English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2018

1 November 2018

Antimicrobial resistance has become an increasing problem in the treatment of a wide range of infectious diseases, including Tuberculosis, gonorrhoea and bloodstream infections. Where many of these infections were previously easily treated with the right course of antibiotics, they are now becoming dangerous infections with potentially life-threatening consequences. Due to a combination of increasing levels of antimicrobial resistance, historic overuse and misuse of antibiotics, and a reduction in funding for development of new antibiotics, we are now on the brink of a crisis in antimicrobial resistance.

The ESPAUR 2018 report, published by Public Health England, aims to contribute to the delivery of the UK Five Year Antimicrobial Resistance Strategy, which has been running from 2013-2018 with the aim of slowing down the development and spread of antimicrobial resistance. The report focuses on specific aspects of usage and resistance to antimicrobial drugs in relation to the most problematic diseases, and details the outcome of campaigns to increase awareness among both health professionals and the wider public about the risks of antimicrobial resistance.

The report details that antibiotic stewardship activities over the last five years have reduced the levels of antibiotic prescribing for bloodstream infections, and as a result the proportions of bacterial species causing these types of infection that are resistant to key antibiotics has remained stable. The majority of E. coli and K. pneumoniae isolates detected in blood samples have been shown to remain susceptible to a key group of antibiotics (carbapenems), and while this is good news, the report stresses the need to remain vigilant over the coming years such that this reserve of antibiotics remains effective.

Antimicrobial resistance in the causative agent of gonorrhoea, Neisseria gonorrhoeae, has become a particular concern in public health, with a rising number of gonococcal infections showing resistance to first-line antibiotics. Cases of gonorrhoea rose in 2016-17 by 22%, and of the 1,268 isolates sent to the Gonococcal Resistance to Antimicrobials Surveillance Programme in 2017, 9.2% were resistant to the first line antibiotic azithromycin, which is usually used in combination with ceftriaxone as a first-line therapy.

Among cases of Tuberculosis which were sent for resistance predictions using whole genome sequencing data, 8.5% had resistance to at least one first-line antibiotic. Multi-drug resistant TB is another major concern in public health due to the length of time that is needed for an antibiotic course to clear the infection (minimum 6 months). Of particular concern with this disease is the potential for the infecting organism to develop resistance where a course of antibiotics has not been properly completed, so vigilance is essential in these cases to ensure antibiotics remain effective for patients in the future and to reduce the spread of multi-drug resistant strains.

The ESPAUR Report 2018 also focussed on general antibiotic prescription and consumption in healthcare settings, with a 6.1% reduction in total antibiotic consumption recorded in England between 2014 and 2017, and a drop of 13.2% over five years in the number of antibiotic prescriptions dispensed in primary care settings. However, in secondary care settings overall antibiotic consumption increased by 7.7% from 2013-2017.

Substantial efforts have been made over the last five years to improve both public and professional education and awareness regarding antimicrobial resistance. The Keep Antibiotics Working campaign was launched nationally in October 2017, and a separate engagement and behaviour change campaign has continued to grow, with more than 57,000 Antibiotic Guardian pledges made in 129 countries by the end of 2017.

Resources are provided by Public Health England for professionals in primary care through the TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools) toolkit which is available on the Royal College of General Practitioners website, and for children and young people PHE has been running e-Bug, an international educational resource on hygiene, spread of infection and antibiotics which was endorsed by NICE in 2016.

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