Research and analysis

ESPAUR report 2024 to 2025: infographics accessible text

Updated 13 November 2025

This document contains text transcriptions of the infographics included in the 2024 to 2025 English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report.

ESPAUR oversight group

There is a graphic summarising the achievements of the ESPAUR oversight group:

•ESPAUR English Surveillance Programme for Antimicrobial Utilisation and Resistance 

•over 30 member organisations including all UK nations, government and member organisations and lay representations

•12 reports since established in 2013

•106 UKHSA peer-reviewed publications from April 2024 to March 2025

•over 90 author contributions (2024 to 25 report)

•multi-professional and multi-organisation group led by UKHSA

ESPAUR report 2024 to 2025

There is a graphic showing the different chapters of the ESPAUR report 2024 to 2025.  

There are boxes representing each chapter of the report:  

1. The ESPAUR foreword, executive summary and lay summary box includes an image of a clipboard with the word SUMMARY in it.
2. The antimicrobial resistance box includes icons of microbes.
3. The antimicrobial consumption box includes icons of antimicrobials.
4. The antimicrobial stewardship box includes a speech bubble, which contains an icon of an antimicrobial.
5. The NHS England and Improvement assurance schemes box includes the NHS logo.
6. The professional and public education, engagement and training box includes an icon of a person pointing at a board, with other people sat in front of the board.
7. The research insights and knowledge mobilisation box includes an icon of a microscope and DNA.
8. The ESPAUR oversight group members’ action to tackle AMR – mapping to the National Action Plan box includes icons of groups of people with arrows to each other.
9. The knowledge mobilization of ESPAUR report: evaluation of feedback from report users box includes an icon of a form and a magnifying glass partly over the left-hand side.

The burden of bacteraemia and resistant bacteraemia

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 selected pathogen bacteraemia by calendar year. The graph shows a decrease from 2019 to 2020 (88,181 to 77,327) followed by annual increases from 2020 to 2024 (92,100 in 2024). The 2020, 2021 and 2022 bars are paler in colour to denote the period of the COVID-19 pandemic. The text reads: “an 4.4% increase in numbers of bacteraemia* since 2019”.

The lower left box contains a red bar chart showing the number of resistantϮ bacteraemia by calendar year. The 2020, 2021 and 2022 bars are paler in colour to denote the period of the COVID-19 pandemic. The graph shows a decrease from 2019 to 2020 (18,103 to 15,527) followed by annual increases from 2020 to 2024 (20,484 in 2024). The text reads: “an increase of 13.1% in resistant bacteraemiaϮ since 2019”.

The large green graphic to the right contains 2 boxes: the top box is titled ‘2019’ and has 100 human figure outlines, 21 of which are coloured red. The other 79 figure outlines are coloured grey.

On the bottom another box filled with 100 figure outlines is titled ‘2024’. Twenty-two figure outlines are coloured red and the other 78 are coloured grey.

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

Underneath these boxes is one statement: “This means that 22 out of 100 people with a bacteraemia* had a resistant infection in 2024.”

Underneath all the boxes are caveats to the figures:

• 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 – 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 resistantϮ bacteraemia per week in England in 2024

Full double-decker buses representing how many people get a bacteraemia per week in England in 2024 (87 people per bus). On the left, there are 20 blue double-decker buses representing the average number of newly reported susceptible bacteraemia cases per week (approximately 1,775 cases). On the right, there are 4 red double-decker buses and one red single-decker bus representing the average number of newly reported resistant bacteraemia cases per week (approximately 400 cases).

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

Thirty-day all-cause mortality of patients with Gram-negative bacteraemia* in 2024

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

The bar at the top shows that 15.4% of patients (8,394) with any Gram-negative bloodstream infection died within 30 days in 2024. 

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

The second bar shows that 17.2% of patients (2,379) with an antibiotic-resistant¥ Gram-negative bacteria bloodstream infection died within 30 days in 2024. 

The third bar shows that 24.1% of patients (68) with a Carbapenemase-producing Gram-negative bacteria bloodstream infection died within 30 days in 2024. 

The fourth bar shows that 14.7% of patients (5,952) with an antibiotic-sensitive Gram-negative bacteria bloodstream infection died within 30 days in 2024. 

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: 

• 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​

**sterile site infections

The burden of bacteraemia* resistant to critically important antibiotics

Bar graph on the left-hand side with 2 pie charts displayed to the right.  

The bar graph on the left shows the total bacteraemia* in 2024 (92,100), 71,616 being antibiotic susceptible and 20,484 being antibiotic-resistant. 

The pie chart on the upper right has the title ‘Bacteraemia*’ and an arrow from the bar graph indicates that the pie chart represents all bacteraemia in 2024 (both those antibiotic-resistant and susceptible). The pie chart is split up into 3 sections with E. coli displaying 47%, ‘Gram-positive’ displaying 32%, and ‘Other gram-negatives’ displaying 20%.  

The pie chart on the lower right has the title ‘Antibiotic-resistantϮ bacteraemia’. An arrow from the bar graph indicates that the pie chart represents only the antibiotic-resistant bacteraemia in 2024. The majority of the pie chart is taken up by E. coli at 71%, the smaller proportions are ‘Other gram negatives’ (17%) and ‘Gram-positive’ (13%). 

• 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

Rate of resistant bacteraemiaϮ per 100,000 by Index of Multiple Deprivation in 2019 and 2024

A bar graph is displayed showing the rate of AMR burden per 100,000 population by IMD quintile, with an arrow across the top of the graph indicating the most deprived group is on the right and least deprived group on the left. Each quintile has 2 bars, one for 2019 and one for 2024, with the percentage change from 2019 to 2024 within each quintile displayed above them. The bar graph shows a gradient of lower rate of AMR burden in the least deprived quintiles compared to the more deprived quintiles.​

The most deprived quintile shows, per 100,000 population, a rate of 35.7 in 2019 and 43.3 in 2024, indicating this is an increase of 21.2% from 2019 to 2024.​

The second most deprived quintile shows, per 100,000 population, a rate of 34.2 in 2019 and 38.2 in 2024, indicating this is an increase of 11.4% from 2019 to 2024.​

The middle quintile shows, per 100,000 population, a rate of 32.4 in 2019 and 35.8 in 2024, indicating this is an increase of 10.7% from 2019 to 2024.

The second least deprived quintile shows, per 100,000 population, a rate of 30.1 in 2019 and 34.0 in 2024, indicating this is an increase of 12.9% from 2019 to 2024.

