Research and analysis

ESPAUR report 2022 to 2023: infographics accessible text

Updated 5 January 2024

This document contains 31 infographics for the 2022 to 2023 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

A graphic summarising the achievements of the ESPAUR oversight group, namely:

• ESPAUR English Surveillance Programme for Antimicrobial Utilisation and Resistance
• all devolved administrations, lay representation and 23 member organisations
• 10 reports since established in 2013
• 57 UKHSA peer-reviewed publications from April 2022 to March 2023
• over 100 author contributions (2022 to 2023 report)
• multi-professional and multi-organisation group led by UKHSA

ESPAUR report 2022 to 2023

A graphic showing the different chapters of the ESPAUR report 2022 to 2023.

A box represents 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 antimicrobial stewardship box includes a speech bubble, which contains an icon of an antimicrobial and a cross.
4. The NHS England and Improvement assurance schemes box includes the NHS logo.
5. The professional and public education, engagement and training box includes an icon of a person pointing at a board, with other people sitting in front of the board.
6. The research box includes an icon of a microscope and DNA.

Chapter 2: Antimicrobial resistance (AMR)

The burden of bloodstream infections (BSIs) and resistant BSIs

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 key pathogen blood stream infections by calendar year. The graph shows an increase from 2018 to 2019 (86,060 to 88,851), a subsequent decline in 2020 to 79,466, and an increase in 2022 to 84,685. The 2020, 2021 and 2022 bars are paler in colour to denote the period of the COVID-19 pandemic. The text reads: ‘A decrease of 2% in key pathogens* BSI since 2018’.

The lower left box contains a red bar chart showing the number of resistant key pathogen* bloodstream infections by calendar year. The 2020, 2021 and 2022 bars are paler in colour to indicate the period of the COVID-19 pandemic. The graph shows an increase from 2018 to 2019 (17,437 to 18,259) followed by a reduction in 2020 (16,043) which has then increased in 2022 (16,643). The text reads: ‘A decrease of 5% in resistant key pathogensϮ BSI since 2018’.

The large green graphic to the right contains 2 boxes: the left-hand box is titled ‘2018’ and 20 human figure outlines of the 2 bottom rows of the 10-by-10 grid are coloured red. The other 80 figure outlines are coloured grey.

On the right another box filled with 100 figure outlines is titled ‘2022’. Twenty figure outlines in the bottom 2 rows of figure outlines are coloured red and the other 80 are coloured grey.

Below these 2 boxes a key shows a red figure outline indicating resistant and grey indicating susceptible.

Underneath these boxes is a statement: ‘This means that 20 out of 100 people with a key pathogen BSI had a resistant infection in 2022’.

Underneath all the boxes are caveats to the figures:

*The key pathogens include: E. coli, K. pneumoniae, K. oxytoca, Acinetobacter spp., Pseudomonas spp., Enterococcus spp., S. aureus, and S. pneumoniae.

Ϯ The resistance combinations included are: E. coli, K pneumoniae and K. oxytoca, resistant to any of: carbapenems, third-generation cephalosporins, aminoglycosides, or 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.

The burden of bacterial bloodstream infections and resistance to critically important antibiotics

Bar graph on the left-hand side with 2 pie charts displayed one above another.

The bar graph on the left shows the total number of bacterial bloodstream infections in 2022 (84,685), 68,042 being antibiotic susceptible and 16,643 being antibiotic-resistant.

The pie chart on the upper right has the title ‘Bacterial bloodstream infections’ and an arrow from the bar graph indicates that the pie chart represents all bacterial bloodstream infections in 2022 (both those antibiotic-resistant and susceptible). The pie chart is split up into 3 sections with E. coli displaying 46%, ‘Gram-positive’ displaying 34%, and ‘Other gram-negatives’ displaying 20%.

The pie chart on the lower right has the title ‘Antibiotic-resistant bacterial bloodstream infections’. An arrow from the bar graph indicates that the pie chart represents only the antibiotic-resistant bloodstream infections in 2022. The majority of the pie chart is taken up by E. coli at 68%, the smaller proportions are ‘Other gram negatives’ (17%) and ‘Gram-positive’ (15%).

30-day all-cause mortality of patients with Gram-negative bloodstream infections in 2022

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

The bar at the top shows that 16.9% of patients (8,135) with any Gram-negative bloodstream infection died within 30 days in 2022.

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

The second bar shows that 19.1% of patients (2,023) with an antibiotic resistant Gram-negative bacteria bloodstream infection died within 30 days in 2022.

The third bar shows that 30.4% of patients (41) with a Carbapenemase-producing Gram-negative bacteria bloodstream infection died within 30 days in 2022.

