The Loss of Antibiotics and its Future Impact on Hospitals and the Prevention of HCAIs Professor Alan Johnson Department of HCAI & AMR National Infection Service Public Health England

Loss of antibiotics and future impact

Loss of antibiotics and future impact

In the face of widespread antibiotic use, resistant bacteria have a selective advantage I have called this principle, by which each slight variation, if useful, is preserved, “Natural Selection” Following exposure to antibiotics, resistant bacteria survive Loss of antibiotics and future impact

Antibiotic Discovery Loss of antibiotics and future impact

Intact Skin is a Barrier to Infection Loss of antibiotics and future impact

Modern medicine provides new opportunities for bacteria New entry portals Surgery/catheters/intubation Immuno-suppression Cancer Rx, transplants Survival of the unfit Vulnerable clustered in hospital Loss of antibiotics and future impact

Modern Medicine Depends on Effective Antibiotics Loss of antibiotics and future impact

Loss of antibiotics and future impact

2.5 x increase in 30-day all cause mortality 3-fold increase in mortality during entire hospital stay Excess LOS of 5 days Loss of antibiotics and future impact

The Five Year UK AMR strategy Overarching goal is to slow the development and spread of antibiotic resistance Three strategic aims: Improve knowledge and understanding of resistance Conserve the effectiveness of existing treatments Stimulate development of new treatments and diagnostics Loss of antibiotics and future impact

The Five Year UK AMR strategy Improving infection prevention and control practices Optimising prescribing practices (stewardship) Improving professional education, training and public engagement Developing new drugs, treatments and diagnostics Better access to and use of surveillance data Better identification of research needs Strengthened international collaboration Loss of antibiotics and future impact

MRSA Among S. aureus Causing Bacteraemia, UK Loss of antibiotics and future impact

MRSA Bacteraemia in England, 2002-2014 Loss of antibiotics and future impact

MRSA in Europe 2006 2014 Data from EARS-Net Loss of antibiotics and future impact Data from EARS-Net

MRSA and E. coli Bacteraemia in England Loss of antibiotics and future impact

Cephalosporin Resistance in E. coli from Blood (%) Loss of antibiotics and future impact

Numbers of E. coli From Blood Resistant to Cephalosporins Loss of antibiotics and future impact

A problem with E. coli bacteraemia… Loss of antibiotics and future impact

% carbapenem resistance Carbapenem Resistance in UK Blood Culture Isolates of E. coli and K. pneumoniae Pathogen % carbapenem resistance 2010 2011 2012 2013 2014 E. coli 0.1 K. pneumoniae 0.4 0.6 0.7 0.8 1.3 Loss of antibiotics and future impact

CPE referred to PHE Data from AMRHAI Reference Unit Loss of antibiotics and future impact Data from AMRHAI Reference Unit

Prudent use of antibiotics Infection control measures Active screening Summary of ECDC Risk Assessment and Guidance for Prevention and Control of CPE Transfer of patients Prudent use of antibiotics Infection control measures Active screening Loss of antibiotics and future impact Available at: http://ecdc.europa.eu/en/publications/Publications/110913_Risk_assessment_resistant_CPE.pdf

The Five Year UK AMR strategy Improving infection prevention and control practices Optimising prescribing practices (stewardship) Improving professional education, training and public engagement Developing new drugs, treatments and diagnostics Better access to and use of surveillance data Better identification of research needs Strengthened international collaboration Loss of antibiotics and future impact

AMR Resource Handbook Loss of antibiotics and future impact

AMR Resource Handbook Loss of antibiotics and future impact

AMR Resource Handbook Loss of antibiotics and future impact

Summary Modern medicine dependent on antibiotics as patients frequently have increased risk of developing infection Need to prolong the efficacy of existing antibiotics Infection prevention and control Antimicrobial stewardship Resources are available to facilitate local AMR action plans (both primary and secondary care - whole health economy) Loss of antibiotics and future impact

Loss of antibiotics and future impact