The least deprived quintile shows, per 100,000 population, a rate of 27.7 in 2019 and 29.4 in 2024, indicating this is an increase of 6.3% from 2019 to 2024.

Note that figures are rounded and may cause different rates to appear the same in the text.

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

Rate of AMR burdenϮ by Index of Multiple Deprivation from 2019 to 2024

A line graph is displayed showing the rate of AMR burden per 100,000 population by most deprived and least deprived IMD quintile from 2019 to 2024, with an arrow between the 2 lines indicating the percentage change between the most deprived group and least deprived group. The most deprived IMD quintile rate is shown by a green line and is increasing at a greater rate than the least deprived IMD quintile, which is shown as a blue line.

In 2019, the most deprived IMD quintile had a 29% higher rate than the least deprived IMD quintile (35.7 versus 27.7 per 100,000 population).

In 2020, the most deprived IMD quintile had a 41% higher rate than the least deprived IMD quintile (31.9 versus 22.7 per 100,000 population).

In 2021, the most deprived IMD quintile had a 36% higher rate than the least deprived IMD quintile (31.6 versus 23.2 per 100,000 population).

In 2022, the most deprived IMD quintile had a 40% higher rate than the least deprived IMD quintile (34.1 versus 24.3 per 100,000 population).

In 2023, the most deprived IMD quintile had a 41% higher rate than the least deprived IMD quintile (39.0 versus 27.7 per 100,000 population).

In 2024, the most deprived IMD quintile had a 47% higher rate than the least deprived IMD quintile (43.3 versus 29.4 per 100,000 population).

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

Regional notifications per 100,000 population of acquired carbapenemase-producing organisms and proportion of carbapenemase mechanism in England, 2024

There is a map of England showing the rate per 100,000 population of acquired carbapenemase-producing Gram-negative bacterial notifications by carbapenemase families (NDM, OXA-48-like, KPC, IMP, VIM and other) by region, 2024. The rate is highest in London (75.2 per 100,000 population), followed by the North West (66.9 per 100,000 population).

Each region has a pie chart showing the proportion of acquired carbapenemase-producing Gram-negative bacterial notifications by carbapenemase families. NDM, OXA-48-like and KPC are the most common carbapenemase families across regions in 2024.

Estimated regional rate of bacteraemia* per 100,000 population in England, 2024, and estimated regional rate of resistant bacteraemiaϮ per 100,000 population in England, 2024

Maps showing the variation in rate per 100,000 population of the estimated burden of resistant bacteraemia on the right in red, and the estimated rate of overall bacteraemia by region on the left in blue.

Resistant bacteraemia by region

The highest rate per 100,000 population of resistant bacteraemia was observed in London (44.3 per 100,000), followed by the North West (38.6 per 100,000) and Yorkshire and Humber (37.0 per 100,000). The lowest rates were observed in the South West (28.2 per 100,000), East Midlands (31.6 per 100,000), and West Midlands (32.8 per 100,000).

Bacteraemia by region

The highest rate per 100,000 population of bacteraemia was observed in the North East (200.0 per 100,000) followed by Yorkshire and Humber (182.0 per 100,000) and the North West (171.9 per 100,000), with the lowest rates in London (140.6 per 100,000), East of England (148.6 per 100,000), and South East (154.3 per 100,00)

• 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

Fungaemia due to yeast species, 2019 and 2024

Two waffle charts present the proportion of bloodstream infections due to yeast species in 2019 and 2024 respectively. In 2019 Candida albicans was the predominant cause of bloodstream infections due to yeast (40%) followed by Nakaseomyces glabratus (formerly Candida glabrata; 29%). Candida parapsilosis was the third most prevalent cause of bloodstream infections due to yeast (11%). The remaining 20% of bloodstream infections due to yeast we caused by other yeast species. In 2024 C. albicans remained the predominant cause of bloodstream infections due to yeast (40%) followed by N. glabratus (27%). C. parapsilosis was the third most prevalent cause of bloodstream infections due to yeast with the proportion caused by this species increasing to 13%. The remaining 20% of bloodstream infections due to yeast were caused by other yeast species. 

Detections of C.auris in patients in England in UKHSA region 2024

This infographic is a map of the 9 English regions, showing the number of patients who have tested positive for C. auris colonisation or infection for the first time in England, 2024. 

Candidozyma auris (C. auris) is a rapidly emerging fungal pathogen with a global distribution. Designated a critical priority fungal pathogen by the World Health Organisation in 2022, it can cause severe invasive infection, mostly within healthcare settings. There was a significant increase in the prevalence of C. auris in England in 2024 including protracted outbreaks in 2 large NHS trusts in London and the South-East. These regions reported the majority of C. auris detections in England. In 2024, 212 patients were reported to the UKHSA with first detections of C. auris, of these 150 patients were reported in London and 50 in the South East, and between 1 and 3 detections in all other regions.

Total consumption of antibiotics increasing towards pre-pandemic levels

Total consumption of antibiotics are presented across the 6-years studied, from 2019 to 2024. Consumption has steadily decreased across the years. Vast reduction noted in 2020 (from 17.9 in 2019 to 16.0 DDDs per 1,000 inhabitants per day in 2020). However, 2024 data showed an increase from 2020 to 17.5 DDDs per 1,000 inhabitants per day. 

Total antibiotic use in the NHS by prescriber setting as proportion of overall prescribing, England 2024

Pie chart showing total antibiotic consumption by prescriber setting as proportion of overall prescribing, in England, for the year 2024. General practices account for 70% of consumption, followed by hospital inpatients (14%), hospital outpatients (7%), Other community settings (6%), and dental practices (3%). Note: Other community settings now includes the Pharmacy First service.

Antibiotic prescribing in primary care from 2019 to 2024

Primary care consumption of antibiotics are presented across the 6-years studied, from 2019 to 2024, measured as items per 1,000 inhabitants per day. Consumption saw a large decline in 2020 and 2021 due to the COVID-19 pandemic. Antibiotic consumption subsequently increased to 2019 levels in 2022 and saw a further increase in 2024 (1.71 in 2024 compared with 1.66 items per 1,000 inhabitants per day in 2022). 

Antibiotic consumption through private (non-NHS) routes has continually increased

Antibiotic consumption in the independent sector is presented from 2019 to 2024 measured as DDDs per 1,000 population per day. A series of 6 pills increasing in size contain the numbers: 3.47, 2019; 3.20, 2020; 3.70, 2021; 4.20, 2022; 5.47, 2023; 5.71, 2024. In the bottom left corner, there is an image of a hospital with the following text: “Usage across the independent sector, that is via private (non-NHS) routes, includes data on sales to private hospitals and private pharmacies, private prescriptions dispensed in community pharmacies, and private prescription in NHS hospitals.”