The second bar shows that 16.2% of patients (6,051) with an antibiotic sensitive Gram-negative bacteria bloodstream infection died within 30 days in 2022.

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:

*invasive infections ¥ AMR burden combinations

Rate of AMR burden from BSI and Carbapenemase-producing Gram-negative bacteria notification per 100,000 population by Index of Multiple Deprivation in 2022

The bar graph is split into 2 sections, the first 5 vertical orange bars depict the rate per 100,000 population of AMR Burden from BSI by IMD quintile going from the most deprived (163.3 per 100,000 population) to the least (125,9 per 100,000 population) deprived quintile.

The 5 green vertical bars depict the rate per 100,000 population of carbapenemase-producing Gram-negative bacterial notifications by IMD quintile going from most deprived (7.2 per 100,000 population) to the least deprived quintile (3.6 per 100,000 population).

There are arrows on the graph to indicate the most and least deprived quintiles.

Regional notifications per 100,000 population of acquired carbapenemase-producing Gram-negative bacteria by big-5 carbapenemase families in England, 2022.

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 (IMP, KPC, NDM, OXA-48-like and VIM) and overall in England, 2022

OXA-48-like

For OXA-48-like carbapenemases, the West Midlands had the highest rate, followed by London and the East Midlands. The South West had the lowest rate of <1.0 per 100,000 population.

NDM

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

KPC

The North West had the highest rate of KPC carbapenemase notifications, followed by West Midlands, North East and Yorkshire and Humber as indicated by the darker shading in this region. All other regions had low rate of less than 1 per 100,000 population.

IMP

The highest rate of IMP carbapenemase notifications were recorded in the North East, as indicated by the darker shading in this region. All other regions had a rate less than 1 per 100,000 population.

VIM

VIM carbapenemases were comparatively rare in England in 2022, with all regions recording notification rates of 1.25 per 100,000 population or less.

Big-5 carbapenemases

Summary of the combined regional variation of the big-5 carbapenemase families, with the highest rate in the North West.

Regional variation in rate per 100,000 population of a) the estimated burden of resistant bloodstream infections (AMR) and b) the estimated numbers of bloodstream infections (BSI) in England in 2022

Maps showing the regional variation in rate per 100,000 population of a) the estimated burden of resistant bloodstream infections (AMR) and b) the estimated numbers of bloodstream infections (BSI) in England in 2022. AMR is shown in red on the left-hand map and BSI is shown in blue on the right-hand map.

AMR

The highest rate per 100,000 population of resistant bloodstream infections was observed in London, followed by the North West and North East. The lowest rates were observed in the South West, West Midlands and East Midlands (less than 25 per 100,000 population).

BSI

The highest rate per 100,000 population of bloodstream infections was observed in Yorkshire and Humber followed by the North West and North East, with the lowest rates in the West Midlands and the East of England.

Candida species from bloodstream infections in 2018 and 2022

Two waffle charts present the proportion of bloodstream infections due to Candida and former Candida species in 2018 and 2022, respectively. Candida albicans was the causative organism for 38% of bloodstream infections caused by Candida and former Candida species in 2018 increasing to 42% in 2022. Nakaseomyces glabratus (previously Candida glabrata) was the causative organism for 29% of bloodstream infections caused by Candida and former Candida species in 2018 in comparison to 24% in 2022. For bloodstream infections caused by Candida and former Candida species the causative organism was not identified to species level for 10% of these infections in 2022, a decrease from 13% in 2018.

Chapter 3: Antimicrobial consumption

Total consumption of antibiotics continue to decline

Total consumption of antibiotics are presented across the 5 years studied, from 2018 to 2022. Consumption has steadily decreased across the years. Vast reductions noted in 2020 (from 18 in 2019 to 16.1 DDDs per 1,000 inhabitants per day in 2020).

However, 2022 data showed an increase in trends to 17.4 DDDs per 1,000 inhabitants per day.

Total antibiotic consumption by prescriber setting as proportion of overall prescribing, England 2020

Pie chart showing total antibiotic consumption by prescriber setting as proportion of overall prescribing, in England, for the year 2022. General practices account for 72% of consumption, followed by hospital inpatients (13%), hospital outpatients (7%), dental practices (4%) and other community settings (4%). There has been no shift in patient care settings during the COVID-19 pandemic period or with the increases in antibiotic use in 2022.

