The UK 5-year AMR Strategy - a brief overview - Dr Berit Muller-Pebody National Infection Service Public Health England

The UK 5-year AMR Strategy - a brief overview - Dr Berit Muller-Pebody National Infection Service Public Health England

Chief Medical Officer - Annual Report 2013 Antimicrobial resistance poses catastrophic threat 2 AMR Strategy BSAC Spring meeting

The UK 5 Year Strategy Improve the knowledge and understanding of AMR Conserve and steward the effectiveness of existing treatments Stimulate the development of new antibiotics, diagnostics and novel therapies 3 AMR Strategy BSAC Spring meeting

Implementing the UK Strategy - The 7 key areas - Department of Health (DH) High Level Steering Group PHE Human health Defra Animal health DH 1. Improving infection prevention and control practices 2. Better access to and use of surveillance data 3. Optimising prescribing practice 4. Improving professional education, training and public engagement 5. Improving the evidence base through research 6. Developing new drugs, treatments and diagnostics 7. Strengthening international collaboration 4 AMR Strategy BSAC Spring meeting

Improving infection prevention & control Development of a National Strategy CPE Acute & Non-acute Toolkits Work with NICE to update guidelines Quality Statement on prevention of HCAIs 5 AMR Strategy BSAC Spring meeting

Better access and use of surveillance data Overall, AMR continues to increase, though with a slower rate of increase from 2013 to 2014 than in previous years Total antibiotic prescribing, measured using defined daily doses, continues to increase in all NHS areas, except Dental Practice The majority of total prescribing occurs in primary care but secondary care prescribes more broad-spectrum antibiotics 6 AMR Strategy BSAC Spring meeting

Information for action PHE Fingertips 7 AMR Strategy BSAC Spring meeting

One Health approach 8 AMR Strategy BSAC Spring meeting

NICE Antimicrobial Stewardship Guidelines Published in August 2015 Provides good practice recommendations on systems and processes for the effective use of antimicrobials. Recommends the use of two PHE/DH toolkits - TARGET and Start Smart Then Focus Toolkits. 9 AMR Strategy BSAC Spring meeting

Quality and Innovation (CQUIN) & Quality Premiums Improved antibiotic prescribing in primary and secondary care through payments to Hospital Trusts and Clinical Commissioning Groups (CCGs) A reduction in the number of antibiotics prescribed in primary care B reduction in the proportion of broad spectrum antibiotics prescribed in primary care C secondary care providers validating their total antibiotic prescription data D secondary care providers reviewing antibiotic prescribing within 72 hours of the beginning of treatment (NEW) 10 AMR Strategy BSAC Spring meeting

Behavioural Insights Randomised Control Trial - reducing antibiotic prescribing through behaviour 1581 GP practices given marketing materials, CMO letter & TARGET leaflet or a combination of these plus a control group 73 406 fewer items dispensed, estimated saving of 92 356 Cheap, effective and scalable 11 AMR Strategy BSAC Spring meeting

Engaging the Public Public, professionals and organizations undertake a pledge to improve their antibiotic use. e-bug is a free educational resource for classroom and home use and makes learning about micro-organisms, the spread, prevention and treatment of infection fun and accessible for all students. 12 AMR Strategy BSAC Spring meeting

World Antibiotic Awareness Week 13 AMR Strategy BSAC Spring meeting

The Years Ahead Tackling AMR requires collaborative cross-sectoral approach, nationally and internationally Surveillance a foundational tool for public health action Shift from national level to supporting local action Focus on international work Support development of national plans (WHO Global Action Plan) Working to secure resolution on AMR at UN General Assembly 14 AMR Strategy BSAC Spring meeting

Acknowledgements HCAI & AMR Dept, National Infection Service, PHE AMR programme board, PHE 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 15 AMR Strategy BSAC Spring meeting

Antimicrobial Resistance Bacteria Escherichia coli Klebsiella pneumoniae Antibiotic Resistance (non-susceptibility) Metric Proportion Resistant in 2014 (%) 2014 compared to 2010* ciprofloxacin 18.7 cefotaxime and/or ceftazidime 11.1 gentamicin 9.6 imipenem and/or meropenem 0.1 co-amoxiclav 42.0 piperacillin/tazobactam 11.0 ciprofloxacin 10.9 cefotaxime and/or ceftazidime gentamicin 12.1 7.5 Pseudomonas spp. imipenem and/or meropenem 1.5 piperacillin/tazobactam 16.9 ceftazidime 7.4 imipenem and/or meropenem 11.5 Streptococcus pneumoniae penicillin 4.2 Enterococcus spp. vancomycin 14.2 Staphylococcus aureus methicillin 10.0 Acinetobacter spp colistin 3.5 Neisseria gonorrhoeae Mycobacterium tuberculosis ceftriaxone 0.0 azithromycin 1.0 isoniazid 5.5 rifampicin and isoniazid 1.6 16 AMR Strategy BSAC Spring meeting

Antimicrobial Prescribing General Practice Compared to 2010 NHS Trusts Compared to 2010 Broad Spectrum Antibiotics Penicillins & enzyme inhibitor 0.9 0.9 Cephalosporins 0.26 0.22 Carbapenems 0.001 0.08 Quinolones 0.3 0.2 Narrow Spectrum Antibiotics Penicillins (without enzyme inhibitors) 6.2 1.2 Tetracycline 4.5 0.33 Macrolides 2.7 0.5 Sulfonamides and Trimethoprim 1.2 0.4 Proportion of Broad spectrum antibiotics/ total antibiotics Total Antibiotic use expressed as DDD per 1000 inhabitants per day Total Antibiotic Prescriptions expressed as items per STARPU^ 8.5% 33.3% 17.1 4.2 1.233 NA 17 AMR Strategy BSAC Spring meeting