Research and analysis

ESPAUR report 2023 to 2024: infographics accessible text

Updated 14 November 2024

This document contains 41 infographics for the 2023 to 2024 English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report. The infographics are grouped by the chapters which they relate to in the report.

Chapter 1: Introduction

ESPAUR oversight group 

There is a graphic summarising the achievements of the ESPAUR oversight group: 

• ESPAUR English Surveillance Programme for Antimicrobial Utilisation and Resistance 
• over 30 member organisations including all UK nations, government and member organisations and lay representations
• 11 reports since established in 2013
• 103 UKHSA peer-reviewed publications from April 2023 to March 2024
• over 100 author contributions (2023 to 24 report)
• multi-professional and multi-organisation group led by UKHSA

ESPAUR report 2022 to 2023 

There is a graphic showing the different chapters of the ESPAUR report 2023 to 2024. 

There are boxes representing each chapter of the report: 

1. The antimicrobial resistance box includes icons of microbes.
2. The antimicrobial consumption box includes icons of antimicrobials.
3. The point prevalence survey box includes icons of a survey and the map of England.
4. The antimicrobial stewardship box includes a speech bubble, which contains an icon of an antimicrobial.
5. The NHS England and Improvement assurance schemes box includes the NHS logo.
6. The professional and public education, engagement and training box includes an icon of a person pointing at a board, with other people sat in front of the board.
7. The research box includes an icon of a microscope and DNA.
8. The ESPAUR oversight group members’ action to tackle AMR box includes icons of groups of people with arrows to each other.
9. The ESPAUR report feedback from stakeholders and report users box includes an icon of a form and a magnifying glass partly over the left-hand side.
10. The ESPAUR lay summary box includes an image of a clipboard with the word SUMMARY in it.

Chapter 2: Antimicrobial resistance (AMR)

The burden of bacteraemia and resistant bacteraemia

Two boxes placed one above the other, each containing a graph and a core statistic. A large green graphic to the right containing a core statistic and 2 boxes each filled with 100 outlines of a human figure.

The upper left box contains a bar chart showing the overall estimated number of selected pathogen bacteraemia by calendar year. The graph shows a decrease from 2019 to 2020 (88,143 to 77,305) followed by annual increases from 2020 to 2023 (88,085 in 2023). The 2020, 2021 and 2022 bars are paler in colour to denote the period of the COVID-19 pandemic. The text reads: ‘No net change in numbers of bacteraemia* [note 1] since 2019’.

The lower left box contains a red bar chart showing the number of resistantϮ [note 2] bacteraemia by calendar year. The 2020, 2021 and 2022 bars are paler in colour to denote the period of the COVID-19 pandemic. The graph shows a decrease from 2019 to 2020 (18,082 to 15,524) followed by annual increases from 2020 to 2023 (18,723 in 2023). The text reads: ‘An increase of 3.5% in resistantϮ bacteraemia [note 2] since 2019’.

The large green graphic to the right contains 2 boxes: the top box is titled ‘2019’ and has 100 human figure outlines, 21 of which are coloured red. The other 79 figure outlines are coloured blue.

On the bottom another box filled with 100 figure outlines is titled ‘2023’. Twenty-one figure outlines are coloured red and the other 79 are coloured blue.

Below these 2 boxes a key shows a red figure outline indicates resistant and blue indicates susceptible.

Underneath these boxes is one statement: ‘This means that 21 out of 100 people with a bacteraemia* [note 1] had a resistant infection in 2023’.

Underneath all the boxes are caveats to the figures:

Note 1*: Pathogens include: E. coli, K. pneumoniae, K. oxytoca, Acinetobacter spp., Pseudomonas spp., Enterococcus spp., S. aureus, and S. pneumoniae.

Note 2Ϯ: The resistance combinations included are:

• E. coli, K pneumoniae and K. oxytoca, resistant to any of
  • carbapenems
  • third-generation cephalosporins
  • aminoglycosides
• fluoroquinolones
• Acinetobacter spp, resistant to aminoglycosides and fluoroquinolones, or carbapenems
• Pseudomonas spp., resistant to 3 or more antimicrobial groups, or carbapenems
• Enterococcus spp., resistant to glycopeptides
• S. aureus, resistant to meticillin
• S. pneumoniae, resistant to penicillin and macrolides, or penicillin

Thirty-day all-cause mortality of patients with Gram-negative bloodstream infections in 2023

Four horizontal bars indicate the percentage of patients with different types of Gram-negative bacteraemia that have died within 30 days. 

The bar at the top shows that 15.5% of patients (7,776) with any Gram-negative bacteraemia died within 30 days in 2023. 

