AMR: the silent undercurrent of modern medicine

Blog by Dr Ron Daniels BEM & Executive Director, UK Sepsis Trust

As a clinician immersed in the world of infectious diseases, I've been on the front lines of a battle that many outside the medical community may not fully understand. The battle being against antimicrobial resistance (AMR), a growing threat that undermines the very foundation of modern medicine.

Back in 2005, I was treating a young man, only 37, who presented to the hospital far too late. Despite being previously healthy, he succumbed to sepsis, leaving behind his wife and children. This tragedy struck a chord with me, especially as a parent. The realisation that this could happen to anyone, coupled with the knowledge that it was preventable, propelled me into action. This led to the establishment of the UK Sepsis Trust in 2010 and subsequently working in the fight against AMR.

What is antimicrobial resistance or ‘AMR’?

Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals and plants. AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines, meaning effectively that antibiotics – and other antimicrobials – stop working.

AMR is often described as a silent pandemic, in part because many are not aware of how urgent the situation is, and in part because if it is left unchecked, it could have disastrous consequences for all of us. It is predicted that AMR will be the cause of 10 million deaths a year worldwide by 2050[i].

What is the impact of AMR?

Antibiotics are the bedrock on which we've built much of modern medicine. Without these vital medicines, the risk of routine procedures skyrocket, including treatments like elective surgery or cancer chemotherapy. And of course, as I see in my practice, infections like sepsis are already claiming too many lives.

In my years of confronting AMR head-on, one of the most striking observations has been its disproportionate impact across different demographics and socioeconomic groups.

For instance, urinary tract infections (UTIs), predominantly caused by E.coli, show a troubling trend where in some regions of the UK, up to 40% of these bacteria are resistant to first-line antibiotics. The resistance rate is alarming in itself, but the scenario worsens when dissecting the data further. In areas of higher socioeconomic deprivation, the likelihood of encountering resistant UTIs can double compared to more affluent areas.

This pattern underscores a grim reality—AMR does not affect all demographics equally. The burden of resistance is heavier in communities already grappling with various health disparities.

How does the Sepsis Trust help to tackle AMR?

The UK Sepsis Trust is based on the belief that education, awareness, and support can dramatically change outcomes for those affected by sepsis. Our mission doesn't stop at the doors of hospitals and clinics; we're deeply committed to raising public awareness about sepsis, utilising innovative partnerships and channels to spread life-saving messages.

That partnership approach is how we first started working with the ABPI, through the Infection Management Coalition which brings together industry, regulators, advocacy organisations and charitable organisations with a common call around the need to work together to deliver improved outcomes from life threatening infections.

What is the role for innovation?

In the fight against AMR, innovation and access to a robust pipeline of new antibiotics is key. But despite this need, there are too few antibiotics in development.

The UK has been leading the way through the development of a new subscription model that aims to incentivise the development of new antibiotics.

This approach, a first of its kind, offers pharmaceutical companies a fixed payment for developing new antibiotics and ensures that companies are rewarded for their innovations without the pressure to sell large quantities, encouraging the responsible use of these life-saving treatments.

I’m extremely hopeful about this model and I've witnessed firsthand the life-saving potential of these new treatments, as I’m already using them on my patients who otherwise would have died.

Another area which provides huge opportunity to improve the way in which we recognise and treat severe infection – and the way in which we use antimicrobials – is innovation in improving the integration of novel and point of care diagnostics into our clinical systems. At the time of writing, the pace of development of these technologies is far exceeding our ability to bring them to optimal use, hampering clinical efforts to improve outcomes for the individual patient as well as for broader society.

Global reflections and local actions

While the UK has made strides, the fight against AMR demands global cooperation, it is not just a national issue; it's a global crisis that requires worldwide cooperation and action.

My experiences running UK Sepsis Trust have shown me the power of collaboration and innovative thinking —between healthcare professionals, governments, and the public. For the Sepsis Trust this has meant partnerships with ambulance services to raise awareness for paramedics about sepsis; and developing sepsis storylines in popular soap operas to disseminate life-saving information about the condition.

For the government, it means thinking in new ways about how we can work with other countries to fix this problem.  

Last week the government published a new National Action Plan for AMR, and a summary of feedback on its proposed new model for valuing and reimbursing antibiotics, together, these initiatives mark an important step forward in the work to tackle the global AMR challenge.

It's not just about saving lives today; it's about ensuring a safer world for our children and grandchildren. The current lack of urgency in addressing AMR is alarming. Like climate change, many view it as a future problem, not realising its immediate impact.

A call to governments and individuals

As I reflect on my journey, my message to future governments and to each of us is unequivocal: AMR must be a priority. Countries need to take leadership on this issue.

The need for robust public awareness campaigns, strategic investment in antibiotic research, and comprehensive infection management strategies has never been more critical. It's not enough to hope for change; we must demand it, support it, and be part of it and it's on any incoming government to ensure that they don't miss this opportunity.

[i] https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis