WAAW 2022: A focus on prevention (IPC and vaccination)

Was delighted to introduce our series of events planned to coincide with World Antibiotic Awareness Week 2022 earlier today. I gave a short talk on why preventing infection via IPC measures and vaccination needs to be a cornerstone of our strategy to turn the time on antimicrobial resistance (slides here).

I also shot a short video to get us thinking about how the language we use will influence the degree to which we connect with the various stakeholders that need to collaborate to address antimicrobial resistance:

I kicked off by polling the audience about what our priorities should be over the winter to address AMR:

Whilst I clearly agree that optimising antibiotic treatment of infection is key, I think staff and (where applicable) patient vaccination is an even more pressing priority. If the flu season is as bad as we fear, and we get the expected winter surge in COVID-19, which might find ourselves rapidly ‘workforceopenic’ if penetration of staff vaccination isn’t high.

The language that we use to describe the issues around AMR needs to be chosen carefully, and fitted to the intended audience. Too nerdy and technical and we don’t connect or lose people, too simple and we don’t adequately communicate complexity or condescend. A very simple but powerful example is the impact of simplifying the wording of a Cdiff lab report resulting in improved clinical decision making about treatment and isolation.

We have good evidence that preventing the spread of antimicrobial resistant bacteria results in fewer infections with these bacteria, but it also turns the tide on antimicrobial resistance. A good example is the extraordinary reductions in MRSA bloodstream infection achieved in the UK in the mid/late 2000s. Here, the number of MRSA bloodstream infections reduced dramatically – but that is the tip of the iceberg. We also know that the number of MRSA infections and patients colonised with MRSA reduced in step with these serious infections. And here’s the rub – not only did the number of cases reduce, we also saw a reduction in the proportion of S. aureus invasive infections that were resistant to meticillin (a trend that has not been observed universally across Europe!):

Vaccination is a vital part of any strategy to reduce the impact of infectious diseases. The impact of vaccination programmes on vaccine-preventable diseases is nothing short of spectacular. One of the best things to come out of the pandemic was the accelerated discovery, testing, and roll-out of very effective COVID-19 vaccines, which reduce spread and harm attributed to COVID-19 infection. But how can vaccination, which is often focused on viruses, reduce antimicrobial resistance? This can be summarised as follows (please read this excellent review for more info):

  • Direct reduction in prevalence of antibiotic resistant bacteria (e.g. pneumococcal vaccine)
  • Reduce acute febrile disease, which often results in (ineffective) antibiotic use
  • Reduce secondary bacterial infection
  • Vaccination against antibiotic resistant bacteria

I wrapped up by polling the audience on how they felt about the next decade of antimicrobial resistance. Like me, most concluded that the outlook is uncertain but still in our hands!

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