An arrow indicates that the lower 3 bars refer to 30-day all-cause mortality of patients with different types of Gram-negative bacteraemia.  

The second bar shows that 16.9% of patients (2,041) with an antibiotic-resistant¥ [note 3] Gram-negative bacteraemia died within 30 days in 2023. 

The third bar shows that 22.9% of patients (56) with a carbapenemase-producing organism* [note 4] bacteraemia died within 30 days in 2023. 

The fourth bar shows that 15.1% of patients (5,689) with an antibiotic-sensitive Gram-negative bacteria bloodstream infection died within 30 days in 2023. 

A higher percentage of people with antibiotic-resistant bloodstream infections die within 30-days compared with those with an antibiotic sensitive bloodstream infection. 

Underneath all the boxes are caveats to the figures: 

Note 3¥: AMR burden combinations  

Note 4*: sterile site infections

Burden of bacteraemia* [note 5] resistant to critically important antibiotics

Bar graph on the left hand side with 2 pie charts displayed to the right.  

The bar graph on the left shows the total bacteraemia* [note 5] in 2023 (88,085), 69,362 being antibiotic susceptible and 18,723 being antibiotic-resistant. 

The pie chart on the upper right has the title ‘Bacteraemia* [note 5] ’ and an arrow from the bar graph indicates that the pie chart represents all bacteraemia in 2023 (both those antibiotic-resistant and susceptible). The pie chart is split up into 3 sections with E. coli displaying 47%, ‘Gram-positive’ displaying 32%, and ‘Other gram-negatives’ displaying 21%.  

The pie chart on the lower right has the title ‘Antibiotic-resistantϮ [note 6] bacteraemia’. An arrow from the bar graph indicates that the pie chart represents only the antibiotic-resistant bacteraemia in 2023. The majority of the pie chart is taken up by E. coli at 68%, the smaller proportions are ‘Other gram negatives’ (18%) and ‘Gram-positive’ (14%). 

Note 5*: Pathogens include: E. coli, K. pneumoniae, K. oxytoca, Acinetobacter spp., Pseudomonas spp., Enterococcus spp., S. aureus, and S. pneumoniae.

Note 6Ϯ: The resistance combinations included are:

• E. coli, K pneumoniae and K. oxytoca, resistant to any of
  • carbapenems
  • third-generation cephalosporins
  • aminoglycosides
  • fluoroquinolones
• Acinetobacter spp, resistant to aminoglycosides and fluoroquinolones, or carbapenems
• Pseudomonas spp., resistant to 3 or more antimicrobial groups, or carbapenems
• Enterococcus spp., resistant to glycopeptides
• S. aureus, resistant to meticillin
• S. pneumoniae, resistant to penicillin and macrolides, or penicillin

Rate of AMR burden per 100,000 by Index of Multiple Deprivation (IMD) in 2019 and 2023  

A bar graph is displayed showing the rate of AMR burden per 100,000 population by IMD quintile, with an arrow across the top of the graph indicating the most deprived group is on the right and least deprived group on the left. Each quintile has 2 bars, one for 2019 and one for 2023, with the percentage change from 2019 to 2023 within each quintile displayed above them. The bar graph shows a gradient of lower rate of AMR burden in the least deprived quintiles compared to the more deprived quintiles.​

​The most deprived quintile shows, per 100,000 population, a rate of 34.8 in 2019 and 38.1 in 2023, indicating this is an increase of 9.5% from 2019 to 2023.​

The second most deprived quintile shows, per 100,000 population, a rate of 33.2 in 2019 and 34.1 in 2023, indicating this is an increase of 2.5% from 2019 to 2023.​

The middle quintile shows, per 100,000 population, a rate of 31.0 in 2019 and 31.0 in 2023, indicating this is a decrease of 0.2% from 2019 to 2023. 

The second least deprived quintile shows, per 100,000 population, a rate of 29.3 in 2019 and 30.2 in 2023, indicating this is an increase of 3.2% from 2019 to 2023. 

The least deprived quintile shows, per 100,000 population, a rate of 26.9 in 2019 and 26.7 in 2023, indicating this is a decrease of 0.6% from 2019 to 2023. 

Note that figures are rounded and may cause different rates to appear the same in the text.

Regional notifications per 100,000 population of acquired carbapenemase-producing organisms by carbapenemase family in England 2023

There are 6 maps of the 9 English regions, showing the rate per 100,000 population of acquired carbapenemase-producing Gram-negative bacterial notifications by the ‘big 5’ carbapenemase families (NDM, OXA-48-like, KPC, IMP, VIM) separately and overall in England, 2023.

NDM 

London had the highest rate of NDM carbapenemase notifications, as indicated by the darker shading in this region. 

