Topic summary on Antimicrobial resistance (AMR)

Antimicrobial resistance (AMR) occurs when germs develop the ability to defeat drugs designed to kill them, such as antibiotics. This JSNA focuses on issues in respect of AMR in the city of Manchester. It provide an overview of national evidence and data regarding the burden of AMR on different population groups and areas and summarises what is known about AMR and how it impacts the population of Manchester. It goes on to describe what Manchester City Council and other organisations working across the city are doing to tackle AMR and finishes by outlining several opportunities for action that could be done to mitigate the risks and challenges created by AMR.

The evidence presented in the JSNA shows that AMR is due to more than just ‘poor prescribing’ from clinicians. Pressures on healthcare services, presenting themselves in the form of long waiting lists, and overall deterioration in the health of the population are also likely to be contributory factors. Equally, certain healthcare settings provide highly specialised services which may require the use of broad-spectrum, ‘last resort’ antimicrobials, e.g. patients receiving chemotherapy at The Christie. The complex picture in Manchester with regard to the wider determinants of health may also be a factor e.g. poor housing conditions and widespread deprivation, coupled with a high number of people living with long term conditions and co-morbidities. Communities with poor health outcomes and wider health inequalities are more likely to have significant ill-health from infections.

The data shows us that:

• In the UK, there were an estimated 7,600 deaths directly from infections resistant to antibiotics in 2019. This is similar to the number of deaths in the UK due to stomach cancer. There were a further 35,200 deaths which were an indirect result of infectious resistant to antibiotics.
• The number of deaths in the UK attributable to severe antibiotic-resistant infections has risen by 27.9% since the COVID-19 pandemic beginning in 2020.
• Regionally, the North West ranks only behind the North East in respect of the volume of antibiotics prescribed via both primary and secondary care.
• Manchester has the fourth highest rate of prescribed antibiotic items per 1,000 residents in GM (behind Wigan, Stockport and Oldham)
• Just two Primary Care Networks (PCNs) in Manchester prescribe more key broad spectrum antibiotics than the national average.
• Over 2,700 staff and residents in Manchester have pledged to be an Antibiotic Guardian.
• Evidence suggests E.coli resistance is higher in Manchester than the English average.
• Rates of MRSA (methicillin-resistant Staphylococcus aureus) - a type of bacteria that many antibiotics don’t work on - recorded by MFT dropped to their lowest levels in 2013/14 and are lower than the English average.
• Despite an increasing national rate, there have been no confirmed cases of drug-resistant Gonorrhoea in Manchester.

There are a number of ongoing programmes of work underway that are designed to tackle the complex issues of AMR in Manchester.

At a Greater Manchester level, an Improvement Plan has been launched which spans the patient pathway from community to hospital, incorporating infection prevention, infection control and antimicrobial stewardship.

The results of a mapping exercise undertaken by the City Council’s Department of Public Health demonstrate how much of our ongoing work contributes directly and indirectly to tackling AMR.

Programmes delivered in Manchester’s schools, such as E-Bug, are introducing the topic of antimicrobial stewardship and resistance to our younger residents. Voluntary and Community sector organisations in Manchester are also working to engage residents on this topic, for example, the AMR Network run by We Are Vocal.

The JSNA also highlights world-leading research led by the University of Manchester that is aiming to find new ways to treat Tuberculosis and, in doing so, tackle AMR.

The JSNA details a series of opportunities for action to further strengthen Manchester’s commitment to tackling AMR.

In summary they are:

1. Gain clarity at a GM level on governance and any devolved responsibilities to the locality (including strategic, operational and monitoring of AMR)
2. Support the annual World AMR Awareness week
3. Support our Vaccination and Immunisation Programme considering the vital link between the two topics
4. Promote the Antimicrobial Stewardship/Guardian training and increase uptake among our own and partner organisations
5. Explore opportunities to increase resident engagement, including a communications campaign on appropriate antimicrobial use
6. Support the Healthy Schools programme to roll out the e-Bug programme in schools
7. Broaden the mapping exercise to demonstrate how existing work contributes to tackling AMR, and promote the use of viewing our work through an ‘AMR lens’

This JSNA was completed in December 2024 and was presented to the Health and Wellbeing Board on the 29 January 2025.

A full copy of the JSNA can be accessed as part of the papers for that meeting.