Tackling antimicrobial resistance 2019 to 2024: addendum to the UK's 5-year national action plan - GOV.UK

2022-05-28 22:04:47 By : Ms. Tracy Lee

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This publication is available at https://www.gov.uk/government/publications/addendum-to-the-uk-5-year-action-plan-for-antimicrobial-resistance-2019-to-2024/tackling-antimicrobial-resistance-2019-to-2024-addendum-to-the-uks-5-year-national-action-plan

This addendum sets out changes to the commitments in Tackling antimicrobial resistance 2019 to 2024: the UK’s 5-year national action plan. The national action plan is in its third year of delivery and these changes were required to make the commitments:

The Department of Health and Social Care (DHSC) worked with other government departments and agencies, as well as the devolved governments in Scotland, Wales and Northern Ireland to consider, review and update the commitments published in the national action plan. Changes to the human health commitments were approved by a sub-group of the expert committee for Antimicrobial Prescribing, Resistance and Healthcare Associated Infections (APRHAI). Animal, plant, and environment commitments were reviewed, and changes approved, by the Cross-Defra Steering Group. The changed commitments maintain the overall ambition of the UK antimicrobial resistance (AMR) programme and will support progress towards the UK’s vision to contain and control AMR by 2040.

Changes to the commitments were approved by the Secretary of State for Health and Social Care and the Secretary of State for Environment, Food and Rural Affairs in March 2022.

In January 2019, the UK government published its vision for AMR to be contained and controlled by 2040. The vision recognises that a global problem as significant and complex as AMR requires a long-term course of action that progressively strengthens our understanding of AMR and what works to contain and control it.

In support of the vision, the government also committed to develop a series of 5-year national action plans that will each prioritise actions and direct resources based on the latest information about what the biggest risks are, and which interventions are most effective in addressing them. The government’s current 5-year national action plan in support of the 20-year vision was also published in January 2019 and will run until 2024.

The current national action plan focuses on 3 key ways of tackling AMR:

The plan also sets out 4 measures of success to ensure progress towards our 20-year vision. These include, among others, targets to:

In total 93 commitments have been reworded, 17 new commitments have been added, and 8 commitments have been removed. As well as reflecting lessons learned during the COVID-19 pandemic, the proposed changes:

Detail of the changes to the commitments can be found below, according to chapters in the UK AMR national action plan.

To strengthen global collaboration, the UK will:

To support countries to prevent, diagnose and treat infection, the UK will:

To support research and innovation, working with the research community and the private sector the UK will:

To strengthen the prevention and control of priority infections, the UK will:

To improve the professional capacity and capability for infection prevention and control (IPC), the UK will:

To promote better IPC practices among the public, the UK will:

To turn research into practice for effective IPC, the UK will:

To support greater access to clean water and sanitation, the UK will:

To promote animal husbandry that prevents endemic diseases, the UK will:

To better understand how AMR spreads within and between animals, humans and the environment, and how to control it, the UK will:

To deepen understanding about AMR in the environment, the UK will:

To minimise antimicrobial contamination, the UK will:

To strengthen the evidence base for AMR and food safety, the UK will:

To promote good practice across the food chain, the UK will:

To strengthen stewardship programmes, the UK will:

To improve data management, the UK will:

To promote evidence-based guidance and interventions, the UK will:

To strengthen stewardship for responsible use, the UK will:

To improve data and control, the UK will:

To harmonise data collection and use, the UK will:

To enhance existing data and guidelines, the UK will:

To strengthen laboratory capacity and surveillance of AMR in animals, the UK will:

To provide strategic leadership in AMR research, the UK will:

To strengthen our insight and capacity for doing high-quality research, the UK will:

To support the development of new therapeutics, the UK will:

To support global initiatives increasing access and stewardship, the UK will:

To strengthen national procurement and supply, the UK will:

To incentivise R&D for new diagnostics, the UK will:

To support rapid uptake of diagnostics, the UK will:

To stimulate broader access to vaccines for humans and animals, the UK will:

To stimulate more R&D into vaccines and alternatives, the UK will:

To improve quality assurance of AMR health products, the UK will:

Acquired immune deficiency syndrome (AIDS): the name used to describe a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus.

Agriculture: the cultivation of land and breeding of animals and plants to provide food, fibre, medicinal plants and other products.

Antimicrobial: a drug that selectively destroys or inhibits the growth of microorganisms. Sometimes referred to as an ‘antimicrobial agent’. Examples include antibiotics (also known as antibacterials) antivirals and antifungal agents. In this document, antimicrobials includes anti-infectives where that would be relevant in the context of the text.

Antibiotic resistant bacteria: bacteria with the ability to resist the effects of an antibiotic to which they were once sensitive.

Antibiotic resistant genes: occurs due to changes, or mutations, in the DNA of the bacteria, or the acquisition of antibiotic resistance genes from other bacterial species through horizontal gene transfer.

Anti-infective: is a general term used to describe any medicine that can inhibit the spread of an infectious organism; in this document, it includes cleaning products such as antibacterial sprays.

