Antibiotic-Resistant Bacterial Infections

Baroness Masham of Ilton Excerpts

Wednesday 24th July 2013 Grand Committee

[Baroness Masham of Ilton]

My Lords, I thank my noble friend Lord Crisp for securing this most important debate. I declare an interest as, over the years, my life has been saved by the use of antibiotics, and I personally know how important they are for the correct infection.

Is there a problem of people sharing medication such as antibiotics, or stopping taking them when they feel better, thus causing drug resistance? After I brought up the subject of MRSA in your Lordships’ House in 1996, I was a member of the Science and Technology Select Committee’s sub-committee on resistance to antibiotics and other antimicrobial agents from 1997 to 1998, chaired by the noble Lord, Lord Soulsby of Swaffham Prior. We went to Washington, Atlanta and Boston. The amount of research being undertaken in America left a lasting impression. I am pleased that there is a vet speaking in this debate. It is most important that there is good co-operation between human and veterinary medicine.

Antibiotic-resistant bacterial infections are a worldwide problem, and given the economic situation we are in, there should be the greatest cohesion. In the community there is a dangerous toxic substance produced by some strains of staphylococcus aureus called Panton-Valentine leukocidin which can kill within 24 hours. The infection can be contracted from gorse bushes, in military camps, colleges and playgrounds—that is, places where young people often gather together. It seems to be more prevalent in the USA and therefore we should be learning from that country. It is vital that a quick and correct diagnosis is made, and GPs and hospital doctors must be aware of the symptoms that suggest an illness could be PVL-positive MRSA.

The overuse of antibiotics and thus the increasing resistance of bugs to them have led to fears that soon we may run out of effective treatments. Microbes are mutating faster than scientists can come up with new antibiotics. According to the World Health Organisation, some 440,000 new cases of multidrug-resistant tuberculosis are diagnosed every year, causing at least 150,000 deaths. A mutant strain of gonorrhoea, which has emerged in Asia, could be more devastating than AIDS. Antibiotic-resistant strains of e-coli are on the rise, particularly among the elderly, and there are risks from common infections such as pneumonia and urinary tract infections.

What can be done to give the pharmaceutical industry incentives to develop more antibiotics? The absence of rapid diagnostic tests for tuberculosis is further compounded by a widespread inability to screen for drug-resistant bacteria. An ideal diagnostic test for respiratory tract infections should be rapid, cheap, easy to use, sensitive and specific, and should screen for many micro-organisms and their antibiotic resistance. The diagnostic platform should be transportable and robust; ideally, it should also be able to be run on solar power for use in remote healthcare settings in developing countries. In Australia there is such a portable box, called the “lab without walls”, so progress is being made. To achieve this across the world, physicians, scientists, biotechnology companies, funding agencies and Governments need to work together to drive the development of improved diagnostic tests for both developed and developing countries.

Here in the UK we have seen the emergence of multidrug-resistant tuberculosis among homeless people. This should be a wake-up call for us all. I have great admiration for the Find&Treat service, which works with the most vulnerable and excluded people in our society to ensure that they can access diagnostic services and complete tuberculosis treatment. Homelessness is an independent risk factor for multidrug-resistant disease, as is birth in east Asia or eastern Europe or a history of previous tuberculosis treatment. Funding for the Find&Treat service is secure only until March next year, and it still has not been able to replace its only current mobile unit, which is on its last legs. The unit goes around hostels for the homeless and other places in order to test the vulnerable. I stress that the effective control of TB is important to wider public health, and interventions must be made in complex cases. I hope that Public Health England will take this on and work with NHS England.

A dual HIV/MDR TB infection complicates patient management, compromises treatment options and leads to poorer treatment outcomes and greater disease transmission. Basic and clinical research is needed to explore any possible causal relationship between HIV infection and MDR TB specifically.

Extensively drug-resistant TB, which is resistant to at least four of the core anti-TB drugs, and MDR TB both take substantially longer to treat than ordinary TB and require the use of second-line anti-TB drugs, which are more expensive and have more side effects than the first-line drugs. Very worryingly, in some countries extensively drug-resistant TB is on the increase. The modern world is now very accessible. There should be no complacency. All Governments across the world should realise the risk to their populations posed by antibiotic-resistant bacterial infection, and should work closely with the World Health Organisation.