I see a GNBSI reduction target on the horizon…

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I have finally got around to reading the UK Government response to the AMR Review, which includes some interesting details about aspirations to reduce Gram-negative BSIs (GNBSI) and antibacterial agent usage in human and animal health.

The government has committed to a 50% reduction in Gram-negative BSI by 2020. I am pretty sure that this will translate into a reduction target in the not too distant future! So, cue the knee-jerk “but that’s impossible” from the professional community. It’s what we said for MRSA, but we have been proved wrong. The reduction in MRSA BSI in England has been spectacular, and I think that the targets were a key driver of this reduction. But, GNBSI is a different prospect altogether. Unlike MRSA, which is a single organism with very limited strain variation (in the context of healthcare-associated MRSA), Gram-negative BSI are formulated by a diverse army of bacteria, with different genera, species, strains and a plethora of resistance mechanisms. Furthermore, and perhaps most importantly, many Gram-negative BSI originate from an endogeneous source. Whilst we can go some way to reduce this with good line care etc, I suspect that cross-transmission is a minor player in driving GNBSI. Finally, and to steal the thunder of my fellow-blogger Martin Kiernan, if you’re any good at anagrams you will have noticed that if you rearrange the letters of ‘Gram-negative healthcare-associated BSI (GNHABSI)’ – the acronym of choice in the Government report – you can get “BASHING”. Let’s hope the targets won’t be used in this way!

The Government has also committed to a 50% reduction in inappropriate antibacterial agent usage by 2020. The trick here is going to be defining ‘inappropriate’ usage. There is also a commitment to reduce antibacterial agent use in the animal health and husbandry world – although this one is not quite so well defined as the points above. As with any GNBSI reduction target, antibacterial agent reduction targets will be a positive step forwards that we should embrace.

Mary Dixon-Woods made the point in her recent talk at IPS that to drive effective improvement initiatives and avoid verschlimmbesserung, we need a balance between sticks and carrots. As and when these GNBSI and antibacterial targets materialise, we will have the stick. But where is the carrot? Perhaps improving patient outcomes is the only carrot we need.

Image: Wikipedia.

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