Antibiotic items prescribed in primary care have increased to pre-pandemic 2019 levels

Primary care consumption of antibiotics are presented across the 5 years studied, from 2018 to 2022, measured as items per 1,000 inhabitants per day. Consumption was decreasing pre-pandemic, with a large decline in 2020 and 2021. This large reduction has increased in 2022 and is similar to 2019 levels (1.66 in 2019 compared with 1.68 items per 1,000 inhabitants per day in 2022).

Antibiotic prescribing increased in secondary care

Secondary care antibiotic use is presented here, measured as DDDs per 1,000 admissions. 2022 data suggests trends are slightly lower than pre-pandemic and 2020 levels (although rates in 2020 were heavily influenced by decreases in admissions and patient case-mix, rather than increases DDDs). Compared with 2021, 2022 rates have increased.

Being AWaRe

The World Health Organization classified key antibiotics into 3 categories (AWaRe): to improve access (Access), to monitor important antibiotics (Watch) and preserve ‘last resort’ antibiotics (Reserve). Adapted by the UK for the National Action Plan.

Change in AWaRe consumption: 2021 versus 2022 compared to 2018 versus 2022 (% 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 2018 versus 2022, and 2021 versus 2022. Access antibiotics had decreased by 5.3% in 2018 versus 2022. Comparing the most recent years, there was an increase of 4.3% between 2021 and 2022. Similarly, Watch antibiotics have increased in 2021 versus 2022 (+3.6%), while Reserve have decreased by 3.6%.

Consumption of antifungals in primary and seconday care

Primary and secondary care consumption of antifungals are presented across 2018, 2020 and 2022, measured as DDDs per 1,000 inhabitants per day. Antifungal consumption across both primary and secondary care present similar rates in 2022 as with pre-pandemic 2018 (Primary care: 1.13 DID in 2018 and 1 DID in 2022; secondary care 0.14 DID in both 2018 and 2022).

UK National Action Plan ambitions and England progress

This graphic describes 2 of the UK National Action Plan (NAP) ambitions aimed at 1) reducing a specified set of drug resistant infections by 10% by 2025, and 2) reducing UK antibiotic use in humans by 15% by 2024.

It also describes England’s progress towards these measure, in that 1) the estimated number of severe infections in 2022 was 1.6% lower that the AMR 2018 baseline, and 2) total antibiotic consumption in England in 2022, although below 2019 levels, was greater than the NAP set ambition. Both AMR and consumption measures are yet to meet the required NAP measures, highlighting the need for continued stewardship.

Chapter 4: Antimicrobial stewardship

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

Shows the 5 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

4. Algorithms for use in clinical practice.

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

Antimicrobial Stewardship: ‘Start Smart then Focus’ clinical management algorithm

The graphic shows the antimicrobial stewardship: ‘Start Smart then Focus’ clinical management algorithm. The infographic shows a flowchart of the 7 steps taken during clinical management of an infection. The first box is titled ‘Evidence of infection’ and 6 bullet points. These points are: history, signs and symptoms, physical examination, laboratory results, diagnostic test results and medical imaging.

There is an arrow from the ‘Evidence of infection’ box to the second box, which is titled ‘Start Smart’.

A second arrow links to a third box. The third box has the title ‘Assess’, with 2 bullet points: evidence or suspicion of infection, and patient risk (itself sub-divided into: severity, immunocompromise, resistance).

A third arrow links to the fourth box. The fourth box has the title ‘Investigate’ which features 4 bullet points, cultures, laboratory investigations (biomarkers, haematology, immunology, organ function), imaging and source control.

A fourth arrow links to the fifth box. The fifth box has the title ‘Prescribe, with 4 bullet points, being: urgency, guidelines (local), allergy and contra-indications, and spectrum (proportionate).

A fifth arrow links to the sixth box. The sixth box has the title ‘Document’ with 4 bullet points, being: working diagnosis, certainty (possible or probable infection), treatment regime and plan-plus-review date.

A sixth arrow links to the seventh box which says ‘Then focus’. A seventh arrow links to the final box with the title ‘Post-prescription review outcome options’. This box contains 5 bullet points, being: cease, amend, refer, extend and switch.

Antimicrobial Stewardship: Surgical prophylaxis algorithm

This graphic shows the ‘Antimicrobial stewardship: surgical prophylaxis’ algorithm along with accompanying information. Boxes are arranged in 3 columns.

The first column contains 2 boxes. The top box is titled ‘Clean surgery’. An arrow links from the top box to the box underneath. The second box is titled ‘No antimicrobial prophylaxis indicated’.

In the middle column the top box contains 3 bullet points, being:

• clean surgery involving placement of a prosthesis or implant
• clean contaminated surgery
• contaminated surgery

An arrow links to a second box underneath the first with the text ‘Surgical prophylaxis’ and the text ‘one dose within 60 minutes before knife to skin’. An asterisk after the line ‘one dose’ links to the caveat that, in some cases, such as surgery involving implant replacement, 24 hours of antimicrobial prophylaxis may be required.

