The NIHR is tackling one of the biggest public health threats we face – antimicrobial resistance

Resistance to commonly prescribed antibiotics is becoming one of the biggest global challenges we face. Globally, 480 000 people develop multi-drug resistant TB each year, and drug resistance is starting to complicate the fight against HIV and malaria1. Experts are fearing that some previously manageable infections are becoming untreatable with antibiotics. This is why there is an urgent need for research into public health measures, health care interventions and health services to reduce the development and spread of antimicrobial resistance and consequent morbidity.

To help tackle the growing problem of antimicrobial resistance, the NIHR has committed over £91 million into research addressing the use of antimicrobial drugs such as antibiotics. Twenty-one of these studies were funded as part of a specialist call for proposals in the field of antimicrobial resistance. One study recently published in the Journal of Antimicrobial Chemotherapy looked at the social and professional influences on doctors-in-training prescribing antimicrobial drugs.

Most prescribing errors in hospitals are associated with antimicrobial drugs with up to 50% of antibiotic usage in hospitals being inappropriate. The review shows how doctors-in-training often operate within challenging contexts that could influence their prescribing choices.

Chief investigator Dr Geoff Wong, Clinical research fellow at the University of Oxford said: “These results provide an increased understanding of prescribing behaviours of doctors-in-training. This will allow for targeted tailoring, design and implementation of antimicrobial prescribing interventions. Antimicrobial prescribing interventions for doctors-in-training can be embedded more successfully in the hierarchical and inter-professional dynamics of different healthcare settings.”

Read Dr Wong’s blog to find out more.

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Studies that have started recently include a £1.5million trial, the largest of its kind,  looking into antibiotic treatment for sepsis. Researchers in Salford, Manchester and Warwick will determine whether one of two different tests will allow a safe reduction in the time patients in hospital with suspected sepsis are kept on antibiotics.

Professor Paul Dark, NIHR National Specialty for Critical Care and Professor in Critical Care Medicine at the University of Manchester, said: “Sepsis is a very dangerous condition and we have to react very quickly if it’s suspected – it is important to start treating patients as quickly as possible. But there isn’t good quality evidence on which we can base a decision to stop giving antibiotics and that means that even when patients are getting better – and some may not have had sepsis at all – we are still giving antibiotics for at least 7-10 days.

“Ultimately, we want to be able to use antibiotics more effectively, making sure we have the safest possible care for patients. The antibiotics we use for sepsis are the ones we should be preserving, to protect the health of patients both now and in the future.”

A further trial is aiming to tackle the overuse of antibiotics in hospitalised children and reduce the spread of antimicrobial resistance. The BATCH trial (‘Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection’) will use a personalised approach to safely reduce antibiotic duration in children hospitalised with bacterial infection, through the use of a specific blood test called Procalcitonin.

Chief investigator Enitan Carrol, Professor in Clinical Infection, Microbiology and Immunology, at the University of Liverpool said: “Our work on diagnostic and prognostic biomarkers of infection in children with bacterial infection over the past five years, has generated evidence suggesting that a personalised approach using serial measurements of biomarkers, could help to tackle antibiotic overuse in hospitalised children. We are delighted to be leading on this national study which will help to definitively answer that question.”

A five year study aims to reduce the incidence of serious infections caused by antibiotic-resistant bacteria in the future, through substantially and safely reducing antibiotic use in hospitals now. The study addresses the issue that while most antibiotics are started appropriately in hospitals, there is reluctance to stop them once started. Short durations of antibiotic treatment are sufficient to treat most genuine bacterial infections in hospital and clinical review will identify those whose condition has not improved who need to continue taking them.

To find out more read ‘The antibiotic course has had its day’ published in The BMJ.

Alongside individual research studies the NIHR funds research units. This includes two Health Protection Research Units (HPRUs) specifically focused on antimicrobial resistance.

The NIHR HPRU at Imperial College London has developed an online tool to forecast the emergence of bacteria resistant to carbapenems - a last resort antimicrobial. The tool enables not just the detection of epidemics, but also allows them to be predicted. This research could have a beneficial impact on health policy and practice for patients in healthcare settings.

The NIHR HPRU at Oxford University was involved in a study looking to understand the factors that resulted in the decline of C. difficile incidences following a major outbreak in the mid-2000s in the UK.

They found that the incidence of C. difficile infection was most closely linked with national levels of prescribing of the antibiotic fluoroquinolone. Cases fell by 80% when fluoroquinolone use was restricted as part of efforts to control the outbreak. These findings are informing policy on how to avoid further outbreaks in the UK, as well as informing healthcare professionals in other countries where rates remain high.

Reducing antimicrobial resistance is a research priority for the NIHR and we are keen to receive research proposals in this area. Apply now for funding 

 

  1. Figures taken from World Health Organization AMR factsheet http://www.who.int/mediacentre/factsheets/fs194/en/