Antimicrobial resistance – A position statement from the Royal College of Pathologists
What is antimicrobial resistance?
Antimicrobial resistance (AMR) is the resistance of microorganisms, e.g. bacteria, viruses, fungi and parasites, to antimicrobial medicines, such as antibiotics. In other words, the antimicrobial will not be effective. Resistance is a global problem that is being accelerated by the inappropriate use of antibiotics and poor infection prevention and control (IPC).
Why is AMR a risk to our health?
We rely on antimicrobial medicines to treat the microbes that cause many common diseases, such as TB, HIV/AIDS, malaria, sexually transmitted infections, urinary tract infections and chest infections. We also rely on them to prevent and reduce the risk of infections from a range of medical treatments, for example, before routine surgery and chemotherapy. AMR makes infections harder to treat, which then also increases the risk of diseases spreading to others. In serious cases this can lead to severe illness and death.
What is the scale of the problem?
Worldwide, there were 1.27 million deaths in 2019 caused by bacterial AMR.1 In England alone, antibiotic-resistant infections have continued to increase since 2020 and resistance to key antibiotics also remains high, with over 40% of Escherichia coli (E. coli) bloodstream infections being resistant to co-amoxiclav, a key antibiotic used to treat serious infections.2
What is the role of medical microbiologists and virologists?
Medical microbiologists and virologists are at the forefront of tackling AMR, through delivering leadership and expertise in antimicrobial stewardship (AMS) by advising on the responsible use of antimicrobials including antibiotics, and advising on IPC, in hospitals and in the community. They work in the diagnostic laboratory and with clinicians to ensure patients get the right antibiotic treatments and tests, and that infections do not spread. They were instrumental in developing and delivering testing for COVID-19.
Our call to action
Growing the medical microbiology and virology workforce
We need to increase the number of microbiologists and virologists who carry out AMS and IPC activities as lowering infection rates is key to reducing AMR.
The medical microbiology specialist workforce is far below what is needed to implement the full clinical and diagnostic service required to tackle AMR. A recent British Infection Association (BIA) and RCPath UK-wide survey found a 20.3% shortfall in consultant medical microbiologists and a 14% shortfall in consultant virologists. Many NHS services barely have enough consultants to staff a safe on-call rota.3
In addition, over the next 5 years, consultant retirement plans will put microbiology and virology at risk of losing over 30% of their workforce.4
Urgent action is needed to address these workforce shortages. We need an increase in the number of medical microbiology and virology trainee places (both medical and clinical scientists). The number of medical microbiology and virology trainees will need to double over the next 5 years to meet current demands, the existing shortfall in workforce and expected retirements.4 Additionally, processes for specialist overseas-trained doctors transferring to the NHS need to be streamlined.
Guidance on the appropriate number of infection specialists needed to run a high-quality service can be found in this BIA/RCPath publication.5
Improved diagnostic capabilities
The World Health Organization (WHO) lists diagnostics as one of their global research priorities in mitigating AMR.6
Faster, automated diagnostic platforms can help reduce the current time taken to identity infections and determine the correct antibiotic or antiviral to use.
This would reduce the length of time patients are on antibiotics before test results are available and in some cases remove the need for clinicians to prescribe antibiotics at all before test results are available. This in turn will help to prevent AMR developing.
Point-of-care testing at the patient’s bedside or in community settings, such as pharmacies and GP surgeries, offers opportunities for improving antimicrobial prescribing and patient care by rapidly identifying the infection. However, this needs to be supported by high-quality laboratory diagnostics and robust IT connectivity with oversight by laboratory specialists.
The Royal College of Pathologists calls for investment to strengthen the modern diagnostic testing capacity of all UK laboratories.
Medical microbiologists and virologists need robust IT systems to manage antimicrobial use.
As the NHS moves towards Electronic Patient Records (EPR) it is vital that Electronic Prescribing Systems (EPS) are a core component of all EPR systems. By having access to EPS medical microbiologists will be able to capture and monitor antibiotic prescriptions, enabling infection specialists to see which patients are on antibiotics and for how long. This enables them to advise clinicians how to prescribe more appropriately and gives them much better oversight of the use of antimicrobials across their local NHS area.
There needs to be adequate resource allocation to NHS organisations to enable the safe integration of EPS, with involvement of the medical microbiologist at the point of design and implementation, to ensure it provides the functionality and information they require for good AMS. There needs to be integrated connectivity across pathology networks and between all hospitals to ensure information regarding the spread and type of infection and antibiotic use can be seamlessly shared.
A strong surveillance system
The United Kingdom Health Security Agency's (UKHSA) surveillance system, and its equivalents in Scotland, Wales and Northern Ireland, pull data from laboratories around the country to monitor and identify infections and take action to prevent their spread.
Rates of AMR vary across the country. Medical microbiologists and virologists rely on surveillance to manage infections across their regions. Clear and transparent information-sharing, to optimise surveillance, at both national and regional levels, ensures clinicians and services can target their response to infection and treat patients appropriately, and must be maintained.
1 Antimicrobial Resistance Collaborators*. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 2022;399:629.
2 UK Health Security Agency. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2022 to 2023. London: UK Health Security Agency, November 2023. Accessed November 2023. Available at: English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2023 to 2023 (publishing.service.gov.uk)
3 Lawrence S, Aggarwal D, Davies A, Partridge D, Ratnaraja N, Llewelyn MJ. The State of Hospital Infection Services in the UK: National Workforce Survey 2021. Clin Infect Pract 2022;15:100151.
4 The Royal College of Pathologists. Pathology Workforce Report 2023–2024. (In Press).
5 Ratnaraja N, Davies A, Atkins B, Dhillon R, Mahida N, Moses S et al. Best practice standards for the delivery of NHS infection services in the United Kingdom. Clin Infect Pract 2021;12:100095.
6 World Health Organization. Global research agenda for antimicrobial resistance in human health. Policy brief. June 2023. Accessed August 2023. Available at: Global research agenda for antimicrobial resistance in human health (who.int)