It’s great to see the latest ESPAUR report published at the start of World Antibiotic Awareness Week 2021. There’s some good news in the report, but also some warning shots about our need to refocus on the risks attached to antimicrobial resistance as we move into the Covid endemic.

Here’s some headlines and reflections:

• For the first time since ESPAUR reports began, the incidence and antibiotic resistance burden of key organisms causing BSIs has fallen, including Gram-negative and Gram-positive pathogens. This is mainly driven by a reduction in E. coli BSIs.
• The number of deaths attributable to antibiotic-resistant organisms has also fallen in 2020.
• The proportion of key Gram-negative BSIs resistant to antibiotics continues to increase, but the rate of meticillin-resistant in S. aureus continues to fall.
• Rates of candidaemia had been on a downward trend but rose by 10% during the pandemic. Fortunately, Candida auris has been very infrequently reported probably due to reduced international travel.
• Perhaps surprisingly, overall antibiotic consumption continue to decline during the pandemic. This was not true in dental settings, perhaps due to less direct patient contact and more empiric prescribing. However, wouldn’t you expect this to be true across primary care (especially for GPs)?
• The picture for inpatient settings was different, with an increase in total prescribing, and relative increases in the ‘watch’ and ‘reserve’ agents. This is no surprise – acute healthcare providers went through huge organizational upheaval and had to deal with an awful lot of undifferentiated respiratory infection at the front door, combined with surges in critical care provision. Add a large dose of staff exhaustion and redeployment, and it’s no surprise the antimicrobial stewardship suffered!

As ever, I feel incredibly grateful to have this granularity of detail around antimicrobial resistance / incidence trends at a national level. Not a lot of countries have this. COVID-19 has really interrupted our efforts to tackle antimicrobial resistance. I fear that the “good news” in this report about reduced incidence of key BSIs is rather temporary and indirectly related to the changes that have been (rightly) imposed on our lives and lifestyles during the pandemic. So, now is the time to focus and re-focus on antimicrobial resistance and stewardship like never before!