english surveillance programme for antimicrobial utilisation and resistance (espaur) figures...

English Surveillance Programme for Antimicrobial Utilisation and Resistance

(ESPAUR)

Figures Slideset

The 5-year UK AMR strategyKey aims

• improving infection prevention and control practices

• optimising prescribing practices

• improving professional education, training and public engagement

• developing new drugs, treatments and diagnostics

• better access to and use of surveillance data

• better identification and prioritisation of antimicrobial resistance research needs

• strengthened international collaboration

2 ESPAUR 2014: Year 2 Report

English Surveillance Programme for Antibiotic Use and Resistance (ESPAUR)Established by PHE in 2013 in response to the strategy

Terms of reference updated in 2015, at year 2 review

Focuses on bringing together NHS, PHE, Private sector across all prescribers and clinicians to improve

Surveillance data on antibiotic resistance and prescribing

Antimicrobial stewardship activities

Education and training for healthcare professionals

Education and awareness to Public


Key Progress towards objectives• PHE: better surveillance data for non-bacteraemia isolates

• Enhancement of community antibiotic datasets: dentists, Out-of-hours and other providers

• Work on Quality Premium

• Measurement of impact of behavioural interventions published by behavioural insights team

• Antibiotic stewardship curriculum (for healthcare professionals) implementation recommendations delivered to HEE

• Updated Antimicrobial stewardship toolkits (SSTF and TARGET)

• Partnerships external to PHE: universities (HPRU), Vets (VMD), ECDC, WHO, O Neill, Longitude Prize


• NHS Atlas (PHE) - include prescribing data across Area Teams and CCGs

• One Health (PHE/ VMD) report – develop report on zoonotic AMR with VMD, DARC, ARHAI

• CARPHA/PHE report on Combatting Antimicrobial Resistance in the Caribbean

• ECDC: ESAC-Net/EARS-Net reports – data submitted, reports to be released 16 November 2015

5

Other Reports

ESPAUR 2014: Year 2 Report

Antibiotic Resistance

6 ESPAUR 2010-2014: Year 2 Report

Bloodstream Infection rates, 2010-14


2010 2011 2012 2013 20141

10

100

E. coli K. pneumoniae Pseudomonas spp. S. pneumoniae Enterococcus spp. S. aureus K. oxytoca Acinetobacter spp.

Rat

e p

er 1

00,0

00 p

op

ula

tio

n

E. coli BSI resistance, 2010-14


2010 2011 2012 2013 20140

5

10

15

20

25

Ciprofloxacin 3rd-generation cephalosporins Gentamicin Piperacillin/Tazobactam

Carbapenems

% N

on

-su

scep

tib

le

Klebsiella pneumoniae BSI resistance, 2010-14


2010 2011 2012 2013 20140

2

4

6

8

10

12

14

16

18

20

Ciprofloxacin 3rd-generation cephalosporinsGentamicin Piperacillin/TazobactamCarbapenems

% N

on

-su

scep

tib

le

K. oxytoca BSI resistance, 2010-14


2010 2011 2012 2013 20140

2

4

6

8

10

12

14

16

18

20

Ciprofloxacin 3-rd generation cephalosporins Gentamicin Piperacillin/tazobactam

Carbapenems

% N

on

-su

scep

tib

le

Pseudomonas BSI resistance, 2010-14


2010 2011 2012 2013 20140

2

4

6

8

10

12

14

16

18

20

Ciprofloxacin Ceftazidime Gentamicin Piperacillin/Tazobactam Carbapenems

% N

on

-su

scep

tib

le

Streptococcus pneumoniae BSI resistance, 2010-14


2010 2011 2012 2013 20140

5

10

15

20

25

Penicillin Macrolides Tetracycline

% N

on

-su

scep

tib

le

MRSA and MSSA BSI, 2010-14


2010 2011 2012 2013 20140

2000

4000

6000

8000

10000

12000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MRSA MSSA % MRSA

No

. re

po

rts

% M

RS

A

Proportion of Enterococcal BSI resistant to Vancomycin, 2010-14


2010 2011 2012 2013 20140

2

4

6

8

10

12

14

16

18

20

% R

esis

tan

t

Number of isolates referred from UK hospital microbiology laboratories confirmed as carbapenemase-producing Enterobacteriaceae by AMRHAI


2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

200

400

600

800

1000

1200

1400

1600

1800

IMP VIM KPC OXA-48 NDMGES IMI KPC + VIM NDM + OXA-48

No.

of i

sola

tes c

onfir

med

Antibiotic Consumption (use)


Prescriptions dispensed in the community, expressed as DDD per 1000 inhabitants per day and items per 100 inhabitants per year, England, 1998-2014


1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140.0

5.0

10.0

15.0

20.0

25.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

DDD Items

Year

DDD

per 1

000

popu

latio

n pe

r day

(DID

)

