English Surveillance Programme for Antimicrobial ... · English Surveillance Programme for...
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English Surveillance Programme for Antimicrobial Utilisation and Resistance
(ESPAUR)
Berit Muller-Pebody HCAI & AMR Department, Centre for Infectious Disease Surveillance and Control
Chief Medical Officer - Annual Report 2013
Antimicrobial resistance poses ‘catastrophic threat’
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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
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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
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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)
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Antimicrobial resistance
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 6.1
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Summary of key bacterial drug resistance in England, 2013
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, 3rd gen cephalosporins and gentamicin, England 2010-2013
% E. coli bloodstream infection isolates non-susceptible to indicated antibiotics, NHS Area Team, 2013
Grey areas represent ATs where <70% of isolates had susceptibility data available ESPAUR - BSAC Roundtable Series
Antibiotic consumption, England 2010-2013
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, 2010-2013
Total antibiotic consumption by AB group, England, 2010-2013
GP consumption by ATs, England, 2013
Hospital consumption, by ATs, England, 2013
Total consumption, by ATs, England, 2013
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
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, 2010-13
Consumption of most commonly utilised penicillins, DID, 2010-2013
Cephalosporins ~0.2% total use 48% decrease from 2010 to 2013 Hospital inpatients unchanged Lowest in Europe
Consumption of most commonly cephalosporins, DID, 2010-2013
Consumption of cephalosporins by General Practice and Hospitals, DID, 2010-13
Map of cephalosporin consumption by ATs, DID, 2013
Carbapenems ~0.3% of total use 31% increase from 2010 to 2013 99% hospital use Majority of regions increased Huge variability across AT
Consumption of most commonly used carbapenems, DID, 2010-2013
Consumption of carbapenems by General Practice and Hospitals, DID, 2010-13
Map of carbapenem consumption by ATs, DID, 2013
Comparisons with Europe (ESAC-Net)
General Practice
Very low quinolone/ cephalosporins use
Hospital
Much higher except for cephalosporins
Key issues
• Prescribing continues to increase • Too much regional variability • Hospital use very high compared to Europe
• Data not comparable?
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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
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• ESPAUR report data • National General Practice Profiles • ESAC-Net/EARS-Net • UK One Health Report
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Next steps – data transparency
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• Validate hospital data • Develop methodology for paediatric data
• Prescribed Daily Dose (PDD)?
• Develop case mix methodology
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Next steps – data quality improvements
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Health Protection Research Unit (HPRU) • Imperial College/University of Oxford/PHE
• E. coli bacteraemia study
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Next steps - research
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Susan Hopkins
Alan Johnson
Rebecca Guy
Diane Ashiru-Oredope
Alex Bhattacharya
Emma Budd,
Simon Thelwall
Mehdi Minaji
Katherine Henderson
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Acknowledgements
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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