A new report from Public Health England (PHE) shows that overall antibiotic resistant infections increased through 2014. Rates of bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae increased by 15.6% and 20.8% respectively, from 2010 to 2014. However, Streptococcus pneumoniae bloodstream infections reduced by 23% between 2010 and 2014, which may be related to increased pneumococcal vaccination rates.
These data are from the second annual report of PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), published today (16 November 2015).
ESPAUR is a programme developed by PHE to improve the surveillance of antibiotic resistance, antibiotic use data and support interventions and toolkits to improve antibiotic prescribing in general practice and hospitals. Each of these areas are key components of the UK cross-government Antimicrobial Resistance (AMR) Strategy.
Reducing the amount of antibiotics that are prescribed is vital in tackling resistance and today’s report shows that the number of prescriptions dispensed in primary care has declined for the second year in a row. Although the number of prescriptions issued has decreased, when measuring total antibiotic consumption in primary care, there has been an increase of 6.5% between 2011 and 2014, with 2.4% of the increase occurring between 2013 and 2014. This suggests that longer courses and/or higher doses of antibiotics are being prescribed in general practice.
Use of broad spectrum antibiotics (antibiotics that are effective against a wide range of bacteria and more likely to drive antibiotic resistance) has decreased in primary care to 8.5%. This decrease now means that England is the lowest prescriber of some of these drugs in the European Union.
Early evidence suggests that informing prescribers of their prescribing patterns and comparing them to their peers may help reduce antibiotic prescribing. These findings show that a continued focus by every individual who prescribes, administers and dispenses antibiotics is essential to continue to reduce antibiotic consumption.
Dr Susan Hopkins, lead author and healthcare epidemiologist at PHE, said:
Publishing GP and hospital prescribing data and analysing antibiotic prescribing trends is an important part of work to reduce antimicrobial resistance; it is also one of the key areas PHE is responsible for in the cross-government AMR strategy.
Whilst this report shows that overall antibiotic prescribing increased in 2014, we must remember that reducing prescribing is a long journey and it will take time before the effects of our various interventions are reflected in surveillance data. It is vital that we tackle antibiotic prescribing across the population and ensure prescriptions are given only when they will make a difference to patient outcomes.
In 2016, we will start to present data on healthcare associated infections, antibiotic prescribing and resistance online via the PHE Public Health Profiles. This will enable transparent data to be viewed by healthcare professionals and the public in one place, supporting healthcare providers to develop local action plans in their organisations.
There is a lot of work taking place to tackle antibiotic resistance and reducing prescriptions of antibiotics is just one strand of that work. We must not underestimate how much effort is still needed to turn the tide of antibiotic resistance.
The number of antibiotic resistant Escherichia coli bloodstream infections has increased overall between 2010 and 2014. Whilst the proportion of resistance to key antibiotics used to treat infections has remained constant in Escherichia coli, the increased incidence of bloodstream infections means that more individuals have had a significant antibiotic resistant infection.
Increases in Klebsiella pneumoniae bloodstream infections and the proportion of these infections which were drug resistant means the number of individuals with antibiotic resistance infections have increased substantially in the last 5 years.
Secondary care prescribes the highest proportion of broad-spectrum antibiotics – hospitals need to focus their antibiotic stewardship efforts on ensuring that these drugs are prescribed for the right reason and the right duration.
In 2014, the majority of antibiotics in England were prescribed in general practice (74%), followed by prescribing for hospital inpatients (11%), hospital outpatients (7%), patients seen in dental practices (5%) and patients in other community settings (3%).
Antibiotic prescribing to hospital inpatients increased significantly by 11.7% and to hospital outpatients by 8.5% between 2011 and 2014.
With the exception of general dental practice, antibiotic prescribing increased across the NHS in 2014; approximately 50% of dental prescribing is captured in this report as the remainder occurs in private practice.
PHE surveyed Acute NHS Trusts and Clinical Commissioning Groups (CCGs) to review their antimicrobial stewardship (AMS) activities and determine which areas PHE and NHS England need to prioritise. Findings showed that a higher proportion of hospitals had AMS committees to oversee activities compared to CCGs (94% versus 18%).
PHE toolkits promoting AMS (Start Smart Then Focus for secondary care and TARGET for primary care) need to be embedded and utilised; 46% of hospitals had an action plan to implement their AMS toolkit compared to just 13% of GP practices.
AMS is a cornerstone for both the effective treatment of infections and for reducing antibiotic resistance. Analysing the use of PHE toolkits has highlighted the need for increased cross-organisational learning and collaboration in implementing AMS activities.
Dr Mike Durkin, NHS England Director of Patient Safety, said:
Antimicrobial resistance is a major threat to the delivery of healthcare across the globe and these findings clearly show the need for both clinicians and patients to act now and do all they can to behave as responsible stewards of the use of antimicrobial medications. As one of the largest healthcare providers in the world, it is vital the NHS is seen to lead that fight against the global problem of antimicrobial resistance so these immensely important medicines can be preserved for now and future generations.
Professor John Watson, Deputy Chief Medical Officer, said:
The UK is leading the call for international action on drug resistant infections, and we need to ensure we are taking action nationally as well. Understanding patterns of both antibiotic prescribing and resistance is essential to tackling this problem and it is good news that the number of prescriptions for antibiotics by GPs is going down, but there is still work to do. This report will help healthcare professionals take action in their local areas and is crucial to our plans to combat the threat of antibiotic resistance.
As part of work to increase public and professional engagement around antibiotic resistance, PHE launched the Antibiotic Guardian campaign in 2014. Antibiotic Guardian is a ‘One Health’ campaign which aims to drive changes in behaviour around antibiotic use, by asking individuals to make one pledge about how they can personally help prevent infections, make better use of antibiotics and help protect our vital antibiotics. Within the first 3 months of the campaign, over 10,000 individuals signed up and there are currently over 17,000 Antibiotic Guardians.
Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter: @PHE_uk and Facebook: www.facebook.com/PublicHealthEngland.
- The ESPAUR report is available online from Monday 16 November, 2015.
- Data in this report covers the calendar years 2010 to 2014.
- The 5-year cross-government Antimicrobial Resistance Strategy is available online.
PHE is responsible for delivery of 4 key areas highlighted in the 5-year cross-government Antimicrobial Resistance Strategy.