Item

s pe

r 10

0 po

pula

tion

per

year

Total Antibiotic Use 2010 - 2014


Total antibiotic consumption, expressed as DDD per 1000 inhabitants per day, England, 2010−2014


Total Prescribing by Key Agents

Penicillins

Tetracyclines

Macrolides & similar

Sulfonamides and trimethoprim

Other antibacterials

Other β-lactam antibacterials

Quinolones

Anti Clostridium difficile agents

0.0 2.0 4.0 6.0 8.0 10.0 12.0

2014 2013 2012 2011 2010

DDD per 1000 inhabitants per day

Total antibiotic consumption by key antibiotic group, expressed as DDD per 1000 inhabitants per day, England, 2010−2014


Consumption of penicillin, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014

Penicillins


Consumption of cephalosporins, by prescribing location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014

Cephalosporins


Consumption of carbapenems, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014

Carbapenems


Consumption of tetracyclines, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014

Tetracyclines

Consumption of quinolones, by prescribing location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014


Quinolones


Macrolides

Consumption of macrolides, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014

Consumption of sulfonamides and trimethoprim, by prescriber location, England, expressed as DDD per 1000 inhabitants per day, 2010−2014


Sulfonamides and Trimethoprim


Consumption of nitrofurantoin, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014

Nitrofurantoin

Consumption of glycopeptides, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014


Glycopeptides

Antibiotic items by prescribers, expressed as items per 1000 inhabitants per day, England, 2010−2014


Prescriptions in the community


Key antibiotic groups prescribed by general practice, expressed as items per 1000 inhabitants per day, England, 2010−2014



Key antibiotic groups prescribed by dental practice, expressed as items per 1000 inhabitants per day, England, 2010−2014


Prescriptions in Hospitals

Total antibiotic consumption in all NHS trusts, using defined daily doses (DDD) and denominators of admissions, bed-days and population, England, 2010−2014


YearTotal DDD

(x 106)DDD/

100 admissionsDDD/

100 bed-daysDDD/

100 population2010 72.9 397 154 1382011 73.8 398 159 1392012 77.0 412 166 1442013 80.0 424 189 1492014 82.7 421 191 153Difference 2010- 2014

13% 6% 24% 11%


Total antibiotic consumption by trust organisation type, using defined daily doses (DDD), England, 2014


Organisation type DDD % total DDD

Acute-Large 22,650,193 27.4

Acute-Medium 18,044,966 21.8

Acute-Small 11,432,453 13.8

Acute-Teaching 26,154,457 31.6

Community 551,574 0.7

Mental Health & Learning Disability 1,372,398 1.7

Specialist - Cancer 509,568 0.6

Specialist - Chest/Heart 733,319 0.9

Specialist - Children 644,915 0.8

Specialist - Ortho/Rheum 157,541 0.2

Specialist - Other 405,900 0.5


Key antibiotic groups prescribed in hospital, expressed as DDD per 100 admissions per day, England, 2011−2014


Summary Antibiotic Resistance

The rate of Escherichia coli and Klebsiella pneumoniae bloodstream infections (BSI) increased by 13.5% and 17.2% respectively from 2010 to 2014.

More individuals have had antibiotic resistant BSI with Gram-negative bacteria

23% reduction in Streptococcus pneumoniae BSI related to pneumococcal vaccination over last 5 years

Reduction, through effective IPC, in proporiton of Staphylococcus aureus BSI that are resistant to meticillin (MRSA) from 12% to 8% over the last 5 years


Summary Antibiotic Use

• Total antibiotic prescribing, measured using defined daily doses, a standardised measure of antibiotic consumption, continues to increase in the NHS• with a slower rate of increase from 2013 to 2014 than in previous

years.

• Antibiotic prescriptions in primary care, measured as the number of prescriptions dispensed, adjusted for the age and sex distributions in the population, has declined for the last two years and is now lower than the similar measure in 2011 (1.180 in 2014 compared to 1.233 in 2011), suggesting higher doses or longer course lengths in general practice prescriptions.


Summary Antibiotic UseThe majority of antibiotic prescribing occurs in primary care

but secondary care prescribes more broad-spectrum antibiotics (antibiotics that are effective against a wide range of bacteria). These antibiotics are more likely to drive antibiotic resistance than narrow spectrum antibiotics. Early evidence suggests that informing prescribers of their prescribing patterns and comparing them to their peer professionals may be a factor that helps reduce their antibiotic prescribing.

Continued focus by every individual who prescribes, administers and dispenses antibiotics is essential to continue to reduce antibiotic consumption. 37 ESPAUR 2014: Year 2 Report

english surveillance programme for antimicrobial utilisation and resistance (espaur) figures...

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