Antibiotic-Resistant Bacterial Infections

Lord Turnberg Excerpts

Wednesday 24th July 2013 Grand Committee

[Lord Turnberg]

My Lords, this has been a remarkable and important debate. I am grateful to the noble Lord, Lord Crisp, for laying out the issues so clearly, and for the many valuable contributions made by other noble Lords.

The noble Lord, Lord Crisp, spoke very persuasively about the global impact of infectious diseases, especially in the third world, a point re-emphasised by the noble Lord, Lord Trees. However, I am going to narrow my focus to the problems in the UK. There is little doubt that infectious diseases that we once thought had been conquered never really went away. They are rearing their collective head once again. With about 5,000 deaths a year from gram-negative sepsis in the UK alone, we cannot afford to be complacent. No sooner have we managed to get a grip on one set of antibiotic-resistant bacteria, MRSA and Clostridium difficile, than another set has appeared, but the fact is that we managed to have an impact on MRSA through a concerted and focused effort. That suggests at least that we can do something if we put our minds to it.

However, we are now faced with a new set of antibiotic-resistant germs that pose a major threat to the population, in particular to highly susceptible subgroups of the population. These are the gram-negative bacteria, particularly E. coli and Klebsiella species, which make up more than a third of all causes of bacteraemia reported to the Health Protection Agency—now the public health laboratories. It is worth noting that septicaemia due to E. coli has a 30% mortality rate. These bacteria are now the biggest threats, but others are creeping up on us. We are seeing more cases of resistant gonorrhoea, a very common disease, and multidrug-resistant TB, which is much less frequent at least in the UK but still very disturbing—a point well made by the noble Baroness, Lady Masham. The reasons for all these rises are complex and multiple. They include the increase in the number of vulnerable patients—the very young and the very old, and those with diseases that lower their resistance, such as cancers and leukaemia—and the powerful immunosuppressive treatments that they need. Bringing them close together in a hospital or a care home increases their risk. We have heard about the overprescribing of broad-spectrum antibiotics that allow the evolution of resistant strains.

Perhaps the major impact of inappropriate or over- prescribing has been felt in Asia, particularly in China and the Indian subcontinent, with their huge populations, as the noble Lord, Lord Trees, emphasised. Here, there has been a dramatic rise in antibiotic-resistant strains and they are increasingly being imported as international travel grows. There are now no more frontiers that can stop the spread of germs. So what is to be done?

It is possible to reduce the spread of antibiotic resistance. We reduced the incidence of MRSA and C. difficile by a combination of spreading good practice—with handwashing or alcohol hand rubs at the bedside, and nasal swabbing of all admissions to pick up carriers—and better management of intravenous lines and better infection-control measures. They all played a part. The noble Lord, Lord Trees, spoke about the zoonoses. Stopping a few years ago the practice of using antibiotics in animal feeds to promote growth must also have been very valuable. Concerted action can therefore work. We must once more pay attention to the recommendations of the Chief Medical Officer in her admirable report of 2011. Here it was proposed that we should ensure that NHS trusts and their chief executives manage, report and audit infection rates. That was successful before, and we must place even more emphasis on it in the duties placed on NHS England and CCGs. Spreading the message yet again about thoughtful prescribing of antibiotics, both in general practice and in hospitals, has never been more important.

However, we also need some different approaches. We desperately need better and quicker diagnostic tests for bacteria and their resistance. It now takes about 48 hours or more to get a report from the laboratories on what bacteria are responsible for an infection. Meanwhile, one is faced with treating a serious infection blindly or not at all—a point made by the noble Lord, Lord Crisp, and the noble Baroness, Lady Masham. Tests are becoming available, using genetic profiling or next-generation sequencing, that will bring the time for diagnosis down to a very few hours. If we can get there, antibiotic prescribing will become much refined and we will be able to avoid giving ineffective antibiotics. There is also a desperate need for new antibacterials.

It is unfortunately the case, as has been emphasised by a number of noble Lords, that the pharmaceutical company pipelines are pretty low at the moment. The cost of the development of new drugs is prohibitive and too often drug companies are inhibited by overregulation and cost. The noble Baroness, Lady Masham, mentioned that and the noble Countess, Lady Mar, underlined the point. It has been suggested that the Government might encourage investment in R&D by industry through such measures as prolonging the period during which the patents for new antibacterial drugs may be retained, or by a more favourable tax regime for companies developing those drugs. Perhaps we should take note, too, of the ideas expressed by the noble Countess, Lady Mar, about a multipronged attack; I found those very attractive. It seems to me that we must do more in these two areas: more research into rapid diagnostic techniques and more engagement with and encouragement for industry to develop new antibacterials.

My questions for the Minister are as follows: what efforts are the Government making to ensure that NHS England, the CCGs and hospital trust boards are keeping infection control high on their agenda? In what way are the Government ensuring that the laboratories of Public Health England are given the necessary research funds to develop new rapid diagnostic tests for bacterial resistance? Have the Government paid any attention to the incentives they need to provide for the pharmaceutical industry to invest in a search for new antibacterials? I have not spoken about the area of vaccines, although clearly it is very important. The noble Countess, Lady Mar, drew to our attention the issue of the meningitis B vaccine, and I hope that the noble Earl will be able to respond to that.

This has been a valuable debate on an important subject and I look forward very much to the noble Earl’s response.