Next to this is a heading which reads “2024: 5.71 DDDs per 1,000 inhabitants per day (DID)”. Below this is small rectangle graphic which shows dispensing 4.40 DID, and purchasing 1.31 DID. Below this is the image of a pill showing that 22% of primary care prescribing was from private prescriptions dispensed in community pharmacies. In the bottom right is a graph showing the percentage of AWaRe use in the independent sector. It also shows that:

• private prescriptions dispensed in community pharmacy was 3.93 DDDs per 1,000 population per day
• private pharmacy purchasing was 0.27 DDDs per 1,000 inhabitants per day
• independent hospital purchasing was 1.04 DDDs per 1,000 inhabitants per day
• private usage in NHS hospitals was 0.47 DDDs per 1,000 inhabitants per day

Antibiotic prescribing in secondary care from 2019 to 2024

Secondary care consumption of antibiotics is presented across the 6-years studied, from 2019 to 2024, measured as DDDs per 1,000 admissions. In 2024, consumption decreased compared to 2022 (4,663 in 2024 compared with 4,684 DDDs per 1,000 admissions in 2022). Consumption has returned to pre-pandemic 2019 levels.

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). Where Access are first and second choice antibiotics for treating the most common infections; Watch are antibiotics with increased toxicity concerns and higher resistance potential, that should only be prescribed for specific indications to minimise unnecessary harm to patients and costs to health care systems, and Reserve antibiotics are last resort options that should only be used in severe circumstances, when other options have failed. Adapted by the UK for the National Action Plan. 

Proportion of AWaRe antibiotic use across the NHS (primary and secondary care), in 2024 (using the 2024 UK AWaRe classification)

AWaRe antibiotic use as a proportion of total antibiotic use in 2024 is presented for primary care, secondary care and total across both settings, using the 2024 UK-AWaRe classification. The proportion of Access antibiotic use represented 65.6% of total antibiotic use in primary care and 53.8% in secondary care. Access antibiotic use represented 63.2% of total antibiotic use across the healthcare system, 6.8% below the UK NAP target for 2024 to 29 (70% Access antibiotic use). For primary care, Watch antibiotic use represented 29.5% of the total antibiotic use, whilst the Reserve and Other categories accounted for 0.1% and 4.8%, respectively. In secondary care, Reserve, Watch and Other antibiotics accounted for 42.8%, 2.3% and 1%, respectively. This amounts to a total Watch proportion of 33.2%, 0.6% for Reserve and 4% for Other antibiotics.

England regional variation in antibiotic consumption, across the NHS

The image highlights variation in total primary and secondary care antibiotic use in UKHSA centers across England as DDDs per 1,000 inhabitants per day. A map on the left side shows primary care antibiotic use was highest in the North East (15.826), followed by the East of England (14.254) and was lowest in London (10.617). A map in the centre shows secondary care antibiotic use was also highest in the North East (4.501), followed by London (4.081) and was lowest in the South West (2.694). A map on the right shows total antibiotic use was highest in the North East (20.327), followed by Yorkshire and Humber (17.996) and was lowest in London (14.699).

Consumption of antifungals in primary and secondary care

Primary and secondary care consumption of antifungals are presented across 2019, 2020 and 2024, measured as DDDs per 1,000 inhabitants per day (DID). Antifungal consumption across primary care was 1.10 DID in 2019, reducing to 0.84 DID in 2020 then increasing to 1.13 DID in 2024. Antifungal consumption across secondary care was 0.14 DID in 2019, reducing to 0.12 DID in 2020 then returning to 0.14 DID in 2024.

UK National Action Plan ambitions and England progress

This slide describes 2 of the UK National Action Plan (NAP) ambitions aimed at:

• preventing any increase in a specified set of drug-resistant infections by 2029
• reducing UK antibiotic use in humans by 5% by 2029, compared to 2019 baseline

The figure also describes England’s progress towards these measures, in that:

• the estimated number of drug-resistant infections in FY 2024 to 2025 is 22.7% higher than FY 2019 to 2020 baseline
• total antimicrobial use in humans in England in 2024 was 17.5 DID, a lower rate of consumption to that of 2019 (17.9 DID)

Both AMR and consumption measures are yet to meet the required NAP measures, highlighting the need for continued stewardship. 

Using TARGET tools throughout the stewardship process

The infographic shows the TARGET Cycle of Antimicrobial Stewardship. It outlines the following cyclical steps that should be taken to encourage antimicrobial stewardship within primary care:

1. Identify – Regularly measure antimicrobial prescribing and action plans. Use the TARGET action plan template to set practice goals and regularly monitor antimicrobial prescribing with audit toolkits.
2. Learn – Stay informed on the latest evidence, refresh knowledge on area identified for improvement. Stay up to date with the latest evidence using NICE summary guidance in the TARGET toolkit. Refresh knowledge through training tools, webinars, eLearning courses and podcasts, focusing on areas identified for improvement.
3. Act – Take proactive steps to enhance stewardship. Support consultations and promote good stewardship by using TARGET posters and patient information leaflets. A whole-practice approach is encouraged.
4. Review – Assess the impact on antimicrobial prescribing. Evaluate the impact of your actions using TARGET self-assessment checklists and audit templates to guide the review process.

TARGET activities 2024 to 2025

Between April 2024 and March 2025, TARGET (Treat Antibiotics Responsible, Guidance, Education and Tools) completed the following activities:

• published updated patient information leaflets following an evidence review and redesign
• published new resources for managing patients on long-term antibiotics for recurrent urinary tract infection
• a urinary tract infection pre-consultation survey accessed by over 191,000 people
• ran 3 webinars with a combined total of 577 live attendees and 374 online views
• World AMR Awareness Week campaign reached over 45,000 RCGP members and viewed over 1.2 million times on Google and social media

Summary of findings from an evaluation of UKHSA AMS tools to support secondary care in England

Flow diagram outlining findings from an evaluation of UKHSA AMS tools to support secondary care in England.

