The decision by the Health Information and Quality Authority (Hiqa) to carry out a national quality assurance review of antimicrobial stewardship in the State’s public hospitals is timely. A recent discovery by Chinese scientists of a gene that renders Gram-negative bacteria resistant to the last line of currently available antibiotics is just the latest indication of the growing global threat posed by multidrug resistant bacteria. Gram-negative bacteria include E. coli and are named for their response to a crystal violet stain when viewed under a microscope. They cause pneumonia, bloodstream infections, wound or surgical site infections, and meningitis.
In the first phase of the Hiqa review, all public hospitals are being asked to self-assess their use of antibiotics and other drugs subject to growing microbial resistance. Subsequently 16 of the hospitals will be inspected to verify the findings of self-assessment. The overall aim is to produce one unified piece of regulation to reflect the need for consistent good practice across the entire health service. Antimicrobial stewardship helps to combat resistance by ensuring that every patient receives the right antimicrobial therapy, at the right dose, route and duration, for the right infection type at the right time.
The problem posed by infections developing drug resistance has been a feature of medicine since Alexander Fleming’s discovery of the first antibiotic, penicillin, in 1928. However the ongoing discovery of new antibiotics has failed to keep pace with the growth of antibiotic resistance. A review carried out last year for the UK government warned of the indirect effects of growing drug resistance which could “cast medicine back to the dark ages” by making routine surgery more dangerous.
As part of a wider solution to the problem the excessive agricultural use of antibiotics must be addressed; the drugs are mostly used to promote growth of livestock and not to treat sick animals. The Government must lead efforts in the EU to tackle this inappropriate use of a precious resource.