October 16, 2015

expert reaction to study quantifying threat of antibiotic resistance on surgery and chemotherapy in the USA

Publishing in the Lancet Infectious Diseases journal a group of scientists has estimated the impact of antibiotic resistance on surgery and chemotherapy treatments in the USA, as well as modelling what may happen with increased levels of resistance.

Prof. David Livermore, Professor in Medical Microbiology, Norwich Medical School, UEA, said:

“There are legitimate concerns about prophylaxis failure in a small number of settings, including prostate biopsy and in leukaemia patients. However, as yet there is no substantial evidence that surgical prophylaxis fails owing to resistance. Trend data in the UK shows no evidence that standard prophylaxis is failing. At present infection rates are generally falling slightly in the UK, see: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/386927/SSI_report_2013_14_final__3_.pdf”

Prof. Nigel Brown, President of the Microbiology Society, said:

“While predictive work from meta-analyses can be difficult to quantify accurately, the study is robust and shows an increase in antibiotic resistance will cause increased problems and mortality following routine operations. Although this analysis was carried out in the US, antibiotic resistance is a global problem and it is likely that routine surgery such as hip replacement and elective caesarean sections will become much rarer in the UK, unless steps are taken to prevent its spread.”

Prof. Alison Holmes, Professor of Infectious Diseases, Imperial College London, said:

“This paper in The Lancet Infectious Diseases describes the quantitative analysis and the modelling of US based data that provides much more specific and detailed information that supports and reinforces the CMO’s message regarding the threat of antibiotic resistance to routine surgical procedures and management of some cancers. The success of these interventions and treatments rely on the use of prophylactic antibiotics to protect against the risk of infection that is associated with them, and this protection is being lost with increasing resistance and with fewer effective antibiotics. As well as providing data to quantify this loss of infection protection and the impact on clinical outcomes, the authors also call for strategies to limit resistance in addition to developing new antibiotics. However, this direct threat to medical and surgical care means that strategies must include strong clinical leadership and action from those within threatened specialities and not just those with an interest in infectious diseases.”

Prof. Laura Piddock, Director of Antibiotic Action and Professor of Microbiology, University of Birmingham, said:

“I have long warned of the potential effects of antibiotic resistance upon routine procedures such as joint replacements, transplant surgeries and cancer chemotherapy regimens. It is good to see evidence from the USA that supports these serious concerns that antibiotic resistance will impact upon many areas of medicine including that it is undermining the treatment of cancer patients. I hope that this will be a loud ‘wake-up call’ to pharmaceutical companies and encourages them to discover, research and develop new treatments for bacterial infections as without them patients will be less likely to survive cancer and so unable to take advantage of new life extending cancer therapies.”

‘Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study’ by Aude Teillant et al. published in the Lancet Infectious Diseases on Friday 16 October 2015.

Declared interests

Prof. Nigel Brown declares that he has no interests.

Prof. Alison Holmes: “I am also an author on a paper that is coming out in a series in the Lancet itself in November. One of the papers also has Ramanam Laximinarayam and me as co-authors.  I am the Director of the NIHR Health Protection Research Unit Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London.

Prof. Laura Piddock: Professor Piddock did not participate in or advise on the research described in this publication. Despite being part of the communications and public engagement work package in the DRIVE-AB consortium that funded the described work, she was unaware of the research described in the article. Professor Piddock is an employee of the University of Birmingham. A grant from the British Society of Antimicrobial Chemotherapy (BSAC) is paid to the University of Birmingham to allow Professor Piddock to carry out her duties at 20% FTE as the BSAC Chair in Public Engagement and Director of Antibiotic Action. In that role, she is part of work package 3 (Communications and Public engagement) in the DRIVE-AB consortium funded by the EU Innovative Medicines Initiative New Drugs for Bad Bugs. For her basic research, Professor Piddock is currently in receipt of funding from the BBSRC and MRC, and has a Roche Extending the Innovation Network Award. Professor Piddock is the vice-chair of the EU Joint Programming Initiative on AMR scientific advisory board. She is also member of the Longitude Prize Advisory panel.

None others received.