A box on the far left contains the text 12 AMS tools identified. To the left of this box, the 12 AMS tools are listed:

• Antibiotic Guardian
• IV to Oral Switch (adult)
• IV to Oral Switch (paediatrics)
• Fingertips AMS portal​
• prescribing competencies
• ESPAUR report
• WAAW toolkit
• national audit ​tool
• national AMS ​surveillance system​
• peer-to-peer review tool​
• Start Smart then Focus toolkit​
• England AWaRE categories

Three arrows extend from this box linking to a second column of 3 boxes. The top arrow links to a box containing the text “Peer-reviewed publications for 9 out of 12 tools”. An arrow links this to a box in the top right of the image containing the text “Average citation rate equals 44 (range 2 to 206)”. The middle arrow that extends from the far left box links to a box containing the text “Website analytics for 7 out of 12 tools”. This links to another box with the text “Average website visits over 4-years = 71,588 (range 1,526 to 407,761)”. The third arrow extending from the initial far left box links to a box with the text “Evidence of use in secondary care for 7 out of 12 tools”. This links to 2 final boxes containing the text “Evidence of impact in the UK for 11 out of 12 tools” and “Evidence of international impact for 4 out of 12 tools”.

A footnote is included defining impact as evidence of the tool influencing national or international AMS policy, guidelines or other tools.

The review authors are listed at the bottom of the image: Berry R and Ashiru-Oredope D. ‘Evidence of impact of national stewardship tools for secondary care in England’ 2025

Summary of the WHO emergency cycle and levels of public health activities undertaken by pharmacy professionals

The infographic provides a summary of the WHO emergency cycle and levels of public health activities undertaken by pharmacy professions. A series of 4 circles are linked by arrows. Starting at the top centre circle of the infographic and moving clockwise the linked circles contain the following text:

• preparedness
• prevention
• response
• recovery

In the centre of this are a series of 3 concentric circles. From largest to smallest they contain the text:

• macro-level – national level activities
• meso-level – group or institutional level activities
• micro-level – activities focused on individuals

A box on the right-hand side contains the text Infectious disease outbreaks and subsequent high use of antimicrobial treatment can be a driver for AMR. Pharmacy professionals are well placed to undertake pharmaceutical public health roles in the management of outbreaks as part of the WHO emergency cycle, including AMS activities. These activities can be at micro-, meso- or macro-levels.

Underneath the box the paper authors are listed: Berry R, Wilkinson A, Turk A, Ng B.Y, Pinkney S, Halai B, Emoche A, Thornley T and Ashiru-Oredope D. ‘Pharmacy professionals’ contribution to the prevention, preparedness, response, and recovery of non-COVID outbreaks: a rapid systematic review’ 2025

What indicators are used to estimate or measure appropriateness of antibiotic prescribing in high-income countries: a rapid systematic review

A box on far left of the infographic says there were 154 studies identifies in initial results:

• 119 discussed general indicators
• 35 discussed proxy indicators
• results highlight complexity of defining appropriateness of prescribing
• guideline compliance, drug choice for indication, correct dose and appropriate duration are common indicators used
• these recurring themes reflect core principles of antimicrobial stewardship

To the right of the box is the word example. An arrow above this contains the word general. This points to a word cloud made up of the following words: Unnecessary treatment, end-of-life, restricted use, sensitivities, pregnancy, documentation, drug, diagnostic criteria, IV to oral switch, age, frequency, dose, colonisations, spectrum, evidence-based, patient adherence, renal function, marketing authorization, combination therapy, timing discontinuation, guideline compliance, intolerance, gender, cost, allergy, therapeutic drug monitoring, rationalistion, treatment, travel history, patient centered, duration, weight, route, monitoring, interaction, contraindication, previous antibiotic use, form catheter, review, indication, investigations, target site, expert opinion, redundancy, blood/urine culture.

An arrow below the word example contains the word ‘proxy’ and points to 4 boxes with the following text:

Antibiotic consumption data:

• defined daily doses (DDDs) per patient
• % of AWaRe categories
• antibiotic diversity

Prescription information:

• duration or days of therapy
• seasonal variation

Prescription information linked to diagnostic coding:

• proportion of first-line antibiotic prescribed for a diagnosis
• appropriate duration of treatment for a diagnosis

Patient-level data required:

• prescribing versus no prescription
• diagnostic test was carried out
• appropriate for age, diagnosis, gender, pregnancy status

A footnote at the bottom of the infographic contains the authors details: Berry R, Magrini E, Medioli F, Caris MG, Kherabi Y, Ng BY, Catteau L, Peiffer-Smadja N, Murri R, De Boer M, Ashiru-Oredope D and ESGAP. ‘Measuring appropriateness of antibiotic prescribing in high income countries: a rapid systematic review of indicators’ 2025

Rapid systematic reviews of inclusion health groups and adult social care

The infographic provides an overview of rapid systematic reviews of inclusion health groups and adult social care. The infographic provides an overview of rapid systematic reviews of inclusion health groups and adult social care. A box in the top left corner of the infographic contains the text “Submitted for publication”. This is linked by an arrow to a second box containing the text “Individuals in contact with the justice system”. The top right-hand box contains the text “Not started”. It is linked by 2 arrows to 2 boxes containing the text “People experiencing homelessness and Gypsy, Roma and traveller communities”. The top middle box contains the text “In progress”. This links by 4 arrows to 4 boxes. Three contain the following text “Individuals living in adult social care, sex workers and victims of modern slavery”. The fourth box contains a summary of the findings so far for a review on antimicrobial use, antimicrobial resistance and relevant antimicrobial stewardship interventions in people who use drugs. It contains the following summary: “Assessing antimicrobial use, antimicrobial resistance and relevant antimicrobial stewardship interventions in people who use drugs. 1,765 abstracts identified. Screened in duplicate. 103 articles identified for full text review. 47 papers ultimately eligible for final inclusion. Screening of meta-analyses and systematic reviews to identify relevant additional papers. Synthesis of findings ongoing.

Overview of NHS England improvement and assurance schemes 2024 to 2025

The image provides an overview of NHSE improvement and assurance schemes from 2024 to 2025. On the far left a box is titles NHS oversight Framework. A graph shows that in 2024 to 2025 40% and 98% of integrated care boards (ICBs) met the NHS Oversight Framework targets for total antibiotic prescribing and proportion of broad spectrum prescriptions in primary care respectively compared to 24% and 95% in 2023 to 2024.

There were 1,221,553 fewer general practice antibiotic prescription items compared to the previous 12-months to March 2024.

The middle box contains the title National Medicines Optimisation Opportunities. The proportion of amoxicillin 500mg capsules 5-day courses in Primary Care increased from 57% in 2024 to 69% in 2025. In the first year of expanding IV to Oral Switch to include paediatrics 24% of trusts participated and 50% of trusts met the threshold of having 15% or fewer patients receiving IV antibiotics past the point at which they meet the switch criteria.

