high risk procedures if serious infections can’t be treated. 

The UK government published a 20 year vision for antimicrobial resistance in January 2019 (PDF, 739 KB).

Some key information from this document is shown below:

  1. No poverty: AMR strikes hardest on the poor; treatment of resistant infections is more expensive. 
  2. Zero hunger: Untreatable infections in animals threatens sustainable food production for growing populations.
  3. Good health and wellbeing: Antimicrobials are fundamental components of all health systems. 
  4. Clean water and sanitation: Reduces infections and antibiotic residues from multiples sources contaminate water. 
  5. Decent work and economic growth: Cost of AMR is predicted to be US $100 trillion by 2050, driving an extra 28 million people into poverty. 
  6. Responsible consumption and production: It is crucial to balance access and conservation of antimicrobials with innovation, to contain AMR. 

The World Bank estimates that an additional 28 million people could be forced into extreme poverty by 2050, through shortfalls in economic output, unless resistance is contained.

The 20-year vision for AMR

By 2040, the vision is of a world in which AMR is effectively contained and controllled through strong mitigation.

The UK is determined to sustain its efforts to combat resistance, taking local, national and global 'one-health' approaches across humans, animals, the environment and food, in line with global ambitions and in collaboration with other nations, partners and the international community.

In our vision, stakeholders at local, national and global levels are collectively strengthening policy and practice, ever improving understanding through research and surveillance, developing effective regulation and advocacy to contain and control resistence in the UK, we will contribute to the global effort through:

  1. A lower burden of infection, treatment of resistant infection and minimised transmission in communities, the NHS, farms, the environment and all other settings. 
  2. Optimal use of antimicrobials and good stewardship across all sectors, including access to the safe and effective medicines that have been manufactured responsibily for all who need them, achieving usage levels, by sector, as good as the best countries in the world where comparable data is available.
  3. New diagnostics, therapies, vaccines and interventions in use, and a full antimicrobial resistance research and development pipeline for antimicrobials, alternatives, diagnostics, vaccines and infection prevention across all sectors. 

Local AMR work

In response to the first UK national strategy in 2013 a Cornwall antibiotic strategy group (CARG) was convened.

Purpose

  • Responsible for ensuring implementation of UK five year AMR national action plan, specifically supporting delivery of three main strategic aims.
  • Reports to health and wellbeing boards via health protection committee.
  • Also reports into various committees within each stakeholder organisation eg medicines optimisation programme board.

Workstreams

  • Education and engagement with the public.
  • Education and engagement with healthcare workers and vets.
  • Comprehensive stewardship programme for all sectors.

Further information can be found on CARG website.

Primary care

GP practices in Cornwall and the Isles of Scilly have been implementing the TARGET Antibiotics toolkit:

  • Treat
  • Antibiotics
  • Responsibly
  • Guidance
  • Education
  • Tools

The toolkit aims to help influence prescribers and patients personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing. It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use, helping to fulfil continuing professional development (CPD) and revalidation requirements. 

Quarterly antibiotic prescribing data is sent out to GP practices, including data for individual prescribers, so that they can monitor their total antibiotic items and numbers of broad spectrum antibiotics that should be kept to a minimum because of antimicrobial resistance.

Education 

An e-learning for healthcare module on reducing antimicrobial resistance was launched in November 2015.

This module has been designed to support all health and social care staff – both clinical and non-clinical - in a variety of settings to understand the threats posed by antimicrobial resistance, and ways they can help to tackle this major health issue. This programme has been developed by Health Education England in collaboration with Public Health England and NHS England.

Antimicrobial prescribing and stewardship (APS) competencies

The APS competencies can be used by any independent prescriber to help develop their prescribing practice at any point in their professional development in relation to prescribing antimicrobials. There are five competencies:

  1. Infection prevention and control.
  2. Antimicrobial resistance and antimicrobials.
  3. Prescribing antimicrobials.
  4. Antimicrobial stewardship.
  5. Monitoring and learning.

Drug and bug project

The project is a nurse lead innovative programme designed to educate those from both clinical and non-clinical backgrounds in the issues surrounding AMR and how we can all adopt collaborative approach to the way we use antimicrobials - now and in the future across Cornwall. This approach includes promoting better infection prevention and control (IP&C) practices in other health and social care settings outside the hospital setting and also amongst the public.

The project is based at Royal Cornwall Hospital NHS Trust but works closely with all health and social care providers and other community groups throughout out Cornwall.  We particularly want to help people stay well for longer and help them keep safe from harmful infections.

We have worked in collaboration with Devon CCG and developed a learning resource www.utistop.co.uk. This resource goes some way to empowering people in their own homes and carers looking after people at home or in care homes. It provides helpful, short succinct, clear videos that have been clinically written, reviewed and approved.

You can follow the project and keep up to date with all the latest news on AMR and IP&C on Twitter @BugDrugProject or join our group on Facebook: Bug & Drug Project.