OXA-48-like 

For OXA-48-like carbapenemases, London had the highest rate, followed by the West Midlands.

KPC 

The North West had the highest rate of KPC carbapenemase notifications, followed by West Midlands and North East, as indicated by the darker shading in this region. All other regions had a rate of less than 2 per 100,000 population. 

IMP 

The highest rate of IMP carbapenemase notifications were reported in the North East, as indicated by the darker shading in this region, followed by London. All other regions had a rate less than one per 100,000 population.  

VIM 

VIM carbapenemases were comparatively rare in England in 2023, with all regions recording notification rates of less than one per 100,000 population. 

Total carbapenemases 

Summary of the combined regional variation of all reported carbapenemase families, with the highest rate in London, followed by the North West. 

Regional variation in rate per 100,000 population of the estimated rate of bacteraemia* [note 7] in England 2023 and regional variation in rate per 100,000 population of the estimated burden of antimicrobial resistance in bacteraemia* [note 7]

Maps showing the regional variation in rate per 100,000 population of a) the estimated rate of overall bacteraemia in England in 2023 and b) the estimated burden of resistant bacteraemia in England in 2023. Overall bacteraemia is shown in blue on the left-hand map and resistant bacteraemia is shown in red on the right-hand map.

Bacteraemia

The highest rate per 100,000 population of bacteraemia was observed in the North East (186.5 per 100,000) followed by Yorkshire and Humber (172.7 per 100,000) and the North West (167.8 per 100,000), with the lowest rates in London (139 per 100,000), East of England (145.3 per 100,000) and West Midlands (149.5 per 100,00).

Resistant bacteraemia

The highest rate per 100,000 population of resistant bacteraemia was observed in London (41.5 per 100,000), followed by the North West (35.8 per 100,000) and Yorkshire and Humber (34.7 per 100,000). The lowest rates were observed in the South West (25.9 per 100,000), East Midlands (26.6 per 100,000) and North East (30.0 per 100,000).

Note 7*: Pathogens include E. coli, K. pneumoniae, K. oxytoca, Acinetobacter spp., Pseudomonas spp., Enterococcus spp., S. aureus and S. pneumoniae.

Yeast species bloodstream infections 2019 and 2023

Two waffle charts present the proportion of bloodstream infections due to yeast species in 2019 and 2023 respectively. In 2019 Candida albicans was the predominant cause of bloodstream infections due to yeast (40%) followed by Nakaseomyces glabratus (formerly Candida glabrata; 29%). Candida parapsilosis was the third most prevalent cause of bloodstream infections due to yeast (11%). The remaining 20% of bloodstream infections due to yeast we caused by other yeast species. In 2023 C. albicans remained the predominant cause of bloodstream infections due to yeast (40%) followed by N. glabratus (27%). C. parapsilosis was the third most prevalent cause of bloodstream infections due to yeast with the proportion caused by this species increasing to 15%. The remaining 18% of bloodstream infections due to yeast were caused by other yeast species. 

Detections of C.auris in patients in England in UKHSA region 2023

This infographic is a map of the 9 English regions, showing the number of patients who have tested positive for C. auris colonisation or infection for the first time in England, 2023. 

Candidozyma auris (C. auris) is a rapidly emerging fungal pathogen with a global distribution. Designated a critical priority fungal pathogen by the World Health Organisation in 2022, it can cause severe invasive infection, mostly within healthcare settings. There was a significant increase in the prevalence of C. auris in England in 2023 including protracted outbreaks in 2 large NHS trusts in London and the South-East. These regions reported the majority of C. auris detections in England. In 2023, 93 patients were reported to the UKHSA with first detections of C. auris, of these 50 patients were reported in London and 27 in the South East.

Chapter 3: Antimicrobial consumption

Total consumption of antibiotics increasing towards pre-pandemic levels

Total consumption of antibiotics is presented across the 5 years studied, from 2019 to 2023. Consumption has steadily decreased across the years. Vast reductions noted in 2020 (from 18.0 in 2019 to 16.1 DDDs per 1,000 inhabitants per day in 2020). However, 2023 data showed a continuing increase in trends from 2022 levels to 17.6 DDDs per 1,000 inhabitants per day. 

Total antibiotic consumption by prescriber setting as proportion of overall prescribing, England 2023

Pie chart showing total antibiotic consumption by prescriber setting as proportion of overall prescribing, in England, for the year 2023. General practices account for 71.8% of consumption, followed by hospital inpatients (13.6%), hospital outpatients (6.6%), dental practices (3.4%) and ‘other’ community settings (4.6%).

