While some hospitals have made major progress in protecting patients from the growing threat of antimicrobial resistance, some smaller hospitals do not have adequate measures in place, which is a ‘significant patient safety concern', according to a new report.

Antimicrobial resistance is resistance of microorganisms to antimicrobial drugs (antibiotics) that originally treated infections caused by them. When microorganisms become resistant to these drugs, the drugs simply do not work anymore, allowing infections to persist.

Along with poor infection control, antimicrobial resistance is driven by the overuse and misuse of antibiotics. As a result, existing antibiotics are becoming less effective and new multi-resistant bacteria are emerging in medicine. On top of this, few new antibiotics are in development.

This new report by the Health Information and Quality Authority (HIQA) looked at how public acute hospitals are protecting patients from the growing threat of antimicrobial resistance.

It found that while progress has been made in larger hospitals in relation to the management and use of antibiotics, this progress varies nationwide, with smaller hospitals lacking in this area.

For example, a number of smaller local hospitals had no antimicrobial stewardship programme in place. Antimicrobial stewardship programmes aim to ensure that every patient receives the right antimicrobial therapy at the right dose, route and duration, and for the right infection type at the right time.

It also aims to ensure that therapy is continually reviewed, refined and discontinued where the patient's condition allows.

However, the report noted that these smaller hospitals ‘had not received specialised resources to support setting up such programmes'.

‘‘This review examined how well public acute hospitals implement antimicrobial stewardship best practice. We identified that a number of hospitals need urgent support from the HSE in this area, as they do not have an antimicrobial stewardship programme in place and lack specialised resources. This is a significant patient safety concern and should be reviewed as a matter of urgency by the HSE," commented HIQA'a acting head of healthcare regulation, Sean Egan.

He pointed out that in some cases, ‘the level of antimicrobial resistance now being detected leaves clinical staff with a very limited choice of medicines that they can use to try to treat people'.

"Ensuring prudent antimicrobial usage, through antimicrobial stewardship, should be a priority across all health services to help to address this problem," he said.

Meanwhile, the report also found that while rates of the so-called hospital superbugs, MRSA and Clostridium difficile, have fallen in Ireland, the incidence of multidrug resistance among Gram-negative organisms is on the increase. These organisms cause a number of different infections, including blood and urinary tract infections.

"A number of these Gram-negative bacteria are highly resistant, and are associated with serious infections, up to and including life-threatening sepsis. Unlike MRSA, patients who carry these bacteria cannot be treated to eradicate them from their bodies. Antimicrobial prescribing and infection control practises in hospitals, and equally in community health and social care settings, need to be of a high standard to fully address this emerging problem," Mr Egan noted.

He said that this situation ‘requires a different, nationally coordinated response by the HSE'. In particular, this needs to be extended ‘beyond acute hospitals and into other non-acute residential and community care settings'.

Mr Egan added that while the report found ‘much commendable progress' by committed frontline staff, ‘this has been hampered by the lack of an up-to-date national plan in this area'.

"There are pockets of excellence in some hospitals, yet others lag behind, and progress in non-acute settings such as nursing homes has been very limited. More needs to be done to ensure that good practice in this area becomes the routine norm," he said.