English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR)

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1 English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Berit Muller-Pebody HCAI & AMR Department, Centre for Infectious Disease Surveillance and Control

2 Chief Medical Officer - Annual Report 2013 Antimicrobial resistance poses catastrophic threat 2 ESPAUR - BSAC Roundtable Series

3 The 5-year UK AMR strategy 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 of antimicrobial resistance research needs strengthened international collaboration 3 ESPAUR - BSAC Roundtable Series

4 English Surveillance Programme for Antibiotic Use and Resistance (ESPAUR) Established by PHE in 2013 in response to the strategy To develop surveillance systems to measure both antimicrobial utilisation and resistance To measure the impact of antimicrobial utilisation on resistance To develop quality measures for optimal prescribing To develop initiatives with key partners for both public and professional behaviour change 4 ESPAUR - BSAC Roundtable Series

5 ESPAUR Report 2014 Main findings The number of patients with bloodstream infections has increased each year Increased numbers of these bloodstream infections are caused by resistant bacteria Antibiotic prescribing to patients has increased form 2010 to 2013 Almost 80% of antibiotics are prescribed by General Practices (GPs) 5 ESPAUR - BSAC Roundtable Series

6 Antimicrobial resistance Summary of key bacterial drug resistance in England, 2013 Pathogen Antibiotic or antibiotic class % non-susceptible Escherichia coli Ciprofloxacin 18.2 Third-generation cephalosporins 10.9 Gentamicin 9.7 Imipenem/meropenem 0.1 Klebsiella pneumoniae Ciprofloxacin 11.1 Third-generation cephalosporins 11.4 Gentamicin 8.5 Imipenem/meropenem 1.0 Pseudomonas spp. Ciprofloxacin 10.4 Ceftazidime 6.7 Gentamicin 3.6 Imipenem/meropenem 9.5 Streptococcus pneumoniae Penicillin 3.1 Macrolides 8.1 Tetracycline ESPAUR - BSAC Roundtable Series

7 Resistance in Escherichia coli Proportion resistance stable Increased rate of bacteraemias & antibiotic resistant bacteraemias Regional variation across the country E. coli isolates non-susceptible to ciprofloxacin, 3 rd gen cephalosporins and gentamicin, England % E. coli bloodstream infection isolates non-susceptible to indicated antibiotics, NHS Area Team, 2013 ESPAUR - BSAC Roundtable Series Grey areas represent ATs where <70% of isolates had susceptibility data available

8 Antibiotic consumption, England Total prescriptions 6% GP 4.1% Hospital inpatients 11.9% Hospital outpatients stable other community (e.g. dentists) 32% Total antibiotic consumption by prescriber, England, Total antibiotic consumption by AB group, England,

9 Significant regional variation General Practice Durham, Darlington and Tees over 40% higher than London 26.5 compared to 18.9 DID Hospital London twice Leicestershire and Lincolnshire 6.0 DID compared to 2.9 DID Total Merseyside, highest (similar to Southern Europe) over 30% higher Thames Valley 30.4 DID compared to 22.8 DID GP consumption by ATs, England, 2013 Hospital consumption, by ATs, England, 2013 Total consumption, by ATs, England, 2013

10 Penicillins ~50% of total use 3.2% increase from 2010 to 2013 Co-amoxiclav 13% increase Piperacillin-tazobactam 46% increase Consumption of penicillins by General Practice and Hospitals, DID, Consumption of most commonly utilised penicillins, DID,

11 Cephalosporins Consumption of cephalosporins by General Practice and Hospitals, DID, ~0.2% total use 48% decrease from 2010 to 2013 Hospital inpatients unchanged Lowest in Europe Map of cephalosporin consumption by ATs, DID, 2013 Consumption of most commonly cephalosporins, DID,

12 Carbapenems Consumption of carbapenems by General Practice and Hospitals, DID, ~0.3% of total use 31% increase from 2010 to % hospital use Majority of regions increased Huge variability across AT Map of carbapenem consumption by ATs, DID, 2013 Consumption of most commonly used carbapenems, DID,

13 Comparisons with Europe (ESAC-Net) General Practice Very low quinolone/ cephalosporins use Hospital Much higher except for cephalosporins

14 Key issues Prescribing continues to increase Too much regional variability Hospital use very high compared to Europe Data not comparable? 14 ESPAUR - BSAC Roundtable Series

15 Next steps - improve quality of prescribing Antimicrobial prescribing quality measures (APQM) Active monitoring of national prescribing Open benchmarking compare with peer and historic data Education/teaching 15 ESPAUR - BSAC Roundtable Series

16 Next steps data transparency ESPAUR report data National General Practice Profiles ESAC-Net/EARS-Net UK One Health Report 16 ESPAUR - BSAC Roundtable Series

17 Next steps data quality improvements Validate hospital data Develop methodology for paediatric data Prescribed Daily Dose (PDD)? Develop case mix methodology 17 ESPAUR - BSAC Roundtable Series

18 Next steps - research Health Protection Research Unit (HPRU) Imperial College/University of Oxford/PHE E. coli bacteraemia study 18 ESPAUR - BSAC Roundtable Series

19 Acknowledgements Susan Hopkins Alan Johnson Rebecca Guy Diane Ashiru-Oredope Alex Bhattacharya Emma Budd, Simon Thelwall Mehdi Minaji Katherine Henderson ARHAI Antimicrobial Stewardship subgroup NHS Business Services Authority Health and Social Care Information Centre IMS Health NHS microbiology laboratories PHE regional information managers PHE field epidemiology services Antimicrobial pharmacists across English NHS Trusts East of England pharmacy network All members of ESPAUR oversight group 19 ESPAUR - BSAC Roundtable Series