NHS set to miss key targets in fight against antibiotic-resistant infections

As part of the government’s 2019 five-year-action plan to tackle the growth in antimicrobial resistance, the NHS was set the target of reducing the number of healthcare-associated bloodstream infections of three gram-negative bacteria by 25 per cent by March this year, and 50 per cent by the end of March 2024.

Infections caused by E coli, pseudomonas aeruginosa and klebsiella can cause urine or wound infection, blood poisoning or pneumonia. The AMR action plan said: “In the UK, the biggest drivers of resistance [include] a rise in the incidence of infections, particularly gram-negatives.”

Last week, health and social care secretary Sajd Javid stressed the continuing importance of the issue, stating that antimicrobial resistance is “one of the biggest health threats facing the world”.

Analysis by HSJ has shown there has been only a small decline in the numbers of cases involving the three bacteria since monitoring started. The baseline for measuring the reduction was 2016-17, when there were 23,037 healthcare associated infections related to the bacteria.

The target for the end of the 2021-22 financial year was therefore 17,278. However, ffigures for the first nine months of the last financial year – the latest available – show that there were a total of 15,636 healthcare-associated infections related to the three bacteria. The full year figure, based on extrapolating this, would be 20,848.

A key advisory committee to the government has said achieving the 50 per cent reduction will be very challenging, in part due to the diversity of underlying causes of these infections. Minutes of a meeting of the advisory committee on antimicrobial prescribing, resistance and healthcare-associated infection revealed it has asked for evidence-based recommendations “on whether the target should be adjusted and on what a more appropriate target for the national action plan may be if so”.

The current baseline does not capture infections where there was a history of recent healthcare intervention – such as antibiotic prescribing or catheterisation. When these are added in the baseline could rise to 32,038 but it is unclear how any change in baseline will relate to ongoing infection figures published by the United Kingdom Health Security Agency.

The Department of Health and Social Care has commissioned academics at Strathclyde University to carry out modelling work to inform these recommendations. HSJ understands this work will not be complete until later this year.

The NHS England web page dealing with the gram-negative infections does appear to suggest the 50 per cent target has been shifted to March 2025. However, an  NHSE spokesperson insisted this was not the case. 

Senior figures in infection prevention and control do not believe the government target will have been met. Dr Luke Moore, a trustee of the Healthcare Infection Society, said: “Having a quarter reduction by the end of March is not going to happen.” He was “pessimistic” that the NHS ”will meet the 2024 target”.

Another senior infection prevention and control figure said reducing gram-negative cases was proving a lot more complex than reducing MRSA numbers – which the NHS managed to do in the early 2010s.

Both they and Dr Moore agreed the pandemic had affected progress on gram-negative bacteria, with focus on some basic transmission-related measures designed to stop the spread of covid. Tackling the spread of gram-negative bacteria often required a different approach – for example, looking at the use of catheters.

During the pandemic the number of E coli cases dropped but there were spikes in the number of klebsiella and pseudomonas aeruginosa cases during hospitalisation peaks.

A DHSC spokesperson said: “We are reducing the incidence of gram-negative bloodstream infections in the UK and have so far commissioned work to model clinical pathways and the impact of various interventions in this area.”