Antibiotic prescribing increased in primary care

Primary care consumption of antibiotics is presented across the 5 years studied, from 2019 to 2023, measured as items per 1,000 inhabitants per day. Consumption saw a large decline in 2020 and 2021 due to the COVID-19 pandemic. Antibiotic consumption subsequently increased to 2019 levels in 2022 and saw a further increase in 2023 (1.7 in 2023 compared with 1.66 items per 1,000 inhabitants per day in 2022). 

Antibiotic prescribing decreased in secondary care

Secondary care consumption of antibiotics is presented across the 5 years studied, from 2019 to 2023, measured as DDDs per 1,000 admissions. In 2023, consumption decreased compared to 2022 (4,690 in 2023 compared with 4,781 DDDs per 1,000 admissions in 2022), but consumption remains slightly higher than 2019 levels. 

Being AWaRe

The World Health Organization classified key antibiotics into 3 categories (AWaRe): to improve access (Access), to monitor important antibiotics (Watch) and to preserve ‘last resort’ antibiotics (Reserve). Where Access are first and second choice antibiotics for treating the most common infections, Watch are antibiotics with increased toxicity concerns and higher resistance potential that should only be prescribed for specific indications to minimise unnecessary harm to patients and costs to healthcare systems, and Reserve antibiotics are last resort options that should only be used in severe circumstances, when other options have failed. This has been adapted by the UK for the National Action Plan.

Proportion of AWaRe antibiotic use across the healthcare system in 2023 (2024 UK AWaRe classification)

AWaRe antibiotic use as a proportion of total antibiotic use in 2023 is presented for primary care, secondary care and total across both settings, using the 2024 UK classification. The proportion of Access antibiotic use represented 66.7% of total antibiotic use in primary care and 53.4% in secondary care. Access antibiotic use represented 64.0% of total antibiotic use across the healthcare system, 6% below the UK NAP target for 2023 to 2029 (70% Access antibiotic use). For primary care, Watch antibiotic use represented 30% of the total antibiotic use, whilst the Reserve and Other categories accounted for 0.1% and 3.2%, respectively. In secondary care, Reserve, Watch and Other antibiotics accounted for 43.1%, 2.9% and 0.6%, respectively. This amounts to a total Watch proportion of 32.6%, 0.7% for Reserve and 2.7% for Other antibiotics.

Change in secondary care AWaRe consumption: 2022 versus 2023 compared to 2019 versus 2023 (% change in DDDs per 1,000 admissions)

The change in AWaRe consumption are presented by comparing Access, Watch and Reserve consumption, measured by percentage change in DDDs per 1,000 admissions in 2019 versus 2023, and 2022 versus 2023. Access antibiotics decreased by 1.1% in 2023 compared to 2019. When comparing the most recent years, there was a 0.8% increase in the use of Access antibiotics, a 3.5% increase in Watch antibiotics and a 5% increase in the use of Reserve antibiotics between 2022 and 2023.

Consumption of antifungals in primary and secondary care

Primary and secondary care consumption of antifungals are presented across 2019, 2020 and 2023, measured as DDDs per 1,000 inhabitants per day. Antifungal consumption across both primary and secondary care present the same rates in 2023 as with pre-pandemic 2019 (Primary care: 1.10 DID in both 2019 and 2023; secondary care 0.14 DID in both 2019 and 2023). 

UK National Action Plan ambitions and England progress 

This slide describes 2 of the UK National Action Plan (NAP) ambitions aimed at:

• reducing a specified set of drug resistant infections by 10% by 2025
• reducing UK antibiotic use in humans by 15% by 2024 (that is to or below 16.92 DID), compared to 2014 baseline

The figure also describes England’s progress towards these measure, in that:

• the estimated number of severe infections in 2023 was 12.8% higher than the AMR 2018 baseline
• total antimicrobial use in humans in England reduced by 11.5% (that is to 17.63 DID) by 2023 compared to 2014

Both AMR and consumption measures are yet to meet the required NAP measures, highlighting the need for continued stewardship. 

Chapter 4: Point-Prevalence Survey on Healthcare-Associated Infections, Antimicrobial Use and Antimicrobial Stewardship in England 2023

Participation in PPS of HCAI and AMU in England 2023  

This infographic describes the number of organisations and patients included in the 2023 Point-Prevalence Survey on Healthcare-Associated Infections, Antimicrobial Use and Antimicrobial Stewardship in England by trust or organisation type.

The top half of the image shows the number of trusts or organisations participating in the survey for each healthcare sector:

• NHS acute-general – 58 trusts or organisations
• NHS acute-specialist – 9 trusts or organisations
• NHS mental health – 21 trusts or organisations
• NHS community – 9 trusts or organisations
• independent sector – 16 trusts or organisations

Each sector is represented by an icon of a hospital building, with the number of participating organisations noted below each icon.