Animals: unless specified otherwise, the term animal is used in this publication to refer to food-producing animals and aquaculture as well as companion animals and horses.

Antimicrobial resistance (AMR): occurs when the microorganisms that cause disease (including bacteria, viruses, fungi and parasites) cease to be affected by the drugs we use to kill them and treat the disease.

Antimicrobial stewardship (AMS): a key component of a multifaceted approach to improve the safety and quality of patient care whilst preventing the emergence of AMR. Good antimicrobial stewardship involves selecting an appropriate drug and optimising its dose and duration to cure an infection while minimising toxicity and conditions for selection of resistant microbes. Good AMS includes a review of the continuing need for antibiotics following clinical diagnosis and documented actions to stop, continue or change antimicrobial treatment.

Autologous vaccines: a therapeutic agent produced by isolating cells from an individual and processing these cells into a vaccine formulation for treatment of that individual.

Bacteriophage: a group of viruses that infect specific bacteria, usually causing their disintegration or dissolution.

Bacteraemia: the presence of bacteria in the bloodstream.

Broad-spectrum antibiotics: these are drugs effective against a wide range of bacteria. For example, meropenem is a broad-spectrum antibacterial. Their use needs to be limited to resistant infections because they tend to increase the risk of resistance in other bacteria.

Carbapenems: broad-spectrum antibiotics, often used as the last line of treatment for hard to treat human infections caused by Gram-negative bacteria.

Carbapenemese producing Gram-negative organisms: a group of bacteria that is resistant to carbapenems class of antibiotics.

Cephalosporins: a class of beta-lactam antibiotic exhibiting broad-spectrum activity to bacteria.

Third-generation cephalosporins: cephalosporins with activity against a wide range of Gram-positive and Gram-negative bacteria.

Commensal: living on or within another organism and deriving benefit without harming or benefiting the host individual.

Commissioning for Quality and Innovation (CQUIN): an NHS initiative intended to deliver clinical quality improvements and drive transformational change in the acute sector or hospitals. Achieving improvement against a defined set of criteria enables an NHS trust to qualify for a payment.

Critically important antimicrobials (CIAs): antibiotics identified by the World Health Organization as critically important for human health and their use needs to be restricted, especially in the veterinary sector. In the UK, we use the European Medical Agency definition of the CIAs. There are 3 classes of highest priority CIAs to which the animal industry applies restrictions.

Disease burden: includes the number of infections in the population and includes economic costs like treatment costs and the cost to health in terms of mortality and morbidity.

Escherichia coli (E. coli): a type of bacteria common in human and animal intestines, and forms part of the normal gut flora (the bacteria that exist in the bowel).

Extended-spectrum beta-lactamase (ESBL): enzymes that can be synthesised and expressed by bacteria, resulting in resistance to many penicillin and cephalosporin antibiotics and often to other types of antibiotic. In humans, the most frequently identified bacteria that produce ESBLs are Escherichia coli (E. coli) and Klebsiella species. The ESBLs that E. coli most often produce are called CTX-M enzymes. E. coli with ESBLs may cause urinary tract infections (UTIs) that can sometimes progress to more serious infections like blood poisoning.

Falsified medications: medications that deliberately or fraudulently misrepresent their identity, composition or source and are likely to be ineffective.

G7: the Group of Seven (G7) is a group consisting of Canada, France Germany, Italy, Japan the United Kingdom, and the USA. These countries, with the seven largest advanced economies in the world, represent more than 62% of the global net wealth.

G20: the Group of Twenty (G20) is an international forum for the governments and central bank governors from Argentina, Australia, Brazil, Canada, China, the European Union, France, Germany, India, Indonesia, Italy, Japan, Mexico, Russia, Saud Arabia, South Africa, South Korea, Turkey, the United Kingdom and the USA. Founded in 1999, the G20 aims to discuss policy pertaining to the promotion of international financial stability.

Gram-negative bacteria: those bacteria that do not retain crystal violet dye in the Gram-staining procedure. They can cause many types of infection and include E. coli and Pseudomonas aeruginosa.

Gram-positive bacteria: those bacteria that are stained dark blue or violet in the Gram-staining procedure. They include Staphylococcus aureus and Clostridium difficile.

Healthcare associated infections: infections associated with the provision of healthcare in hospital or community settings.

Healthcare associated Gram-negative blood stream infection: a laboratory-confirmed positive blood culture for a Gram-negative pathogen in patients who had received healthcare in either the community or hospital in the previous 28 days.

Hepatitis C: a virus that can infect the liver.

Human immunodeficiency virus (HIV): a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease.

Inappropriate prescribing: for the purpose of delivering the ambition of halving inappropriate prescribing in the UK, inappropriate prescribing is defined as:

Intestinal infectious diseases: viral, bacterial or parasitic infections that cause gastroenteritis, an inflammation of the gastrointestinal tract involving both the stomach and the small intestine.

Klebsiella spp: Gram-negative bacteria that can cause infections including bloodstream infections; wound or surgical site infections; and meningitis.

