For those of you who have had your head in a hole all week, you may not be aware that today is European Antibiotic Awareness Day, which coincides with Global Antibiotic Awareness Week. The antibiotic stewards amongst us (which should really be all of us!) have launched many and varied campaigns to highlight the need to handle antibiotics, our ‘miracle drugs’, with care (see Andreas’ 30-second-antibiotics-myth-buster-survey, for example).

Earlier this week, a report from the ‘English surveillance programme for antimicrobial utilisation and resistance’ (ESPAUR) was published. This report covers antimicrobial prescribing and resistance, using a unique dataset including data from 95% of NHS hospital labs. Key findings are as follows:

• Prescription of all antibiotics to hospital inpatients increased significantly by 11.7% and to hospital outpatients by 8.5% between 2011 and 2014. The year-on-year increase in the prescription of carbapenems in hospitals is especially troubling; this will drive the emergence of CPE.
• There is some better news from primary care, where the use of broad spectrum agents has decreased by 8.5% and there has been a reduction in the number of prescriptions dispensed (although the total amount of antibiotics prescribed in primary care has actually increased, probably due to a smaller number of longer courses prescribed; I can’t work out whether this is a good or bad thing)!
• Between 2010 and 2014 the rate of bloodstream infections caused by E. coli and K. pneumoniae has increased by 15.6% and 20.8%, respectively; and the number of antibiotic resistant K. pneumoniae bloodstream infections has increased during this period. Perhaps most importantly, the proportion of K. pneumoniae resistant to carbapenems increased from 0.3% in 2010 to 1.5% in 2014. This doesn’t match the startling increase in the US (from 1% in 2001 to 10% in 2011), but the trend is very worrying.
• The latest data from the PHE reference lab shows a pretty dramatic year-on-year increase in the number of CPE reported, from a handful in 2009 to >1600 in 2014. These are mainly KPC, OXA-48 and NDM producers.
• Surprisingly, only 13% of CCGs and 46% of acute Trusts had implemented an antimicrobial stewardship action plan.
• More than 12,000 individuals have pledged to be an Antibiotic Guardian!
• Rates of MRSA continue to decrease, with the rate of meticillin-resistance in S. aureus BSI falling from 12% to 8% in the last 5 years. There has also been a 23% reduction in Streptococcus pneumoniae BSI, probably related to pneumococcal vaccination.
• The report highlights the excellent work of the Oxford and Imperial HPRUs around antimicrobial stewardship.

I was reflecting during the week with Mark Gilchrist (a consultant ID pharmacist here at Imperial who has formulated our European / World Antibiotic Awareness campaign) how unique ESPAUR is. It could only work in a very connected healthcare system (like the NHS). I know we complain about how disconnected the NHS can be at times, but compared with most healthcare systems throughout the world, it is very connected, for which we should be grateful.

I think the bottom line from this report is that much progress has been made (not least in tackling the threat of MRSA), but much work is still to be done – especially in reducing the use of carbapenems in hospitals, and addressing the threat of CPE.

Image: ECDC.