On the right is a box titles NHS Standard Contract. This shows that 50% of trusts reduced their Watch/Reserve antibiotic consumption and 36% of trusts achieved a 10% or more reduction compared to a 2017 baseline. An improvement from 23% of trusts achieving this in 2023 to 2024.

Overview of Pharmacy First service in England during 12 months April 2024 to March 2025

The image highlights key findings from an evaluation of Pharmacy First from April 2024 to March 2025.

A graph on the top left shows the number of Pharmacy First consultations in 12 months for 7 common infection clinical pathways, split by gender. Females saw the highest number of consultations for uncomplicated urinary tract infection (UTI) (over 600,000) with 4 in 5 supplied an immediate antibiotic. Overall, the largest number of consultations were for acute sore throat (n=806,491) with 63% of these consultations for females and 37% for males. The lowest number of consultations in females were for shingles and for males were uncomplicated UTI.

Over 2.3 million consultations were delivered to over 2.2 million patients with 45 to 85% of consultations having a antimicrobial supplied. 97% of consultations were face to face.

Children aged 0 to 14 years accounted for 21% of all consultations and acute otitis media accounted for half of the consultations in this age group. 30% of these consultations were supplied antibiotic-sparing analgesic anaesthetic ear drops.

Capability framework for antimicrobial stewardship (AMS) specialists

Four boxes on the left of the screen contain the following text:

Domain 1: Professional practice​. Provides specialist AMS knowledge, skills and practices to shape and deliver AMS in their organisation and healthcare system, for the benefit of individual patients and services; collaborating with other patients, and the public​

Domain 2: Leadership and management​. Provides leadership across organisations and systems to optimise the management of infections and use of antimicrobials; leading on complex issues relating to AMR and behaviours driving antimicrobial use.​

Domain 3: Education​. Develops and improves the knowledge, attitudes, and practices of others regarding the optimal use of antimicrobials, and uses their own professional development to improve AMS programmes and patient care.​

Domain 4: Research and Quality Improvement​. Co-ordinates and surveillance and monitoring of antimicrobial use across services, organisations, and systems, and develops and applies evidence to improve AMS programmes and interventions and optimise the use of antimicrobials.​

Arrows extend from these boxes and intertwine pointing towards 3 bubbles containing the text:

• core (enhanced) – supports the delivery of AMS activities​
• advanced – delivers and develops AMS programmes and activities​
• expert – leads and is responsible for AMS programmes​

Additional text in the image is as follows:

Capability statements and descriptors of practice for core, advanced and expert to guide users through benchmarking and professional development​.

Applicable to healthcare professionals specialising in AMS from all professional backgrounds working in all sectors of the NHS.​

Associated resources:​

• job descriptions
• person specifications
• job plans​

Signposting to educational resources for AMS knowledge and skills to support practitioners to move from core to advances and expert advice.

TARGET training roll out: reach and evaluation

The infographic provides an evaluation of the TARGET training roll out. A map of England is shown on the left of the infographic with shading to show the number of people who received training*. The North west has the darkest shading indicating the highest number of people trained. This is followed by the Midlands then East of England and the South East then the North East. The south West and London are greyed out indicating that training has not yet been rolled out in these areas. Three boxes next to the map contain the text:

• 126 trainers trained on the toolkit
• 862 people reached through the NHSE training cascade
• 2024 to 2025 total training reach = 1035 (unspecified training = 47)
• overall training reach (October 2022 to March 2025 = 2,539)

The right side of the infographic contains information on local implementation. One pie chart shows information on evaluation of local trainers and contain the following text:

• 67% reported that stakeholder engagement and prioritising AMS helped toll out the training

Two pie chart contains data on evaluation of prescribers:

• 94% were able to implement the strategies planned
• 90% reported that discussions with patients affected the outcome of the consultation in relation to antibiotic prescribing

Information is also included on the impact of prescribing at ICB level:

• 1.2% decrease in prescribing rate following training per ICB
• estimated monthly savings across England equal £317,375

*Figures obtained through completed evaluation surveys, actual training reach will be higher

TARGET and RCGP AMS webinars

Between April 2024 and March 2025, TARGET hosted 3 webinars in partnership with the Royal College of General Practitioners. After each webinar, attendees were asked to give feedback. Their responses were used to calculate a Net Promoter Score (NPS) – a way to measure how satisfied people were with the event:

• scores of 0 to 6 = detractors, subtract one point
• scores of 7 to 8 = passives, no change
• scores of 9 to 10 = promoters, add one point

Attendees rated the webinar from 0 to 10 and their responses were used to calculate the NPS. The total sum of all responses is the NPS and shows how likely people are to recommend the webinar to others, with a score above 50 as excellent, 20 to 50 as great, 0 to 20 as good and below 0 needing improvement.

Webinar 1: Patient perceptions of infections and antibiotics: insights from national surveys – 89 attendees and a NPS of 53.

Webinar 2: Navigating antimicrobial stewardship for new and early career prescribers – 133 attendees and a NPS of 41.

Webinar 3: Managing recurrent UTI and reviewing long-term and repeat antibiotic therapy – 355 attendees and a NPS of 64.

e-Bug topics across key stages

e-Bug contains 4 age-specific teaching packs for educators. This infographic shows which topics are covered in each key stage pack:

• Early Years (3 to 5 years) – hand hygiene, respiratory hygiene and oral hygiene
• Key Stage 1 (5 to 7 years) – introduction to microbes, hand hygiene, respiratory hygiene and oral hygiene
• Key Stage 2 (7 to 11 years) – introduction to microbes, useful microbes, harmful microbes, hand hygiene, respiratory hygiene, oral hygiene, food hygiene, animal and farm hygiene, vaccinations and antibiotics
• Key Stage 3 (11 to 14 years) – introduction to microbes, useful microbes, harmful microbes, hand hygiene, respiratory hygiene, oral hygiene, food hygiene, sexually transmitted infections, vaccinations and antibiotics
• Key Stage 4 (14 to 16 years) – introduction to microbes, useful microbes, harmful microbes, hand hygiene, respiratory hygiene, oral hygiene, food hygiene, sexually transmitted infections, vaccinations, antibiotics and antimicrobial resistance

e-Bug engagement 2024 to 2025

Between April 2024 and March 2025, e-Bug carried out the following engagement activities:

• access – over 128,000 views on the e-Bug website
• social media – reached over 3,000 followers on X and over 288,000 views on YouTube
• global reach – partnered with a further 7 countries
• training – 2 e-learning courses hosted on FutureLearn
• newsletter – quarterly newsletter distributed to 10,000 subscribers

Antibiotic Guardian pledges

The infographic provides an overview of the antibiotic guardian campaign.