Low- and middle-income countries (LMICs): as included in the OECD Development Assistance Committee (DAC list) – a list of all countries and territories eligible to receive official development assistance (ODA). These consist of all LMICs based on gross national income (GNI) per capita as published by the World Bank, except for G8 members, EU members, and countries with a firm date for entry into the EU. The list also includes all the Least Developed Countries (LDCs) as defined by the United Nations.

Malaria: a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.

Macrolides: a class of antibiotic effective in the treatment of a range of infections, including respiratory, skin, soft tissue and sexually-transmitted infections. Erythromycin, azithromycin and clarithromycin are examples of macrolide antibiotics.

Meticillin-resistant Staphylococcus aureus: a strain of Staphylococcus aureus that is resistant to beta lactam antibiotics which include penicillins (for example, methicillin and oxacillin) and almost all cephalosporin antibiotics.

Microbiome: the microbiome comprises all the genetic material within a microbiota (the entire collection of microorganisms in a specific niche, such as the human gut).

Milligram per kilogram of use in animals: a measure of the use of antibiotics in animals. For example, a 50mg/kg figure for food producing animals would mean that on average, and over the course of a year, 50mg of antibiotic active ingredient was used for every kg of bodyweight at time of treatment.

Multi-drug resistant: resistant to multiple classes of antimicrobial.

Sensitivity breakpoints: a concentration (mg/L) of an antibiotic which defines susceptibility of bacteria is to the antibiotic. If the Minimum Inhibitory Concentration (MIC) is less than or equal to the susceptibility breakpoint, the bacteria is susceptible to the antibiotic. If the MIC is greater than this value the bacteria is considered intermediate or resistant to the antibiotic.

SNOMed CT: a structured clinical vocabulary for use in an electronic health record.

Infectious disease surveillance: the systematic collection of data from the population at risk, the identification of infections using consistent definitions, the analysis of these data and the dissemination of the results to those who collected the data, those responsible for care of the patients and those responsible for prevention and control measures.

‘One Health’ approach: collaborative multi-disciplinary work at local, national, and global levels to attain optimal health for people, animals and the environment.

Pathogen: an infectious agent (bug or germ), a microorganism such as a virus, bacterium, or fungus that causes disease in its host.

Patient Safety Collaborative: a safety initiative in the NHS supporting and encouraging a culture of safety, continuous learning and improvement, across the health and care system. It is a joint initiative, funded and nationally coordinated by NHSEI, with the 15 regional PSCs organised and delivered locally by Academic Health Science Networks (AHSNs).

Piperacillin-Tazobactam: a drug combination that has activity against many Gram-positive and Gram-negative bacteria including Pseudomonas aeruiginosa. Piperacillin is a synthetic penicillin; tazobactam enhances the effectiveness of piperacillin.

Population Correction Unit: a theoretical unit of measurement developed by the European Medicines Agency (EMA) in 2009. It takes account of a country’s animal population over a year, along with the estimated weight of each particular species at the time of treatment with antibiotics.

Prevalence: a snapshot at a point in time of the total number of cases of interest, like cases of healthcare-associated infection, in a given population.

Primary care: services provided by GP practices, dental practices, community pharmacies and high street optometrists.

Quality premium: an NHS scheme intended to reward clinical commissioning groups (CCGs) for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities.

Quinolones: a family of antibiotics, including broad-spectrum agents like ciprofloxacin.

Responsible prescribing: the use of antimicrobials in the optimal way, for the right pathogen, at the right dose, for the right duration, for the treatment or prevention of infectious disease.

Resistome: the antibiotic resistome is the collection of all the antibiotic resistance genes, including those usually associated with pathogenic bacteria isolated in the clinic, non-pathogenic antibiotic producing bacteria and all other resistance genes.

Secondary care: covers acute healthcare, either elective care (planned specialist medical care or surgery, usually following referral) or emergency care.

Sepsis: a serious a complication of infection leading to potentially life-threatening organ dysfunction.

Staphyloccocus aureus: Staphyloccocus aureus (S.aureus) is a Gram-positive bacterium which is not always pathogenic (and can commonly be found existing as a commensal) but is a common cause of infection and bacteraemia. Meticillin-resistant Staphylococcus aureus (MRSA) is the antibiotic-resistant strain of S. aureus.

Substandard medications: medications produced by legitimate companies, but are damaged or degraded through poor manufacturing, storage or distribution.

Susceptibility testing: testing to detect possible drug resistance in common pathogens and to assure susceptibility to drugs of choice for treatment of infections.

Sustainable development goals (also known as the global goals): a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. The 17 goals build on the successes of the Millennium Development Goals while including new areas such as climate change, economic inequality, innovation, sustainable consumption, peace and justice, among other priorities.

Therapeutics: the branch of medicine concerned with the treatment of disease. In this context specifically, the treatments against microbial infection.

It was agreed by the UK AMR national action plan delivery board that this target may need to be reviewed. DHSC has commissioned the University of Strathclyde to undertake work to model clinical pathways to GNBSI and the impact of various interventions, in order to inform recommendations on if the target should be adjusted and, if so, what a more appropriate target may be. ↩

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