The bottom half of the image presents the number of patients surveyed in each healthcare sector:

• NHS acute-general – 36,985 patients
• NHS acute-specialist – 1,251 patients
• NHS mental health – 3,540 patients
• NHS community: 1,451 patients.
• independent sector – 1,145 patients

PPS on HCAI and AMU in England 2023

This slide describes the HCAI and AMU prevalences in the PPS 2023.

Eight out of 100 adult patients and 7 out of 100 paediatric patients in participating organisations had at least one HCAI at the time of the survey.

The percentage of patients receiving at least one antimicrobial by trust or organisation type at the time of the survey:

• NHS acute-general trusts – 37% of patients received at least one antimicrobial
• NHS acute-specialist trusts – 47% of patients received at least one antimicrobial
• NHS mental health trusts – 7% of patients received at least one antimicrobial
• NHS community trusts – 9% of patients received at least one antimicrobial
• independent sector organisations – 44% of patients received at least one antimicrobial

Chapter 5: Antimicrobial stewardship

TARGET antibiotics toolkit activities 2023 to 2024

This graphic summarises the activities and updates of the TARGET antibiotics toolkit activities which took place between 2023 to 2024. TARGET stands for ‘Treat Antibiotics Responsibly, Guidance, Education and Tools’. 

Activities included: 

• new summary of antimicrobial guidance section on TARGET website – viewed over 67,000 times 
• developed and promoted resources to support clinicians managing patients on long-term antibiotics 
• over 134,000 people used a UTI pre-consultation survey developed by TARGET, supporting clinicians to follow national UTI guidance 
• urinary tract infection and respiratory tract infection leaflets for community pharmacy were accessed 15,226 and 10,667 times respectively 
• World Antimicrobial Resistance Awareness Week campaign reached over 51,000 Royal College of General Practitioners’ members 
• ran 3 webinars with a combined total of 922 live attendees and 436 online views

The TARGET antibiotics toolkit

Roadmap showing the TARGET cycle of stewardship.

1. Assess: Regularly measure antibiotic prescribing and action plans – self-assessment checklists for GPs, community pharmacists and commissioners
2. Learn: Stay informed on the latest evidence, research and guidance on antibiotic use – interactive training tools, webinars, eLearning courses and podcasts
3. Act: Take proactive steps to enhance stewardship – patient information leaflets and quick reference tools to practice appropriate use of antimicrobials
4. Evaluate: Review your practices against current prescribing guidelines – audit toolkits and ‘How to…’ resources for review of long-term antibiotics

Updating the ‘Start Smart then Focus’ (SSTF) antimicrobial stewardship (AMS) toolkit for secondary care

Shows the 6 steps of updating the ‘Start Smart then Focus’ antimicrobial stewardship toolkit for secondary care.

1. ‘Start Smart then Focus’ AMS toolkit for secondary care – update.

2. Venn diagram with categories – multidisciplinary SSTF update group, clinical input, and focused literature searches.

3. Key themes, being:

• foster a culture of AMS in practice
• embed AMS within clinical practice

1. Algorithms for use in clinical practice.

2. Final review of draft external stakeholders prior to publication.

3. Knowledge mobilisation workshop:

• SSTF updates
• case studies
• COM-B model

IV-to-oral switch in children and young people: a modified-Delphi approach

Flow diagram for the modified Delphi approach used to develop IV to oral switch guidance in children and young people.

1. Literature data: rapid review of 32 out of 158 papers
2. Delphi process:
   • Step 1 – web-based questionnaire with 170 respondents
   • Step 2 – virtual meeting with 8 participants

There is a split arrow from the second box to an image of the published criteria and an image of the sample decision aid.

Antimicrobial stewardship in domiciliary care: infographic for ESPAUR

Image shows different factors that are linked to antimicrobial stewardship in domiciliary care.

In the top left corner there is box with key contextual factors:

• unpredictable client home environments
• carers travelling from home to home, often seeing many clients in a day
• a compliance culture, where carers strictly adhere to a care plan

In the centre of the image is a circle containing the text ‘Antimicrobial stewardship in domiciliary care’. This is surrounded by 5 factors linked to AMS in domiciliary care with each factor linked to a positive and negative behaviour that domiciliary care workers reported.