Three boxes on the left side of the infographic contain the following text:

• 190,648 antibiotic guardian pledges on main pledge page form inception (2014) to end of 2024

• 104 Organisations registering AMS activity through Antibiotic Guardian in 2024

• 75 entries to the Antibiotic Guardian Shared Learning Awards in 2024

Three arrows extend from these boxes. The top arrow contains the number of pledges in 2024 (12,967). The middle arrow contains the number of pledges in 2023 (19,321), and the bottom arrow contains the number of pledges for 2020 (36,733), 2021 (32,423) and 2022 (13,951).

On the right had side of the infographic there are 2 boxes containing the following text: “17,053 International pledges on main pledge page, African subpages and translated subpages and 194 countries represented in international pledges.”

International antibiotic guardian pledges

Two red circles in the top left of the infographic contain the text:

• total pledges (29 August 2025) 212,741
• international pledges (31 December 2024) 17,053

A graph in the top left shows new international pledges on the left Y-axis and total number of international antibiotic guardians on the right Y-axis. The X-axis shows years from 2015 to 2024. A red line showing total number of international antibiotic guardians increases year on year from 0 in 2015 to 17,053 in 2024. A series of purple bars show the number of new international pledges per year as:

• 2015: 340
• 2016: 1,082
• 2017: 928
• 2018: 2,632
• 2019: 2,458
• 2020: 4613
• 2021: 1,299
• 2022: 687
• 2023: 1,648
• 2024: 1,366

Text in the bottom left of the infographic shows there were 3,997 pledges via African sub-pages and a map highlights that most of these pledges were in south Africa, followed by Nigeria, then Kenya, then Uganda, then Ethiopia.

Next to the map, a box shows the number of African AGs registered on the Africa subpages (n = 3,882). An image of a doctor has the text “67.7% were healthcare professionals”. Below this, ‘Other categories’ include:

• students 21.1%
• farmers 10.8%
• citizens 0.4%

Next to this is a bar graph showing proportion of incorrect and correct responses to 5 knowledge questions.

You can share antibiotics with others (false): 8% were incorrect and 92% were correct.

Taking antibiotics often has side-effects such as diarrhoea (true): 14% were incorrect and 86% were correct.

Unnecessary use of antibiotics makes them ineffective (true): 3% were incorrect and 97% were correct.

Antibiotics are effective against colds and flu (false): 25% were incorrect and 75% were correct.

Antibiotics are effective against viruses (false): 17% were incorrect and 83% were correct.

In the bottom right of the infographic is a pie chart that show 61.2% of respondents answered all 5 AMR knowledge questions correctly.

National World AMR Awareness Week (WAAW) toolkit evaluation

A series of 4 boxes run across the top of the infographic containing the text:

1. World AMR Awareness Week (WAAW)
2. Toolkit views
   • a.    2024 4,061
   • b.    2023 963
3. Social media posts
   • a.    #WAAW = 1,513
   • b.    #KeepAntibioticsWorking = 962
   • c.     #AntibioticGuardian = 340
4. WAAW webinar
   • a.    906 registrants

In the bottom left are 2 pie charts. The first shows the number of webinar registrants who would recommend the toolkit to others:

• 313 would recommend and 17 were unsure

The other shows the number of webinar registrants who reported using the toolkit for their WAAW activities:

• 333 used the toolkit to inform WAAW activities, 277 did not use the toolkit and 269 were unsure

In the bottom right there is a graph showing the proportion of WAAW webinar registrants who though the WAAW toolkit content was useful, neither useful nor not useful or not useful:

• key messages for healthcare professionals on AMS: 95% useful, 4% neither useful nor not useful, 1% not useful
• suggested actions to consider: 92% useful, 7% neither useful nor not useful, 1% not useful
• public awareness campaigns: 89% useful, 9% neither useful nor not useful, 2% not useful
• information to support planning your local WAAW/EAAD activities: 88% useful, 10% neither useful nor not useful, 2% not useful
• additional AMR resources, toolkits and wider activity: 84% useful, 14% neither useful nor not useful, 2% not useful
• social media messages: 76% useful, 22% neither useful nor not useful, 2% not useful
• information about tackling AMR through a One Health approach: 73% useful, 25% neither useful nor not useful, 2% not useful
• daily themes: 71% useful, 26% neither useful nor not useful, 3% not useful
• digital notes: 67% useful, 28% neither useful nor not useful, 5% not useful

2024 to 2029 National Action Plan for AMR Human Health Target 2a

A box across the top of the infographic contains the text: By 2029, we aim to increase UK public and healthcare professionals’ knowledge on AMR by 10%, using 2018 and 2019 baselines, respectively.

Below this, a box on the left side of the infographic, titled Public Survey Methods contains the text: “Ipsos conducted an online questionnaire as part of a routine survey across the UK. Representativeness of the sample was ensured in 2024 by using quotas set on age, gender, region and working status and weighting. Results were compared to findings from the 2018 Eurobarometer questionnaire.”

Next to this is a graph showing the proportion of respondents who answered currently and incorrectly in 2018 and 2024 to 4 knowledge questions. The following data is shown for each of the knowledge questions:

• Antibiotics are effective against viruses: In 2018, 49% were correct, 41% were incorrect and 10% did not know. In 2024, 55% were correct, 28% were incorrect and 17% did not know
• Antibiotics are effective against colds and flu: In 2018, 78% were correct, 16% were incorrect and 6% did not know. In 2024, 71% were correct, 17% were incorrect and 12% did not know
• Unnecessary use of antibiotics makes them ineffective: In 2018, 90% were correct, 5% were incorrect and 5% did not know. In 2024, 87% were correct, 5% were incorrect and 8% did not know
• Taking antibiotics has associated side effects: In 2018, 62% were correct, 17% were incorrect and 21% did not know. In 2024, 52% were correct, 14% were incorrect and 34% did not know

A box on the far right of infographic contains the text: “Percentage of people answering all 4 questions correctly, 2018 (29%), 2024 (28%).”

A box in the bottom left of the infographic, titled HCP Survey Methods, contains the text: A previously EU-wide validated online survey tool was used to survey HCPs across 30 EU/EEA countries, including the UK, between 28 January and 4 March 2019, and repeated between 1 March and 18 March 2024. Patient-facing HCPs from the 4 UK nations participated. The information source is cited as Tang et al. JAC-AMR, under review. 2025.

