The latest ESPAUR report (2024–2025) paints a sobering picture of AMR in England. While prescribing practices have improved in some areas, the resistant infections are increasing, and new threats like Candidozyma auris are emerging.

It’s always a treat to read, and reminds me what a privilege it is to work in a part of the world with such strong national surveillance systems. And a team of epidemiologists behind the scenes working hard behind the scenes to pull together this comprehensive (300 page!) report. I’d imagine the team are already getting started on the 2026 edition!! Here are a few reflections, focussed on antibacterial resistance and the emergence of C auris.

Antibacterial resistance: key trends

AMR burden surpasses pre-pandemic levels

• In 2024, BSI incidence caused by bacteria of ‘public health importance’ (Escherichia coli (E. coli), Klebsiella pneumoniae, Klebsiella oxytoca, Pseudomonas spp., Acinetobacter spp., Staphylococcus aureus (S. aureus), Enterococcus spp., and Streptococcus pneumoniae) rose by 5.7% compared to 2023, surpassing pre-pandemic levels.
• The AMR burden (BSIs resistant to one or more key antibiotics) increased by 9.3% in a single year, reaching 20,484 episodes (that’s nearly 400 resistant bloodstream infections every week).
• E. coli remains the leading culprit, accounting for 70.5% of resistant BSIs.
• Resistance to third-generation cephalosporins, piperacillin-tazobactam, and aminoglycosides continues to rise.
• The rate of reported CPOs has more than doubled between 2021 and 2024, although this is due in part to an increase in screening and reporting. Although carbapenem resistance remains low (<3%), its upward trend is concerning.
• Crude 30-day mortality for Gram-negative BSIs stands at 15.4%, rising to 17.2% for resistant strains and peaking at 24.1% for CPOs. These mortality figures need to be interpreted with caution because of confounding variables (mainly that patients who acquire AMR bacteria have other things going on like longer hospital stays and more underlying conditions, which also predispose mortality).

Regional and socioeconomic disparities

• London reports the highest resistant BSI rate (44.3 per 100,000), while the South West has the lowest (28.2 per 100,000).
• We already know that there is an association between social and material deprivation and AMR / HCAI. However, the gap between the most and least deprived populations widened to 47% in 2024, compared to 29% in 2019.
• Ethnic disparities persist: the Asian or Asian British group shows the highest proportion of resistant infections, though most cases occur in the White population.

Candidozyma auris: an emerging threat

While bacterial resistance dominates headlines, fungal infections are quietly escalating:

• Fungaemia rates have increased by 15.4% since 2020, with Candida albicans still the most common species.
• C. auris, a multidrug-resistant yeast, is gaining ground. (I did a talk last year providing an overview of the threat, here.) In 2024:
  • 212 first detections were reported in England, mostly colonisations.
  • Seven bloodstream infections occurred, underscoring its invasive potential. Whilst 7 BSIs is a drop in the ocean at this stage, it may well be the beginning of an important trend.
• Outbreaks have been concentrated in London and the South East, prompting UKHSA to classify C. auris as a national standard incident in early 2025.
• From April 2025, C. auris became a notifiable organism, reflecting its high outbreak potential and resistance profile. The hope is that this will improve surveillance, encourage hospitals to implement screening programmes, and result in early detection and effective management of outbreaks.

What’s can be done?

The UK’s 2024–2029 AMR National Action Plan aims to halt further increases in drug-resistant infections by 2029, a daunting task given the 22.7% rise since 2019! Key areas of development to reverse these trends include:

• Strengthening antimicrobial stewardship across all care settings.
• Rapid diagnostics and surveillance to detect resistance early.
• Targeted interventions addressing health inequalities and high-risk populations.
• Preparedness for emerging pathogens, including robust infection prevention and control measures for C. auris.

The latest ESPAUR report reminds us that AMR is not a distant threat in a far off land, but a clear and present danger that is already changing our healthcare. Urgent and collective action is required to tackle these issues.