The burden of antimicrobial-resistant infections in black and minority ethnic groups
Author: Hannah Lishman, Enrique Castro-Sanchez, Esmita Charani, Sid Mookerjee and Céire Costelloe
Briefing series: Better Health Briefing Paper 43
Publisher: Race Equality Foundation
Publication date: November 2016
Antimicrobial resistance (AMR) is increasingly being recognized as one of the major threats to human health globally, as outlined by the World Health Organisation, who warned that a “post-antibiotic era – in which common infections and minor injuries can kill...is a very real possibility for the 21st century” (World Health Organisation, 2014). AMR includes resistance to antivirals, antifungals, antiparasitics or, most commonly, antibiotics which are used to treat bacterial infections. Antibiotic resistance, on which this briefing will focus, emerges when an antibiotic is no longer effective against combatting a bacterial infection due to the bacteria having acquired genes which allow it to avoid the antibiotic’s therapeutic mechanism of action. Drug-resistance, more generally, is hindering the progress towards control and/or elimination of diseases around the world such as HIV/AIDS, tuberculosis, malaria, pneumonia, diarrhoeal diseases and gonorrhoea. This is exacerbated and accelerated by causes such as increased exposure to antibiotics in the food-chain, a lack of effective rapid diagnostic tests to confirm whether an infection is bacterial or viral, and the misuse and overuse of antibiotics in healthcare settings and in the community.
Infections caused by bacteria resistant to antibiotics are on the rise. In the most recent report from the English Surveillance Program for Antimicrobial Utilisation and Resistance, released by Public Health England inNovember 2015, the rate of E. coli bloodstream infections (one of the most common and severe healthcare-associated infections) increased by 15.6 per cent between 2010 and 2014, with the proportion of these infections being antibiotic-resistant increasing over the same time period (Public Health England, 2014). Antibiotics are some of the most commonly prescribed drugs not only in the UK but around the world. However up to 50 per cent of all antimicrobial prescriptions are considered to be unnecessary (Centres for Disease Control and Prevention, 2013).
In this briefing, the NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance will explore the evidence base to identify areas where practice could be improved to ensure that all service users are equally aware of the drivers of AMR infections. Countering this global threat cannot be done without the awareness, prudence and participation of all members of society, from healthcare providers to politicians to patients.
- Overuse and misuse of antibiotics is one of the main drivers of antimicrobial resistance (AMR) – particularly prescribing antibiotics for upper respiratory tract infections (URTIs).
- History of recent travel (particularly to the Indian subcontinent) is correlated with a higher risk of colonisation with antibiotic-resistant bacteria.
- There is some evidence that ethnic variation in diet could influence the risk of developing an antimicrobial-resistant infection.
- Public knowledge of antimicrobial resistance and the behaviours contributing to it needs to reach all members of the population, including new entrants to the UK.
- More research needs to be conducted in the UK pertaining to the burden of AMR in black and minority ethnic groups as the current evidence base is limited and there is a paucity of relevant data.
- Inadequate prescribing, self-medication and over-the-counter antibiotics: stemming the tide
- Returning travellers at a higher risk of multi-drug resistant strain carriage
- Do differences in microbiome confer differences in AMR risk?
- Public knowledge of antimicrobial resistance is crucial to combatting AMR