Preventing infection:

• carers see IPC as common sense and undertake a wide range of IPC measures
• a lack of time and challenges working in clients’ homes can lead to poor IPC practices – current training on IPC varies between care agency and is often developed organically by managers  

Identifying symptoms of infection:

• associate some symptoms with infection, for example UTIs – will signpost clients to seek healthcare
• do not see themselves as having a medical role – ability to notice and act on early signs of infection could be strengthened

Medicine management:

• routinely administer and monitor antibiotic use by clients, in line with medical advice and if on care plan
• if antibiotics are not recorded on care plans in a timely way, there may be delays in carers administering antibiotics – occasional examples of antibiotic misuse identified and inconsistencies with taking antibiotics to the pharmacy for disposal 

Educating clients of client’s family on AMS behaviours:

• carers will reinforce instructions for antibiotic use
• their role in reinforcing AMS practices with the client and their families could be formalised

Understanding of how actions relate to AMR:

• while they have limited understanding of AMR currently, they are open to learning more and – when told about AMR – agree their role is important
• currently, their limited awareness of how their actions relate to AMR means that, when faced with an unexpected situation, they may unintentionally act in an unhelpful way

Rapid systematic review of inclusion health groups and adult social care

Graphic shows findings from 3 rapid systematic reviews of inclusion health groups and adult social care.

The far left box has an image of a set of balance scales with the title ‘Levels of AMR and AMU among people in contact with the justice system’. The box then contains the following text:

• antibiotic use – 3 studies
• inappropriate prescribing found (one paper)
• recent antibiotic use associated with higher risk of resistant infections (2 papers)
• bacterial AMR – 14 papers
• prevalence of drug-resistant tuberculous – 5.2% to 37% (4 papers)
• MRSA colonization – 8.1% to 8.8% (4 papers)

At the bottom of the box is the sentence: ‘Individuals in contact with the criminal justice system are at risk of resistant bacterial infections.’

The middle box has an image of a condom and a dollar bill with the title ‘Interventions to tackle AMR or AMU in sex workers’. The box then contains the following text:

No studies of relevant interventions for sex workers identified.

At the bottom of the box is the sentence: ‘Research into AMS interventions for sex workers is urgently needed.’

The right-hand box contains an image of a pair of hands cupping 4 smaller figures with the title ‘Interventions to tackle AMR and AMU in adult social care’. The box then contains the following text:

• 18 studies found
• education and training reduced inappropriate antimicrobial prescribing by 13% to 55.5% (17 papers)
• pharmacist oversight improved correct treatment options being prescribed to patients (one paper)

At the bottom of the box is the sentence: ‘Interventions including education and training reduced inappropriate antibiotic use in adult social care settings.’

The bottom of the infographic contains a citation to Oliver-Williams C, Nasim M, Akpan-Ajetunmobu A, Cook M, Edge C, Ashiru-Oredope D. ‘Rapid systematic reviews of inclusion health groups and adult social care’ 2024

Barriers – the barriers to providing advice or resources on prudent antibiotic use or management of infections

Graphic shows the top 3 barriers to providing advice on appropriate antibiotic use in the UK identified from a survey of healthcare workers in the UK conducted in 2024. It shows a podium, the middle box contains the percentage 29% and has text saying lack of resources underneath with a crossed out image of prescribing resources above the podium. The right-hand step of the podium contains the percentage 28% and has text saying insufficient time underneath with an image of a clock above the podium. The left-hand step contains the percentage 25% and has the text patient uninterested in the information with an image of a man distracted on his phone while someone is handing him some information.

Access

Graphic HCPs access to resources identified from a survey of healthcare workers in the UK conducted in 2024. The image contains a bar graph with 3 bars. The left bar shows 91% of HCP agreed or strongly agreed that they have easy access to the guidelines they need on managing infections. The middle bar shows 73% of HCPs agreed or strong agreed that they have easy access to the materials they need to give advice on prudent antibiotic use and antibiotic resistance. The right bar shows 81% of HCPs agreed or strongly agreed that they have good opportunities to provide advice on prudent antibiotic use to individuals.

Behaviour

Graphic shows behaviours reported by HCPs in a survey of healthcare workers in the UK conducted in 2024. The left half on the graphic has an image of a doctor handing a patient a leaflet with the following text above the image: 27% gave out resources on antibiotic use at least once a week. The image on the right of the graphic shows a doctor speaking with a patient with the following text above: 63% gave out advice on the prudent use of antibiotics at least once in the previous week.

