english surveillance programme for antimicrobial utilisation and resistance (espaur) figures...
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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
3 ESPAUR 2014: Year 2 Report
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
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• 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
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Other Reports
ESPAUR 2014: Year 2 Report
Antibiotic Resistance
6 ESPAUR 2010-2014: Year 2 Report
Bloodstream Infection rates, 2010-14
7 ESPAUR 2014: Year 2 Report
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
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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
9 ESPAUR 2014: Year 2 Report
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
10 ESPAUR 2014: Year 2 Report
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
11 ESPAUR 2014: Year 2 Report
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
12 ESPAUR 2014: Year 2 Report
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
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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
14 ESPAUR 2014: Year 2 Report
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
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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)
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Prescriptions dispensed in the community, expressed as DDD per 1000 inhabitants per day and items per 100 inhabitants per year, England, 1998-2014
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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
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Total antibiotic consumption, expressed as DDD per 1000 inhabitants per day, England, 2010−2014
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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
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Consumption of penicillin, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014
Penicillins
21 ESPAUR 2014: Year 2 Report
Consumption of cephalosporins, by prescribing location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014
Cephalosporins
22 ESPAUR 2014: Year 2 Report
Consumption of carbapenems, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014
Carbapenems
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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
24 ESPAUR 2010-2014: Year 2 Report
Quinolones
25 ESPAUR 2010-2014: Year 2 Report
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
26 ESPAUR 2010-2014: Year 2 Report
Sulfonamides and Trimethoprim
27 ESPAUR 2010-2014: Year 2 Report
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
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Glycopeptides
Antibiotic items by prescribers, expressed as items per 1000 inhabitants per day, England, 2010−2014
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Prescriptions in the community
Prescriptions in the community
Key antibiotic groups prescribed by general practice, expressed as items per 1000 inhabitants per day, England, 2010−2014
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Prescriptions in the community
Key antibiotic groups prescribed by dental practice, expressed as items per 1000 inhabitants per day, England, 2010−2014
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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
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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%
Prescriptions in Hospitals
Total antibiotic consumption by trust organisation type, using defined daily doses (DDD), England, 2014
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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
Prescriptions in Hospitals
Key antibiotic groups prescribed in hospital, expressed as DDD per 100 admissions per day, England, 2011−2014
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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
35 ESPAUR 2014: Year 2 Report
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.
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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