Next to this is a graph showing the proportion of respondents who answered currently and incorrectly in 2019 and 2024 to 7 knowledge questions. The following data is shown for each of the knowledge questions:

• Effective against viruses: In 2019, 97% were correct, 3% were incorrect. In 2024, 98% were correct, 2% were incorrect
• Effective against colds and flu: In 2019, 98% were correct, 2% were incorrect. In 2024, 98% were correct, 2% were incorrect
• Unnecessary use of antibiotics increases the risk of them becoming ineffective: In 2019, 97% were correct, 3% were incorrect. In 2024, 99% were correct, 1% were incorrect
• Taking antibiotics has associated side effects: In 2019, 97% were correct, 3% were incorrect. In 2024, 99% were correct, 1% were incorrect
• Every person treated with antibiotics is at increased risk of antibiotic resistant infection: In 2019, 80% were correct, 20% were incorrect. In 2024, 86% were correct, 14% were incorrect
• Antibiotic resistance bacteria can spread from person to person: In 2019, 78% were correct, 22% were incorrect. In 2024, 76% were correct, 24% were incorrect
• Healthy people can carry antibiotic resistant bacteria: In 2019, 90% were correct, 10% were incorrect. In 2024, 94% were correct, 6% were incorrect

A box on the far right of infographic contains the text: percentage of people answering all 7 questions correctly, 2019 – 59%, 2024 – 63%

A footnote at the bottom reads as follows: different methodologies and sample compositions were used between the baseline and 2024 surveys. Therefore, differences should be interpreted with caution.

Word cloud representation of keywords for the research projects showcased in 2024 to 2025 research insights and knowledge mobilisation chapter

Keywords for the research projects showcased in 2024 to 2025 ‘Research insights’ chapter, in order of frequency:

AMR, surveillance, impact evaluation, E.coli, pandemic, bloodstream infections, strains, national, primary care, antibiotic, general practice, development, infection, data, N.gonorrhoeae, COVID, stewardship, prescribing, exploring, therapeutics, pharmacy, incidence, antimicrobial, critical care, resistance, IPC Gram-negative, trends, programme, children, burden, novel strategies, respiratory, Machine learning, OXA, role, cohort, schools, managing, Cost, modelling, interaction, discovery, profiles, community, support, vaccines, case study, selection, dissemination, cost-effectiveness, lineages, interventions, public, national action plan, whole genome sequencing, diverse, multi-drug resistant, Tests, patients, T.vaginalis, antibiotics, prevention, pilot, diagnostic, studying, social risk, immunization, RSV, bacteraemia, Doxycycline, counselling, CPE, urinary tract infection, human, toolkit, deprivation, spread, pathways, transposon-carrying, research, antibiotic-resistant, C.trachomatis, predicting, metric, epidemiology, prediction, carbapenemase-producing infections, patient-level, P.mirabilis, environment, mortality, quantitative, patient, communication, diseases, changing, data linkage, investigating, bacteraemias, secondary care, classification, healthcare-associated, high-value, health analysis, sepsis, Gram-negatives, acne, expert, clinical, model, panel, bacteria, study, bloodstream, urinary tract infections, preventing, teachers, standardized, assays, STI, biomarker, C.difficile, economic, gonorrhoea, NHS, pharmacies, needs, complement, outpatient, Tuberculosis, health inequalities, laboratory, quality improvement, AWaRe, audit, hospitals, training, organisations, consensus

AMR peer-reviewed publications from April 2024 to March 2025 by UK National Action Plan for AMR 2024-to-2029 outcome 

A figure showing the number of peer-reviewed publications by NAP outcome: IPC and infection management = 21 publications, public engagement and education = 2 publications, strengthening surveillance = 13 publications, antimicrobial stewardship and disposal = 14 publications, AMR workforce = 4 publications, innovation and influence = 10 publications, using information for action = 21 publications, health disparities and health inequalities = 11 publications, AMR diplomacy = 10 publications.

Examples of current research projects for the UK National Action Plan for AMR 2024 to 2029 top 10 research priorities

Question 1: What is the cost of AMR? – Cost and clinical impact of IPC measures for CPE in hospitals: a cost-effectiveness model

Question 2: What is the relationship between AMR and health disparities? – Health inequalities in incidence of bacteraemias: a national surveillance and data linkage study, England, 2018 to 2022

Question 3: How to influence public awareness and behaviour on AMR? – Exploring community pharmacy professionals and general practitioners’ views on primary care communication and pathways to access antibiotics in England

Question 4: How to address AMR in international settings? – Novel vaccines and therapeutics for Tuberculosis and other respiratory diseases

Question 5: What are the basic drivers and effects of AMR, and how does it spread? – Dissemination of OXA-23 carbapenemase-producing Proteus mirabilis and Escherichia coli is driven by transposon-carrying lineages in the UK

Research to better understand how the built environment contributes to the spread of infection

Question 6: How can we prevent AMR from spreading? – Preventing and managing urinary tract infections: Exploring interventions and strategies implemented by NHS commissioning organisations in English primary care, 2017–2022

Question 7: How can we optimise the use of antimicrobials? – Adaptation of the WHO AWaRe (Access, Watch, Reserve) antibiotic classification to support national antimicrobial stewardship priorities in the UK

Question 8: What methods can be used to prevent, treat and manage infections without antimicrobial medicines? – Predicting the impact of RSV immunisation on antibiotic use and resistance: a modelling and economic analysis for England

Question 9: How can we drive innovation of new products for tackling AMR? – Development of High-Value Biomarker Diagnostic Tests for Hard-to-Diagnose Infections

Question 10: How can we ensure what is known to work is implemented? – Mixed-method impact and implementation evaluation of the ‘Pharmacy First’ services for management of common conditions

Examples of Health Protection Research Unit (2020 to 2025) projects generating public health and patient impact

Oxford University:

2020:

HPRU COVID-19 response: supporting Pillar 1, Pillar 2, Pillar 3 and Pillar 4 of the Government’s response

Lateral flow devices detect asymptomatic COVID-19

2021:

The SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN) study

Providing SARS-CoV-2 bioinformatics to the world: Global Pathogen Analysis Service (GPAS)

2022:

National carbapenemase-producing Enterobacterales admission screening strategies informed by model-based evaluation

2023:

Network analysis and mathematical modelling informing sentinel-based whole genome sequencing surveillance of novel C. difficile strains

Innovative dashboard to identify unknown data quality artefact that was creating misleading trends in AMR

