Dr David Jenkins
President, British Society for Antimicrobial Chemotherapy (BSAC)
The UK Government’s 20-year vision is of ‘a world in which antimicrobial resistance is effectively contained, controlled and mitigated.’ It’s a fine ambition, but it begs the question — how will we know?
The only certain way to detect resistance is to test bacteria in a microbiology laboratory. That’s not a problem in the UK where every GP and hospital has access to a high-quality lab service.
Patchy surveillance
In many low and middle-income countries, laboratories are scarce; and the only information on resistance comes from occasional surveillance programmes, usually focused on big cities.
A reliable microbiology service requires a lab infrastructure, dependable consumables, trained scientific and technical staff plus a clinical culture that sees value in sending specimens for testing and acting on results.
The challenges facing many developing countries include the lack of lab equipment and consumables that can cope with tropical conditions, training that is relevant to locally prevalent bacterial infections and an infrastructure that delivers specimens to the lab and returns results to the requesting clinician.
In 2019, an estimated 1.3 million people died from an infection caused by resistant bacteria, many of them in sub-Saharan Africa.
Lack of guidance
There are good reasons to be concerned about this. Firstly, in the absence of laboratory guidance, antibiotic prescribing is educated guesswork. Clinicians compensate by prescribing broad-spectrum antibiotics to increase the chances of effective treatment, but at the cost of driving the development of greater resistance.
Eventually, treatment stops working, and patients die. In 2019, an estimated 1.3 million people died from an infection caused by resistant bacteria, many of them in sub-Saharan Africa. This toll is likely to increase year on year. The waste of scarce healthcare resources on expensive but ineffective drugs is another bitter pill.
Migratory bugs
Secondly, resistant bacteria are on the move. Over the last ten years, there have been high-profile outbreaks in the UK caused by extensively resistant bacteria whose origins include low-income countries. Once embedded in our community, these resistant strains may be impossible to eradicate, causing deaths and extra operational and financial strain on the NHS.
A solid start
Improving global laboratory capacity is necessary and possible. Médecins Sans Frontières has developed a transportable lab — the MiniLab — that can be set up anywhere in two days.
With a few months of training, local technicians may detect antimicrobial resistance in bloodstream infections as efficiently as labs in the UK. It’s a great start, but more investment is needed to manufacture, distribute and implement this — and similar approaches.
Without funding, we will all pay the price of resistance.
