As parts of the world begin to contemplate life on the other side of this pandemic, it’s time to address that niggle in the back of our minds as our attention has been focussed on COVID-19: what’s been happening with those other HCAI and AMR issues that usually occupy our days (and nights)? This helpful opinion piece in ICHE discusses the impact of COVID-19 on our usual HCAI & AMR practice.
The 2019 edition of the ESPAUR report has recently been published, including data up to and including 2018. The report is an excellent read – here’s a few summary points.
- There’s a series of lovely infographics at the start of the report. I gave myself a challenge: to select the one infographic that told the story of the report. I toyed with the one about a small but increasing number of CPE BSIs (aghhhhh!), and the stark grave-stone themed image of mortality related to carbapenemase-producers, but ended up with this one: alarmingly, the rate of BSI for the seven priority bacterial pathogens rose 22% between 2014 and 2018 to 145 per 100,000 population. (Around half of these were coli). And there’s a certain inexorability about the antimicrobial resistance trends included in this report, with a 32% increase in AMR BSIs comparing 2014 to 2018.
Figure: Trends in BSIs (blue line) and AMR BSIs (green line).
- There were more than 60k antibiotic resistant severe infections in 2018, <150 per day.
- Confirmed CPEs have topped 4k (but this is a gross underestimate of true prevalence). The report makes the case that the rarity of CPE BSIs (142 reported nationally) represents a success of prevention. This is probably true if we compare across the pond and towards the southern reaches of Europe. But difficult to be sure without a control (i.e. what would have happened without the national initiatives etc)? Also, reporting of CPE BSIs to PHE is voluntary and not mandatory, so there will be some degree of under-reporting.
- Related to this, only 50% of diagnostic labs have introduced methods to detect CPE locally. Which links closely with the change in surveillance system for CPEs going forwards – rather than manual voluntary reporting, locally confirmed CPEs will be reported automatically to PHE. However, if only 50% of diagnostic labs have appropriate methods, we’ll still end up under-reporting (but it will be more a more accurate picture than the current process provides).
- 30 day all-cause mortality of invasive CPE infections is 24% (along with the arresting gravestone-themed infographic)! Not sure how helpful it is to make a big point based on unadjusted mortality data…
- Overall consumption of antibiotics continues to decline. Consumption fell from 20 to 18 DDDs per 1,000 population per day between 2014 and 2018. However, consumption increased by 3% in hospitals over this period.
- There’s a nice section on Candida auris
- ESPAUR reports some good work and outcomes related to training, education, and awareness (e.g. Keep Antibiotics Working and Antibiotic Guardian).
- What a wonderful resource the AMR Fingertips module is: automated data from >90% of NHS laboratories on a range of AMR indicators at our…ahem…fingertips. I am one of the 15k users over the past three years. (As an aside, the volume of traffic is fairly low by popular website standards – but I guess it is somewhat niche!)
ESPAUR is a fantastic resource – it seems that this is the last ESPAUR report related to the UK AMR Strategy from 2013-2018, but I’m confident that ESPAUR will continue to report the successes and challenges of implementing the new five year action plan (from 2019-2024).
I did a talk today in Portugal covering the nine decades since Fleming discovered the effects of Penicillium sp. in 1928. I thought it would be interesting to have two endings to the talk: an upbeat one, and a doomsday one.
I am on the hunt for some free online training resources for HCAI / IPC / AMR / AMS / IPC, at a basic, intermediate, or advanced level. Here’s a summary of what I’ve unearthed so far.
Rossana Rosa (bio below) writes a guest post, reflecting on this recent review and meta-analysis on the effectiveness of antimicrobial stewardship (AMS) programmes…
The first reports on the effects of Antimicrobial Stewardship Programmess date back to the mid-90s, and the interest in them has taken off in the past decade.
Guest blogger Nikki Naylor (bio below) has written this post about a recent review on the cost-effectiveness of antimicrobial stewardship…
I’ll start this blog post off with a promise – I promise not to use any equations or unnecessarily complex terms that just describe logical concepts (something us economists do like to do on occasion). In return, I hope that you will see past the standard and not-to-exhilarating conclusion of “more evidence is needed” and see some of the more useful messages that sit within this recent review that we have published.
A new Lancet ID study suggests that restriction of fluoroquinolone usage has been the main driver of the national reduction in C. difficile infection in England. This paper is challenging in terms of some of the accepted approaches to controlling the transmission of C. difficile: if it’s all about reducing fluoroquinolones (and antimicrobials in general) and nothing to do with these measures, then why invest so much time and energy in isolation of symptomatic cases, cleaning and disinfection etc?