Capability – % of respondents answering all 7 knowledge test questions correctly (by profession)

Graphic showing the percentage of respondents answering all 7 knowledge text questions correctly by profession obtained from a survey of healthcare workers in the UK conducted in 2024. The image is divided into 7 boxes which each contain a pie chart showing the percentage of HCPs in each profession answered all knowledge questions correctly:

• medical doctors – 75%
• pharmacists – 72%
• nurses – 52%
• dentists – 59%
• pharmacy technicians – 32%
• allied health professionals – 56%
• other healthcare workers (for example dental care professionals, assistant nurses) – 40%

Chapter 6: NHS England – improvement and assurance schemes

NHS England improvement and assurance schemes: prescribing in primary and secondary care

Graphic showing 4 charts illustrating performance based on NHS England improvement and assurance schemes for prescribing antimicrobials in primary and secondary care. The first chart shows the proportion of ICBs that met the NHS Oversight Framework Targets for Primary Care for 2 indicators, total antibiotic prescribing and proportion broad-spectrum. It shows that 24% of ICBs met the total antibiotic prescribing target in 2023 to 2024 which is an increase from 17% in 2022 to 2023, and 95% of ICBs met the proportion broad-spectrum target in 2023 to 2024 which is a decrease from 98% in 2022 to 2023. The second chart shows the proportion of 5-day prescriptions of amoxicillin capsules in primary care had increased in 2023 to 2024 to 57% from 42% in 2022 to 2023. The third chart shows 23% of hospital trusts met the 10% target reduction in antibiotic consumption from the Watch and Reserve categories, with 20% of trusts reporting reductions without meeting the target and 57% of trusts reporting an increase. The fourth chart shows the vast majority of hospital trusts achieved the IV-to-oral switch CQUIN target.

Chapter 7: Professional and public education and training

AMS interventions to provide wrap around support for the public and healthcare professionals  

This infographic depicts AMS interventions to provide wrap around support for the public and healthcare professionals. The e-Bug logo covers the left-hand side of the infographic, which includes 3 text bubbles interconnected with arrows. The text bubbles describe population groups and how AMS interventions support them:

• children and young people – empower children to embed and share healthy behaviours with households
• educators – equip teachers to promote infection, prevention, control and treatment learning
• households – empower households to self-care and use antimicrobials appropriately

The TARGET logo covers the right-hand side of the infographic, which includes 3 text bubbles interconnected with arrows. The text bubbles describe population groups and how AMS interventions support them:

• care workers – empowered to identify and treat urinary tract infections
• pharmacists – empowered to provide advice on infection grounded in AMS
• general practice – equipped with tools to provide advice on infection grounded in AMS

Arrows join the bubbles on the left- and right-hand sides to a bubble in the middle showing population groups and how AMS interventions support them. The text bubble in the middle says ‘Public: Public adopt AMS and IPC behaviours’.

The ‘households’, ‘public’ and ‘general practice’ bubbles have bold arrows leading to 3 text boxes that say:

• reduced infection outbreaks in school, social care and community settings
• reduced antimicrobial prescribing
• lower levels of antimicrobial prescribing

At the bottom of the infographic is the Antibiotic Guardian logo, which targets all population groups depicted in the infographic.

TARGET training roll out reach, impact and next steps

A map of England with markers that depict all primary care networks (PCNs) in England – the coloured markers indicate that training has been delivered to the PCN and the grey markers indicate that training has not been delivered to the PCN. There were 222 participants for ‘Train-the-Trainer’ training and 1,100 participants for ‘AMS Training’. However, the total training reach was 1,331 as 9 participants did not specify their training type.

A bar graph compares the use of TARGET resources pre-training against the intention to use the resources post-training. All resources saw an increase for intended use from their current use.

A bar graph shows the timeframe in which respondents intend to implement AMS actions following the training. Respondents mostly intended to implement their actions within 3 months of the training (37%), followed by 3 to 6 months (25%) and 9 to 12 months (10%). Three percent did not plan on taking any action.

The next steps of the national roll out will be to evaluate the local implementation of TARGET training and toolkit use, to assess the impact of the training on prescribing rates and to further extend the reach of the training.

Ten years of Antibiotic Guardian

This infographic provides an overview of 10 years of the Antibiotic Guardian campaign. In the centre of the image is the pledge form taken from the Antibiotic Guardian website.

There are 5 speech bubbles across the top of the image which contain the following text which is taken from different pledge options:

• “When I see a patient with dental pain, I will discuss methods of controlling symptoms rather than prescribing antibiotics as a first course of action” – dentist
• “If I’m prescribed antibiotics, I will take them exactly as prescribed and never share them with others” – public
• “I will ensure that guidelines for diagnosis and management of common infections (including sepsis) are readily available and reliably accessed by supporting their design and dissemination” – infection prevention specialist
• “When handing out a prescription that includes antibiotics, I will inform the patients of dose and duration and to take their antibiotics exactly as prescribed and to return any unused antibiotics to a pharmacy for safe disposal” – pharmacy teams
• “If I prescribe an antibiotic then I will document indication, duration and review dates on the drug chart in line with Start Smart then Focus AMS guidance” – primary or secondary care prescribers

The bottom left of the image contains an image taken from the home page of the Antibiotic Guardian website.