A second arrow links from the second-to-bottom box which has the title ‘Redose for long surgical procedures’ and the text ‘Intraoperative redosing is needed to ensure adequate serum and tissue connections of the antimicrobial if the duration of the procedure exceeds 2 half-lives of the antimicrobial or there is excessive blood loss (that is, more than 1,500mL in adults or more than 25ml per kg in children)’.

The final column contains 3 boxes. The top box contains the title: ‘Established infection’. An arrow links to the box underneath which contains the text ‘Antimicrobial treatment regimen according to local guideline’. A final box in the bottom right of the figure contains the text ‘All decisions should be clearly documented’.

TARGET antibiotics toolkit activities 2022 to 2023

This graphic summarises the activities and updates of the TARGET antibiotics toolkit activities 2021 to 2022. TARGET stands for ‘Treat Antibiotics Responsibly, Guidance, Education and Tools’.

Activities included:

• new community pharmacy resources section on TARGET website
• 827 healthcare professionals registered for a webinar on skin infections
• developed 2 ‘How to’ resources to support primary care to review long-term antibiotic use
• 83,170 people used a UTI pre-consultation survey developed by TARGET, supporting clinicians to follow national UTI guidance
• UTI and RTI leaflets for community pharmacy were accessed 8014 and 5,941 times respectively
• WAAW campaign reached over 42,000 RCGP members

The TARGET antibiotics toolkit

The graphic summarises the range of resources available on the TARGET toolkit. At the centre of the graphic is the text ‘TARGET Keep Antibiotics Working’. At the bottom of the image is the TARGET toolkit website address.

The TARGET Toolkit consists of:

• webinars and podcasts: 12 webinars and 3 podcasts
• interactive training tools: 7 slidedecks and 7 workshop delivery guides and templates
• antibiotic diagnostic quick reference tools: 5 links to tools and quick reference summaries, quick links to management guidance for over 50 common infections
• leaflets to discuss with patients: tips on how to use interactively, 8 leaflets, all available in Word, PDF and HTML, translated into 26 languages, 4 leaflets for use in the pharmacy setting
• audit and other antimicrobial stewardship toolkits: 8 audit toolkits, all available in Word and Excel, 2 ‘How to…’ resources for review of long-term antibiotics
• self-assessment toolkits: available for GPs and commissioners

Use of TARGET acne ‘How to’ toolkit by pharmacy professionals

Outlines the evaluation of the use of TARGET acne ‘How to’ toolkits by pharmacy professionals. The infographic shows the methods and findings of 2 evaluations as well as an overview of the usefulness of the acne ‘How to’ resources.

(An asterisk indicates that a 5-point Likert scale was used.)

Pharmacy professionals working in GP practice:

• 141 completed initial survey
• 19 completed follow-up survey

Use of the acne ‘How to’ resources led to:

• increased capability* 3.68 (SD 0.40) to 4.11 (SD 0.29); p=0.000
• increased opportunity* 3.85 (SD 0.24) to 4.08 (SD 0.28); p=0.007
• increased motivation* 4.35 (SD 0.47) to 4.51 (SD 0.32); p=0.007

Community pharmacy survey

• 44 pharmacy professionals
• 10 stakeholders

Perceived current and future roles in managing acnes:

• moderate current confidence in managing acne*: 3.75 (SD 1.08)
• future roles in managing acnes: reviewing or prescribing long-term medications
• needs identified to undertake future roles: training, PGDs, remuneration

Usefulness of the acne ‘How to’ resources:

• useful to support pharmacy professional working in general practice*: 4.08 (SD 0.18)
• useful to support pharmacy professional working in community pharmacy in perceived future roles*: 4.32 (SD 0.16)

Sections of the acne ‘How to’ resources rated as very useful:

1. Self-care advice.
2. Treatment of acne.
3. Flow chart to review antibiotic use.
4. Acne clinical scenarios.

Assessing the interplay between factors commonly associated with health inequalities, clinical factors, and sepsis incidence and outcomes

This graphic shows the main findings from the studies conducted assessing the interplay between factors commonly associated with health inequalities, clinical factors and sepsis.

