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Resistance to carbapenems

There is rising resistance to carbapenems, a class of antibiotics that constitute doctors' last good line of defence against a range of potentially life-threatening infections such as pneumonia and bloodstream infections.1

"The good health of all people in the world, both now and in the future, is dependent on our capacity to maintain and build upon modern advances in medicine. Much of the progress we’ve made in medicine over the last century is due to antimicrobials, specifically antibiotics. AMR poses a grave threat to our global capacity to continue to deliver modern medicine and develop modern health systems in low-and middle-income countries".2

The number of E. coli blood stream infections (BSIs) diagnosed across the UK has increased from 45,885 in 2015 to 50,400 in 2017 (a change in rate from 70.5 to 76.8 per 100,000 population).

In some countries, the level of resistance among Gram-negative organisms is so high it is compromising the ability to provide safe healthcare.3

Antimicrobial stewardship identified as one of the key responses to this challenge1

Three major goals of antimicrobial stewardship1

  • Optimise therapy for individual patients
  • Prevent overuse, misuse and abuse
  • Minimise development of resistance at patient and community levels

Referrals of Enterobacteriaceae to the AMRHAI Reference Unit increased year-on-year, with approximately 3000 isolates confirmed as positive for at least 1 carbapenemase in 2017.4

Number of confirmed CPE isolates referred to PHE’s AMRHAI Reference Unit, 2008-20174

Full preview Number of confirmed CPE isolates referred to PHE’s AMRHAI Reference Unit

English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2018

Antibiotic susceptibilities of carbapenemase-producing Enterobacteriaceae isolates submitted to AMRHAI, where susceptibility testing was performed, 2017 (n=708)5.

a) Susceptibility defined using BSAC v. 13 (June 2014) breakpoints
b) Diagnostic test to distinguish metallo- from non-metallo- enzymes; not for therapeutic use

References

  1. Walker D and Fowler T. Annual Report of the Chief Medical Officer. Volume Two. London: Department of Health, 2011
  2. Davies, S.C. “Annual Report of the Chief Medical Officer, 2019 Health, our global asset – partnering for progress”. Department of Health and Social Care (2019)
  3. Tackling antimicrobial resistance 2019–2024 The UK’s five-year national action plan Published 24 January 2019
  4. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2018. Contains public sector information licensed under the Open Government Licence v3.0.https://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/
  5. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2017. P.g 26. Published: October 2017. Contains public sector information licensed under the Open Government Licence v3.0. https://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/