Source · Select Committees · Public Accounts Committee
Recommendation 14
14
Acknowledged
Increasing threat from highly resistant Gram-negative infections with limited treatment options
Conclusion
Dr Partridge told us that there is also an increasing threat in the UK from strains of pathogens which cause Gram-negative infections that are more likely to be resistant and more likely to result in the death of the patient. In particular, there has been an increase in Gram-negative pathogens which produce specific types of enzymes which are associated with higher mortality.36 Dr Partridge told us this shift will cause great difficulties for the NHS, given that there are even fewer treatment options.37 30 Q 36; C&AG’s Report, para 11 31 C&AG’s Report, para 3.4 32 Qq 37, 78 33 Qq 21, 77; C&AG’s Report, para 17 34 Q 21 35 Q 77 36 Evidence shows there have been increases in carbapenemase-producing Gram- negative organisms. This refers to a type of organism which produces enzymes called carbapenemase, which can destroy antibiotics called carapenems. A specific type of cabarpenemase-producing Gram-negative organism is one which produces an enzyme called metallo-beta-lactamase, and this type of organism is associated with higher mortality. See Q 1; UKHSA, English surveillance programme for antimicrobial utilisation and resistance 2023–24, October 2014 37 Q 1 12
Government Response Summary
The government agrees with the observation, stating it monitors progress against targets biannually and reviews them annually, with UKHSA modelling trends and seeking expert advice on revisions, but acknowledges that preventing an increase in these infections is ambitious.
Government Response
Acknowledged
HM Government
Acknowledged
2.1 The government agrees with the Committee’s recommendation. Target implementation date: Winter 2025 2.2 Progress against NAP human health targets is closely monitored, using data to assess effectiveness, guide future action, and ensure alignment with broader public health objectives. The government conducts formal reporting on these targets biannually. Additionally, targets are subject to annual review over the summer, with the potential to revise, if deemed appropriate and agreed by the UK AMR Strategy Board. 2.3 Analysis of surveillance trends will inform recommendations on the range and ambition of targets. UKHSA will also model trends in specific drug-resistant infections, accounting for population changes, to project counterfactual trends. Expert advice on target revisions will be sought from the Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection. 2.4 The government supports achievable targets being set, to help secure support from the healthcare system and contribute to long-term change. UKHSA predicts the incidence of drug-resistant and gram-negative blood stream infections will continue to rise due to 20 increasing age, medical comorbidities, and population demographic changes. Therefore, preventing an increase in these infections from the 2019 baseline is currently ambitious. 2.5 The government has previously supported targets developed by the livestock sectors through the Responsible Use of Medicines in Agriculture Alliance (RUMA) Targets Task Force on AMR, which have resulted in a 59% reduction in antibiotic use in livestock since 2014. The livestock sectors, coordinated by RUMA, are developing a new set of sector-specific targets, which are due to be published in late 2025. If sufficiently ambitious, the Vetinary Medicines Directorate (VMD) will incorporate them into the NAP delivery programme.