I am just getting around to reading (well detail-scanning the exec summary) of the ESPAUR report. My main reflection is what a fantastic resource this reporting stream offers us: to have freely accessible, regular, accurate, national data on antimicrobial resistance and usage, and other related indicators is pretty unique!
The ‘uniqueness’ of ESPAUR was brought home to me by an informal chat with an Egyptian microbiologist at a research council event this week. She was telling me that non-prescribed antimicrobial usage is rife in Egypt but the only data on resistance comes from individual reports from hospital labs. Compare the comprehensive national view offered by ESPAUR! On an international scale, ESPAUR is the exception and Egypt is the rule. (By the way, I have nothing against Egypt, and somebody will probably tell me they have a long-standing ESPAUR-equivalent, in which case apologies and congrats to any readers from Egypt!)
And so to the key points from the report:
- Increasing prevalence of E. coli and K. pneumoniae BSI, with something in the region of a 20-30% increase in both between 2010 and 2015. Worryingly, K. pneumoniae seems to be increasing faster than E. coli. And worth remembering that these BSI represent the tip of the iceberg.
- Pip/tazo resistance is on the rise in E. coli and K. pneumoniae, with resistance rates now approaching 12% for E. coli BSIs, and 20% for K. pneumoniae BSIs. Some better news is that resistance to combinations of antibiotics is lower, suggesting that combination therapy is the way forward.
- Carbapenem-resistance in Gram-negative BSIs remains low – although the number of cases reported nationally is increasing and almost certainly at least a 10-fold under-estimate of actual prevalence.
- There is skewed geographical distribution, and higher rates in both the very young and very old, both in terms of prevalence and resistance for Gram-negative bacteria.
- The overall use of antimicrobials has declined across the healthcare sector for the first time, although hospital use of key agents (pip/tazo, carbapenems, and colistin) continues to increase. CQUIN programmes have been launched to try to address this in hospitals.
- Progress is being made on educating healthcare workers and the public (with e-Bug, and the Antibiotic Guardian programmes growing).
- An increased focus is being placed on surveillance of antifungal usage, which seems especially important in the light of C. auris.
I have two minor quibbles with ESPAUR. Firstly, the E stands for English; but wouldn’t it be great if the United Kingdom of Great Britain and Northern Island could take a more United approach to AMR surveillance and reporting? Secondly, couldn’t the brainboxes behind ESPAUR have come up with a more catchy acronym, and ideally one that has a more obvious pronunciation!
These minor quibbles aside, I love ESPAUR and think we should all send-to-all to drive local, regional, national, and inter-island action on AMR!