Antimicrobial Resistance

Baroness Masham of Ilton Excerpts

Thursday 8th March 2018 Grand Committee

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend Lady Greengross for securing this short debate. It may be short but it is of tremendous importance globally. AMR is widely recognised as the biggest threat we face.

Many years ago I was the first person in your Lordships’ House to have a debate on MRSA, after the late Lord Gerry Fitt’s wife died from MRSA in the Chelsea and Westminster Hospital. After that, along with a group from the Science and Technology Select Committee, I went to America to look at the problems around antimicrobials and infection. One of our recommendations was that there should be quick tests for infections so that the correct antibiotic can be prescribed. This is now happening in some places, and that is good news.

The famous physician, Sir William Osler, who is sometimes described as the father of modern medicine, said in 1892 that there are three phases to treatment: diagnosis, diagnosis and diagnosis. In modern times, diagnostics are vital to guiding clinical decision-making, determining whether a patient should be treated with antibiotics, and if so, which ones will be effective.

Sepsis is a bigger killer in the UK than bowel, breast and prostate cancer combined. With the increasing challenges of antimicrobial resistance, it is more important than ever for hospitals to diagnose accurately and rapidly so that patients with sepsis can be treated. The lack of consistency across UK hospitals in their diagnosis of sepsis has been highlighted. Research has found that 56% of hospitals are using only one set of blood cultures where sepsis is suspected rather than the recommended two sets. This leads to much less chance of the successful identification of the bacterium involved.

World Tuberculosis Day is approaching, so I thought it appropriate to remind your Lordships that TB remains the world’s deadliest infectious disease, with 10.4 million people infected and 1.7 million dying from the disease in 2016. In his review on AMR, the noble Lord, Lord O’Neill, estimated that around a third of all AMR-associated deaths are caused by drug-resistant TB. The UK itself struggles with TB and has been known as the drug-resistant capital of northern Europe. I join with the noble Baroness, Lady Suttie, in her remarks on this very important subject.

Until recently, doctors relied on the microscope to identify TB and it took months of growing cultures in laboratories to determine if the strain of TB was drug resistant. However, things have changed for the better with the production of the GeneXpert TB testing machine, which can analyse DNA. The test can identify whether someone has TB and can detect whether there is resistance to one of the main TB drugs, rifampicin. The UK Government have been central to advancing this technology by making a significant investment in it through the Ross Fund. Scientists and policymakers are working to improve this diagnostic tool and ensure that it is used as widely as possible.

The availability of a rapid diagnostic test is vital to fighting AMR and will ensure that those who need antibiotic treatment urgently receive it. It will also ensure that antibiotic drugs are not misused or prescribed inappropriately, thus driving further drug resistance. This is also important to animal health and farming. Exciting research in this field is going on around the world and certain new technologies are now able to determine antimicrobial resistance in as little as 30 minutes. We must invest to drive forward the research and development that will protect patients and the public.

Concern has been expressed about outbreaks of multiresistant hospital bacteria among newborns in hospitals, including in neonatal intensive care and special care baby units. Controlling MRSA has been improved due to hard work, but in high dependency care units where patients are more vulnerable to drug-resistant infections, the risks are great. Is anything being done to systematically collect the data, identify improvements that can be made and fund the emerging diagnostic and monitoring technologies that enable a rapid infection control response?

Another problem that needs addressing is the epidemic of Clostridium difficile-associated diarrhoea in hospital patients, largely attributable to antibiotic overuse. Good work is being done, but it is translation into practice that seems all too slow.

Finally, does the Minister agree that the European Vaccine Action Plan is of great importance? With more and more infections becoming immune to antibiotics, it is vital to prevent conditions such as gonorrhoea, which is resistant to antibiotics and needs a vaccine, as do norovirus, Clostridium difficile, HIV and many others, and a better vaccine is needed for TB. That would make the world a safer place for everyone.