Research and analysis

HPR volume 12 issue 38: news (26 October)

Updated 21 December 2018

English surveillance programme for antimicrobial utilisation and resistance: fifth report

The fifth annual report of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), published by Public Health England (PHE) on 23 October [1], provides data on antibiotic use and resistance in the calendar years 2013 to 2017. It also highlights PHE-driven antimicrobial stewardship work and personal and professional engagement activities. Key findings of the report are summarised below.

Antibiotic resistance

The proportions of bacterial species causing bloodstream infections (BSIs) that are resistant to key antibiotics have remained stable over the last 5 years. However, the burden of resistance as measured in terms of total numbers of antibiotic-resistant BSIs has increased by 35% from 2013 to 2017 – driven by the year-on-year increased incidence of BSI.

Antibiotic usage

Total antibiotic consumption in England fell by 6.1% between 2013 and 2017; this was the inverse of what occurred between 2010 and 2013 when a 6% increase was observed. Primary care settings accounted for 81% of all antibiotics prescribed in 2017. However, the number of antibiotic prescriptions dispensed in primary care declined by 13.2% in the 5 years to 2017.

Overall antibiotic consumption in secondary care in England increased by 7.7% between 2013 and 2017. Prescribing for hospital inpatients increased by only 2% but increased by 21% in hospital outpatient settings over the five-year period. This is an improvement compared to data presented in the first ESPAUR report where, from 2010 to 2013, prescribing to hospital inpatients increased by 11.9%. In 2017, the increased level of antibiotic prescribing in hospital inpatients also reflects a shortage in the supply of a key broad-spectrum antibiotic, piperacillin/tazobactam. The need to use two or more alternative antibiotics to give the same degree of antibacterial coverage resulted in an additional 2.2 million defined daily doses (DDDs) being dispensed.

Antifungal use and resistance

The ESPAUR report refers to the effective control of Candida auris in English hospitals – with no sustained outbreaks currently occurring despite frequent introductions from abroad – at a time when large-scale outbreaks continue to be documented on several continents.

Antimicrobial stewardship

The 2018 report highlights the ongoing work from PHE and associated professional organisations and research partners on delivering tools, interventions and evaluations related to antimicrobial stewardship. It presents early data from PHE modelling work on inappropriate antibiotic use in secondary care where, through an audit of antibiotic use by NHS antimicrobial stewardship teams, 17.1% of total antibiotic therapy days were estimated to be unnecessary.

Public and professional education and awareness

The Keep Antibiotics Working campaign was launched nationally in October 2017. More than 750,000 ‘Keep Antibiotics Working’ posters and leaflets were distributed to a range of partners including local authorities, health care centres and Housing Associations. The ESPAUR report presents data on engagement with this campaign and other PHE resources such as Antibiotic Guardian, e-Bug and TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools).

References

1. GOV.UK website. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report.

Infection reports in this issue of HPR

This issue includes the following annual report.

• Invasive meningococcal disease in England: annual laboratory confirmed reports for epidemiological year 2017 to 2018