Volume 2

Resistance to antibiotics and other antimicrobial agents / Select Committee on Science and Technology.

  • Great Britain. Parliament. House of Lords. Science and Technology Committee.
Date:
1998
Catalogue details

Licence: Open Government Licence

Credit: Resistance to antibiotics and other antimicrobial agents / Select Committee on Science and Technology. Source: Wellcome Collection.

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    14 October 1997] [Continued 1.4.4 As mentioned above (1.1) antibacterial usage may not only select bacterial strains with acquired resistance but also inherently resistant species with a consequent increase in the proportion of infections caused by them. Good examples of this are enterococci (inherently resistant to cephalosporins) which become more prominent as hospital pathogens following the wide-spread use of cephalosporins, and the toxic entero-colitis caused by Clostridium difficile (inherently resistant to many penicillins and cephalosporins) which has become a major problem in recent years in hospitals and to a limited extent in the community. Such changes in the prevalence of bacterial pathogens can alter antibacterial prescribing in a similar manner to a rise in acquired resistance. 1.4.5 Other consequences of infection with resistant bacteria are increased lengths of stay (to treat infections via the intravenous route), less effective treatment (with increased morbidity and mortality), and an increased use of isolation of patients. All these cause greater treatment costs. 2. THE CURRENT ROLE OF MEDICAL MICROBIOLOGY IN THE UK IN DETECTING AND CONTROLLING RESISTANCE 2.1 The structure of microbiology and infection control services The linch-pin of microbiology services in the UK is the medically qualified microbiologist practising in the NHS district general hospitals from where they serve both the hospital, or a group of them, and general practices in the area. England and Wales are unique in having the Public Health Laboratory Services (PHLS) which consists of some 48 peripheral laboratories based in DGHs, and a central facility in North London (HQ functions, reference laboratories, Communicable Diseases Surveillance Centre (CDSC)). In addition, substantial microbiology services are provided by academic microbiologists based in medical schools. There is also a small proportion of services in private laboratories. In all there are about 560 medical microbiologists of consultant standing (NHS Consultants, Professors, Readers, Senior Lecturers) (Table 1). The figures are not absolutely accurate because of the difficulty of collecting constantly changing data. There is a marked difference between the provision of medical microbiologists in the various centres of the UK, but whether this affects their effectiveness is not known. All NHS hospitals have an Infection Control Team (ICT), almost always headed by an Infection Control Doctor (ICD) who is a Consultant Medical Microbiologist. There are about 240 ICDs in the UK. The other important members of the ICT are Infection Contro] Nurses (ICNs), who have specialist training for this role. There are about 250 ICNs in the UK, but some of these are part-time. This equates to about 1 ICN per 400 acute beds (the recommended figure in the USA is 1 per 250). ICTs not only function within hospitals but frequently give extensive advice to community activities (GPs and their teams, nursing homes, etc). The extent of this latter function depends on how much the local Health Authority can provide directly such specialist services. Within hospitals the role of the ICT is to set standards (by developing infection control policies), educate, audit the standards, and to provide everyday advice on implementation of infection control procedures. In the community infection control is the responsibility of the Consultant for Communicable Disease Control (CCDC). There are some 150 CsCDC or equivalent, of whom some 30 are Medical Microbiologists, the remainder being almost all trained in Public Health Medicine. Because infection passes constantly across both functional and physical boundaries there is a close liaison between infection control professionals from hospitals and the community. Apart from the Medical Microbiologists and ICNs other professionals play an important part in diagnosing, treating and controlling infection. Science graduates with post-graduate training in diagnostic, reference and research laboratories (Clinical Scientists) play a valuable role, particularly in the larger centres. Some of the more senior Clinical Scientists have a Consultant equivalent status. Largely in the diagnostic laboratories, but also in others, Biomedical Scientists (formerly termed technicians) are the most numerous staff and the mainstay of everyday work. Some other clinical staff, such as Infectious Diseases physicians, have expertise in antimicrobial therapy. They are small in number, however, and tend to be only on the larger centres. TABLE | Distribution of Consultant (and academic equivalent) Medical Microbiologists in the UK ' Approximate Thousands NHS PHLS Totals for Population population per Consultants Consultants Academics regions (millions) Microbiologist England 216 145 70 431 46 107 Wales 12 16 3 31 3 7 Scotland 55 Nil 34 89 5 56 Northern Ireland 10 Nil 3 13 1.5 115 Es SITS OSG SE PO apres Te Oe eS rs te Total 293 161 110 564 Seis) 98 ns Se ee ee ee ee ee ee ee ee eee, a OE ee ' Data on numbers from AMM survey supporting its Directory of Microbiologists (1997, in press). NB: Data do not include PHLS Colindale (6 Consultants) and the Armed Forces (2 Consultants).