Literature review (53 studies)

1. Deprivation

• lower socioeconomic status
• unemployment
• lower education level
• findings not consistent across studies

2. Ethnicity

• Mixed effects except in pregnancy

3. Other

• Caesarean section delivery, complication during childbirth were associated with increased risk of sepsis
• medically underserved area
• nursing home resident

Data analysis (300,000 cases)

1. Deprivation

• largest socioeconomic deprivation

2. Ethnicity

• patients with non-white ethnicity did not show increase sepsis risk

3. Frailty

• high frailty score

Other clinical factors associated with increased risk of sepsis

1. Most deprived

• alcohol problems
• COPD
• learning disabilities

2. Non-white individuals:

• anaemia
• diabetes
• liver disease
• mental illness

3. Severe frailty:

• anaemia
• heart disease
• Parkinson disease

Chapter 5: NHS England – improvement and assurance schemes

NHSBSA ePACT2 Antimicrobial Stewardship: children’s dashboard: England, financial year 2022 to 2023

This infographic shows 3 images from left to right.

The first is a capsule and images indicating children, illustrating the 5.3 million antibiotic prescriptions for children aged 0 to 14 years.

The second image shows a circle with images indicating children, illustrating 48% as the proportion of antibiotic prescriptions for children aged 0 to 4 years.

The third image shows a circle with images indicating children, illustrating 49% as the proportion of all children aged 0 to 4 years prescribed an antibiotic.

Chapter 6: Professional and public education and training

Antibiotic pledges: Professional and public education and training

This infographic shows the changes in Antibiotic Guardian pledges from 2018 to 2022. 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 8,373 pledges in 2018, the line remains at a similar level with 9,289 pledges in 2019. There is then an increase in 2020 with 36,733 pledges. This then decreases slightly with 33,045 pledges in 2021. A sharper decrease is seen in 2022 with 13,915 pledges. Some text outlines the reduction from 2021 to 2022, but pledges remain above 2019 levels.

A green bubble 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 158,360 pledges from inception of Antibiotic Guardian in 2014 to end of 2022.

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

• 89 organisations registering AMS activity through Antibiotic Guardian in 2022
• 466 entries to the Antibiotic Guardian Shared Learning and Awards event between its inception in 2016 and 2022
• 268 Antibiotic Schools Ambassadors registrants in 2022

APS Competency Framework: updating the national Antimicrobial Prescribing and Stewardship (APS) competency framework

This infographic shows the process used to update the national Antimicrobial Prescribing and Stewardship (APS) competency framework.

There are 2 bubbles on the left side of the infographic joined by a plus sign. Bubble one contains the text: ‘Review of current APS competency framework’ and bubble 2 contains the text: ‘Review of alternative prescribing or stewardship frameworks’. An arrow links these 2 bubbles to 4 text boxes in the middle of the infographic outlining the update process, namely:

• complete a list of potential domains, statements and descriptors complied for review by experts
• review survey received responses from 59 multidisciplinary professionals
• majority of domains, statements and descriptors reached consensus for addition to APS competency framework
• draft APS competency framework produced based on result

Another final arrow then links the ‘Update process’ boxes to an image of the APS competency framework document with the following text: ‘Final review of draft by external stakeholders prior to publication’.

Assessment of global antimicrobial resistance campaigns conducted to alter public awareness and antimicrobial use behaviours: a rapid review (PROSPERO 2022 CRD42022371142)

This infographic shows a circle with 4 other circles around it. The middle circle reads ‘Public AMR Campaigns (evidence from n=41 papers)’. The surrounding 4 circles read:

1. Location

International = 3
National = 14
Community = 8
Local = 5

2. Outcome measure

Knowledge and attitudes = 16
Antibiotic prescribing or usage = 14 Reported behaviour change = 8 Campaign engagement = 6 Other = 5

3. Communication method

Mass media = 9
HCP interaction = 3
Site-based resources = 4
Social media = 1
Website-based = 2
School curriculum = 2
Educational video =1
Combination = 7

4. Target audience

Public = 11
Patients = 1
Parents = 2
Children and students = 3
Public and HCP = 13

Two additional boxes on the right side of the infographic outline the global distribution of campaigns and features of effective campaigns

UK = 6
Europe = 11
Asia = 9
North America = 3
Africa =1

Effective campaigns

1. Mass media
2. Combine HCP and public education
3. Focused messaging on a specific infection site

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

This infographic depicts AMS interventions to provide wraparound 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:

1. Children and young people: empower children to embed and share healthy behaviours with households.

2. Educators: equip teachers to promote infection, prevention, control and treatment learning.

3. 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:

1. Care workers: empowered to identify and treat urinary tract infections.
2. Pharmacists: empowered to provide advice on infection grounded in AMS.
3. 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:

1. Reduced infection outbreaks in school, social care and community settings.
2. Reduced antimicrobial prescribing.
3. 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.