In the bottom middle of the image is a timeline with the following information:

2014 – AG launch

2026 – Launch of AG shared learning event, platform and awards

2017 – Rebranding

2019 – Launch of AG schools ambassadors

2023 – Revision of AG pledges

In the bottom right corner is a yellow box with the following text:

More than 200,000 pledges, 10 peer-reviewed publications, 1,025 organisation pledges, 241 AG school ambassadors, 468 entries to AG awards.

Antibiotic Guardian pledges

This infographic shows the changes in Antibiotic Guardian pledges from 2019 to 2023. A red line across the centre of the infographic shows changes in the number of pledges received per year. The line starts at the bottom left corner with 9,289 pledges in 2019. There is then an increase in 2020 with 36,733 pledges. This then decreases slightly with 32,423 pledges in 2021. A sharper decrease is seen in 2022 with 13,915 pledges. There is then a slight increase in 2023 with 19,321 pledges. Some text outlines there has been an increase in 2023, but pledges remain below 2021 levels.

A green box on the left side of the infographic highlights that the Quality Scheme was implemented in 2020, which required all patient facing pharmacy staff to become Antibiotic Guardians.

A blue bubble on the right of the infographic highlights that there have been 177,681 pledges from inception of Antibiotic Guardian in 2014 to end of 2023.

Four text boxes along the bottom of the infographic describe the following:

• 82 organisations registering AMS activity through Antibiotic Guardian in 2023
• 62 entries for the 2022 to 2023 Antibiotic Guardian Shared Learning and Awards
• 26 Antibiotic Schools Ambassadors registrants in 2023
• global collaborations with Africa Centres for Disease Control and Prevention (CDC), WHO Europe, Belgium and South Africa national AMR programmes

Chapter 8: Research

AMR peer-reviewed publications from April 2023 to March 2024, by National Action Plan (2019 to 2024) major theme

The infographic shows AMR-related peer-reviewed publications from April 2023 to March 2024, grouped by the major themes of the National Action Plan for AMR (2019 to 2024).

For:

• human infection prevention and control there are 21 publications
• clean water and sanitation there is one publication
• environmental contamination there is one publication
• optimal use of antimicrobials in humans there are 19 publications
• stronger laboratory capacity and surveillance of AMR in humans there are 20 publications
• basic research – sustainable investment there are 26 publications
• development of new therapeutics there are 2 publications
• wider access to therapeutics for those who need them there are 3 publications
• development of and access to diagnostics there are 6 publications
• development and access to vaccines there are 2 publications
• international diplomacy there are 2 publications

Chapter 10: Knowledge mobilisation of ESPAUR report – feedback from stakeholders and report users

ESPAUR report feedback from stakeholders and report users

This infographic highlights responses from surveys sent through annual webinars (in 2022 and 2023) and also with members of the ESPAUR oversight group.

The report user feedback from webinars showed there were 393 respondents for the 2021 to 2022 report, and 494 respondents for the 2022 to 2023 report.

The data for the 2021 to 2022 report survey shows:

• the most used chapters were Antimicrobial resistance (96), Antimicrobial stewardship (93), Antimicrobial consumption (84), Executive summary (54), Professional and public education (25), Research (19), NHS England: improvement and assurance schemes (16), Introduction (14), COVID-19 therapeutics (14), Stakeholder engagement (8)
• 55 respondents used multiple chapters
• the most common reasons for accessing the report were reading for information (187) and to share with others, that is presentation (125)

The data for the 2022 to 2023 report survey shows:

• the most used chapters were Antimicrobial resistance (201), Antimicrobial stewardship (154), Antimicrobial consumption (150), Professional and public education (56), NHS England: improvement and assurance schemes (44), Research (41), Stakeholder engagement (29)
• the most common reasons for accessing the report were reading for information (187) and to share with others, that is presentation (125)
• the most common reasons for accessing the report were reading for information (179) and to share with others, that is presentation, (69), followed by informing policy (67) and use for local indicators (32)

For the ESPAUR oversight group members survey, a picture showing 11 out of 21 oversight group members responded from UKHSA, VMD, NHS England, Royal College of General Practitioners, Care Quality Commission, ESPAUR Dental Subgroup, Public Health Agency, College of General Dentistry. A graph titled ‘What does ESPAUR help you achieve?’ should 12 members selecting ‘General awareness or interest’, 9 said for share knowledge, experience or tools, 9 said influence policy or action, 8 said engage stakeholders, 7 said validate, legitimise or defend position, 3 change attitudes, behaviour or practice.