2024:

Using genetics to diagnose and treat tuberculosis

Implementation of point-of-care tests to reduce antibiotic prescribing in primary care

Using sequencing of bacteria routinely undergoing public health surveillance to understand why Enterobacterales cause bloodstream infection

Imperial College London:

2020:

National definition development and surveillance of hospital onset COVID-19 infection surveillance

Whole genome sequencing of outbreak of GES-5-positive K. oxytoca

2021:

The impact of COVID-19 on antimicrobial use, infection, and AMR

Investigation of new multidrug resistant C. striatum infection during the COVID-19 pandemic

2022:

Development of optimised prescribing tools using machine learning and synthetic outcome estimation for antimicrobial cessation 

2023:

Data linkage and machine learning to identify healthcare associated bloodstream infections caused by common skin commensals

Genomic investigation of the emergence of healthcare-associated drug-resistant pathogens occurring during the COVID-19 pandemic

2024:

Portable molecular diagnostic platform for rapid point-of-care detection of infectious diseases

Use of artificial intelligence to improve intravenous to oral antibiotic switching in hospitalised patients 

UKHSA-Oxford Health Protection Research Unit (2025 to 2023) in AMR and HCAI

Optimising surveillance – (needs: better surveillance)

• transformative automated surveillance
• advanced analytics using large-scale patient-level national data

Establishing population impact – (needs: effective, value for money, interventions. New tools for infection prevention and control)

• cost-effectiveness of interventions (for example stewardship, diagnostics, IPC, vaccination, surveillance)

Advancing stewardship approaches – (needs: optimised stewardship. Better route to diagnostic adoption)

• optimise stewardship amongst underserved groups
• tailor methods for different primary care contexts and HCPs

Mitigating Gram-negative infections – (needs: ways to reduce Gram-negative infections)

• innovate surveillance to identify drivers and reservoirs for Enterobacterales/AMR in healthcare
• define robust intervention strategies

All research projects will include the following throughout: 

• equality, diversity and inclusion
• patient and public involvement, engagement and participation
• knowledge mobilisation

With the goal of seeing translational impacts of the research on public health protection policy and practice.

Examples of activities undertaken by ESPAUR Oversight Group members to support the UK National Action Plan for AMR 2024 to 2029

This infographic highlights the ESPAUR Oversight Group members who have contributed to this years’ ESPAUR report as well as supported commitments within the UK National Action Plan for AMR 2024 to 2029.

A circle in the centre of the infographic contains the logos of the organisations who have contributed to this years’ ESPAUR report. Four boxes around the circle contain examples of the work that ESPAUR Oversight Group members have conducted that support the National Action Plan for AMR and not a comprehensive list.

The top left box contains the text:
Theme: Global partner
Outcome: AMR diplomacy
Commitment: 9.2, Access and stewardship
Undertaking Global Antimicrobial Stewardship Accreditation Scheme to support hospitals globally with quality improvement to develop and potentially become a Centre of Excellence for AMS.

The top right box contains the text:
Theme: Optimising the use of antimicrobials
Outcome: Antimicrobial Stewardship and disposal
Commitment: 4.1, Clinical decision support
Collaborating with UKHSA to implement the TARGET antibiotics toolkit to support primary care providers to effectively utilise AMS interventions.

The bottom left box contains the text:
Theme: Optimising the use of antimicrobials
Outcome: AMR workforce
Commitment: 5.1, Health and Social Care training
Delivering professional educational programmes on the prevention of infection, aligned to AMS.

The bottom right box contains the text:
Theme: Global partner
Outcome: AMR diplomacy
Commitment: 9.2, Access and stewardship, 9.5, Advocacy and engagement Collaborating with international governments and with World Health Organization SEARO to present the activities and future direction for dental activities to tackle AMR, and support stewardship.

The organisations that have contributed to this years’ ESPAUR report are: 

• British Dental Association (BDA)
• British Infection Association (BIA)
• British Society for Antimicrobial Chemotherapy (BSAC)
• Care Quality Commission
• College of General Dentistry
• IQVIA
• Microbiology Society
• Royal College of General Practitioners
• Royal College of Nursing
• Rx-Info
• Veterinary Medicines Directorate (VMD) and Department for Environment, Food and Rural Affairs
• NHS England
• Department of Health and Social Care
• Public Health Wales
• Public Health Agency, Northern Ireland
• ARHAI Scotland (Scottish One Health Antimicrobial Use and Antimicrobial Resistance (SONAAR))

ESPAUR report knowledge mobilisation and feedback from report users  

This infographic highlights responses from surveys sent through annual webinars in 2023 and 2024.

The report user feedback from webinars showed there were 404 respondents for the 2022 to 2023 report and 389 respondents for the 2023 to 2024 report.

The data for the 2022 to 2023 report survey (n=404) shows:  

• that the most used chapters were Antimicrobial resistance (201), Antimicrobial stewardship (154), Antimicrobial consumption (150), Professional and public education (56), NHS England: improvement and assurance schemes (44), Research (41), ESPAUR members’ actions to tackle AMR (29)

• the most common reasons for accessing the report were reading for information (179), to share with others that is presentation (69), to inform policy (67) and for local indicators (32)  

The data for the 2023 to 2024 report survey (n=389) shows:

• that the most used chapters were Antimicrobial resistance (165), Antimicrobial stewardship (131), Antimicrobial consumption (110), Professional and public education (53), NHS England: improvement and assurance schemes (36), Research (31), ESPAUR members’ actions to tackle AMR (24). 97 Respondents stated that 3 or more chapters were used

• the most common reasons for accessing the report were reading for information (58), personal learning (31), to share with others that is presentation (30), followed by informing policy (27), systems working (23), use for local indicators (22), research (10) and all of the above reasons (102)

How the ESPAUR report has been used:

The infographic highlights the ways that the ESPAUR report has been used. These are: the ESPAUR report received 14,499 visits from September 2020 to October 2024. Key messages from the ESPAUR report has been knowledge mobilised by Oversight Group members to their organisations and wider audiences. The ESPAUR report was referenced in 63 articles when PubMed literature database and Policy Commons grey literature database searches were conducted.

Further ways that the ESPAUR report has been used has been in National stewardship papers that is Surveillance of Antimicrobial Use and Resistance in Northern Ireland Annual Report, in English hospitals in AMS/IPC reports, in NICE guidelines in patient safety alerts, in the UK One Health Report, used internationally as an example of good reporting in ECDC and the global leading Health Systems Network and Report infographics are used to highlight key messages and statistics.