A new analysis says that strategies to restrict antibiotic prescribing in primary care are insufficient to halt the growth in drug-resistant E. coli infections in England. The Lancet Infectious Diseases has released the first study of NHS England’s Quality Premium intervention on antimicrobial resistance (AMR).
Antimicrobial resistance (AMR) is a worldwide danger to human health and development. To attain the Sustainable Development Goals, urgent multi-sectoral action is required (SDGs). AMR has been named one of the top ten worldwide public health hazards confronting humanity by the World Health Organization (WHO).
In 2015, the Quality Premium plan was implemented, rewarding groups of general practitioners (GPs) for improvements in care quality, such as lowering improper antibiotic prescribing in primary care.
The current paper, headed by Imperial College London researchers, indicates that while the intervention resulted in a downward step-change in antibiotic prescribing, it only resulted in a minor reduction in antibiotic-resistant E. coli infections. The authors of the study conclude that a single intervention in one area is insufficient to combat the growing threat of AMR; instead, a more comprehensive, multi-sectoral approach is required.
AMR is a serious and growing health problem that kills over 700,000 people per year around the world. Because of its widespread antibiotic resistance, E. coli is of special concern. It is the most prevalent drug-resistant infection, with E. coli accounting for more than half of all drug-resistant bacterial bloodstream infections in the UK, which can lead to sepsis.
The economic burden of AMR is enormous. Longer hospital stays, the need for more expensive drugs, and financial hardships for those affected are all consequences of extended sickness.
We found that although the NHS England Quality Premium on AMR succeeded in reducing broad-spectrum antibiotic prescribing, resistance among E. coli causing bacteremia remains on an upward trajectory, despite an initial attenuation. This highlights the fact that a single intervention alone is not enough to tackle the growing threat of AMR.
Dr. Céire Costelloe
The emergence of resistance among the most significant bacterial infections is widely acknowledged as a major public health concern that affects people all over the world.
Understanding the molecular and genetic basis of resistance is critical for developing ways to prevent resistance from arising and spreading, as well as developing novel therapeutic techniques for multidrug-resistant organisms.
The economic burden of AMR is enormous. Longer hospital stays, the need for more expensive drugs, and financial hardships for those affected are all consequences of extended sickness.
The emergence of resistance among the most significant bacterial infections is widely acknowledged as a major public health concern that affects people all over the world.
Understanding the molecular and genetic basis of resistance is critical for developing ways to prevent resistance from arising and spreading, as well as developing novel therapeutic techniques for multidrug-resistant organisms.
During the six-year period (January 2013 to December 2018) when the NHS Quality Premium was in effect, the Global Digital Health unit at Imperial College London, led by Dr. Céire Costelloe, and colleagues linked data from 6,882 English general practices with Public Health England’s (PHE) National surveillance of bacterial infections.
Prescriptions for the five most popular antibiotics were analyzed, as well as resistance trends in E. coli infections, before and after the intervention. The efficacy of modern medicine in treating infections, notably during major surgery and cancer chemotherapy, would be jeopardized without effective antimicrobials.
Dr. Céire Costelloe, Reader and Director of the Global Digital Health Unit at Imperial College London says: “We found that although the NHS England Quality Premium on AMR succeeded in reducing broad-spectrum antibiotic prescribing, resistance among E. coli causing bacteremia remains on an upward trajectory, despite an initial attenuation. This highlights the fact that a single intervention alone is not enough to tackle the growing threat of AMR.”
“A multifactor, multisectoral, collaborative and global approach is needed, taking into consideration antibiotic use across the entire healthcare economy, in combination with a wider, ‘One Health’ approach, which involves efforts that work nationally and globally to improve health for people, animals, and the environment.”
Before the Quality Premium, GP practices in England prescribed an average of 207 broad-spectrum antibiotic items per 100,000 patients each month. Following the establishment of the Quality Premium, a 13% decrease in prescribing rate was recorded, equating to a reduction of 26 items per 100,000 patients in the English population.
This effect was sustained, with a 57 percent reduction in antibiotic prescribing found at the conclusion of the trial period, compared to projected rates if the intervention had not happened.
A monthly average of 275 resistant E.Coli isolates per 1000 isolates tested against broad-spectrum antibiotics were reported to Public Health England in the months leading up to the adoption of the Quality Premium.
Following the adoption of the Quality Premium, a 5% drop in resistance rate was reported, corresponding to a reduction of 14 resistant E.Coli isolates per 1000 isolates analyzed. Despite the fact that this decrease lasted until the end of the trial, E.Coli resistance continues to rise, albeit at a slower rate.
Co-author Shirin Aliabadi, a research postgraduate in the Global Digital Health unit at Imperial College London, and NHS Pharmacist says: “Antimicrobial resistance is predicted to kill 10 million people per year by 2050. Naturally, the nation’s efforts and resources have shifted to responding to the ongoing COVID-19 crisis but our findings suggest that we must nevertheless consider the growing threat of antimicrobial resistance, which can be a viewed as a silent pandemic.”
Co-author Professor Azeem Majeed, GP, and Head of the Department of Primary Care and Public Health, Imperial College London, says: “My colleagues in primary health settings have done the right thing and responded to the focus on their prescribing of antibiotics, but to combat the devastating impacts of antimicrobial resistance, we need global, coordinated efforts and new drugs to treat resistant infections.”
“If the COVID-19 pandemic has taught us anything, it is that we can move fast in the face of large-scale epidemics. If we apply some of the recent lessons learned and work together, we can achieve a great deal in a short time. I hope this is possible.”
