BSAC responds to Lancet ID paper on threat of AMT to surgery and cancer chemotherapy

BSAC has welcomed publication of a study in The Lancet Infectious Diseases that quantifies the threat of rising antibiotic resistance on surgery and cancer chemotherapy. 

The literature review and modelling study, funded by the DRIVE-AB consortium on which BSAC is a partner, examined the effect that the declining efficacy of existing antibiotics might have on outcomes for patients undergoing medical procedures.  Researchers have reported the strongest evidence to date on the consequences THAT antibiotic resistance could have for patients undergoing surgery or cancer chemotherapy. 

Dr Ramanan Laxminarayan, Director of the Center for Disease Dynamics, Economics & Policy, Washington, USA and colleagues conducted a review of all meta-analyses of randomised controlled trials conducted between 1968 and 2011, examining the efficacy of antibiotic prophylaxis in preventing infections and infection-related deaths after 10 of the most common surgical procedures and blood cancer chemotherapy in the USA. They calculated the additional number of infections and infection-related deaths under different scenarios of reduction in the efficacy of antibiotic prophylaxis. Additionally, using the National Health Safety Network data and existing studies, they estimated the proportion of infections caused by bacteria that are resistant to currently used standard prophylactic antibiotics.  

The paper reports that between 39% (after caesarean section) and 50–90% (after trans-rectal prostate biopsy) of surgical site infections was found to be caused by organisms resistant to recommended antibiotic prophylactic regimens.  The figure for infections after blood cancer chemotherapy are resistant to standard antibiotics was found to be 27%.   

Further modelling estimated that a 10% drop in the efficacy of antibiotic prophylaxis could, at best, result in 40,000 additional infections every year in the USA, or 280,000 in a pessimistic scenario—a 70% drop in efficacy. Infection-related deaths could increase by 2100 in an optimistic scenario, or even 15000 in a pessimistic scenario. 

Through Antibiotic Action, the Society has long warned of the potential effects that antibiotic resistance does and will have on now routine procedures such as joint replacements, transplant surgeries and cancer chemotherapy regimens.  Speaking about the report Professor Laura Piddock, Director of Antibiotic Action and Professor of Microbiology, University of Birmingham said: 

‘It is good to see data that supports the concerns that antibiotic resistance will impact upon many areas of medicine and in particular threatens to undermine the treatment of cancer patients.”  She continued “I hope that this will encourage pharmaceutical companies to discover, research and develop new treatments for bacterial infections as without them patients will be less likely to survive and so unable to take advantage of new cancer therapies’.

Professor Dilip Nathwani, OBE, President of BSAC and Consultant Physician and Honorary Professor of Infection, Ninewells Hospital Dundee responded by addressing the responsibility of healthcare professionals to ensure antimicrobial stewardship is at the forefront of thinking and practice.  He said:

 Effective antimicrobial stewardship is critical if we are to successfully combat and contain antimicrobial resistance.  It is a local, national and global responsibility and must be tackled and addressed at all levels through initiatives such as The Massive Open Online Course on Antimicrobial Stewardship which provides a robust and globally applicable training programme for all involved in the prescribing of antibiotics.”