1. 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

2. Loss of antibiotics and future impact

3. Loss of antibiotics and future impact

4. 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

5. Antibiotic Discovery
Loss of antibiotics and future impact

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

7. 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

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

9. Loss of antibiotics and future impact

10. 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

11. 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

12. 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

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

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

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

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

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

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

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

20. % 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

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

22. 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:

23. 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

24. AMR Resource Handbook
Loss of antibiotics and future impact

25. AMR Resource Handbook
Loss of antibiotics and future impact

26. AMR Resource Handbook
Loss of antibiotics and future impact

27. 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

28. Loss of antibiotics and future impact