English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR)

1. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Figures Slideset

2. The 5-year UK AMR strategy Key aims • improving infection prevention and control practices • optimising prescribing practices • improving professional education, training and public engagement • developing new drugs, treatments and diagnostics • better access to and use of surveillance data • better identification and prioritisation of antimicrobial resistance research needs • strengthened international collaboration ESPAUR 2014: Year 2 Report

3. English Surveillance Programme for Antibiotic Use and Resistance (ESPAUR) • Established by PHE in 2013 in response to the strategy • Terms of reference updated in 2015, at year 2 review • Focuses on bringing together NHS, PHE, Private sector across all prescribers and clinicians to improve • Surveillance data on antibiotic resistance and prescribing • Antimicrobial stewardship activities • Education and training for healthcare professionals • Education and awareness to Public ESPAUR 2014: Year 2 Report

4. Key Progress towards objectives • PHE: better surveillance data for non-bacteraemia isolates • Enhancement of community antibiotic datasets:dentists, Out-of-hours and other providers • Work on Quality Premium • Measurement of impact of behavioural interventions published by behavioural insights team • Antibiotic stewardship curriculum (for healthcare professionals) implementation recommendations delivered to HEE • Updated Antimicrobial stewardship toolkits (SSTF and TARGET) • Partnerships external to PHE: universities (HPRU), Vets (VMD), ECDC, WHO, O Neill, Longitude Prize ESPAUR 2014: Year 2 Report

5. Other Reports • NHS Atlas (PHE) - include prescribing data across Area Teams and CCGs • One Health (PHE/ VMD) report – develop report on zoonotic AMR with VMD, DARC, ARHAI • CARPHA/PHE report on Combatting Antimicrobial Resistance in the Caribbean • ECDC: ESAC-Net/EARS-Net reports – data submitted, reports to be released 16 November 2015 ESPAUR 2014: Year 2 Report

6. Antibiotic Resistance ESPAUR 2010-2014: Year 2 Report

7. Bloodstream Infection rates, 2010-14 ESPAUR 2014: Year 2 Report

8. E. coli BSI resistance, 2010-14 ESPAUR 2014: Year 2 Report

9. KlebsiellapneumoniaeBSI resistance, 2010-14 ESPAUR 2014: Year 2 Report

10. K. oxytocaBSI resistance, 2010-14 ESPAUR 2014: Year 2 Report

11. Pseudomonas BSI resistance, 2010-14 ESPAUR 2014: Year 2 Report

12. Streptococcus pneumoniaeBSI resistance, 2010-14 ESPAUR 2014: Year 2 Report

13. MRSA and MSSA BSI, 2010-14 ESPAUR 2014: Year 2 Report

14. Proportion of Enterococcal BSI resistant to Vancomycin, 2010-14 ESPAUR 2014: Year 2 Report

15. Number of isolates referred from UK hospital microbiology laboratories confirmed as carbapenemase-producing Enterobacteriaceae by AMRHAI ESPAUR 2014: Year 2 Report

16. Antibiotic Consumption (use) ESPAUR 2010-2014: Year 2 Report

17. Prescriptions dispensed in the community, expressed as DDD per 1000 inhabitants per day and items per 100 inhabitants per year, England, 1998-2014 ESPAUR 2014: Year 2 Report

18. Total Antibiotic Use 2010 - 2014 • Total antibiotic consumption, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2014: Year 2 Report

19. Total antibiotic consumption by key antibiotic group, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 Total Prescribing by Key Agents ESPAUR 2014: Year 2 Report

20. Penicillins • Consumption of penicillin, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2014: Year 2 Report

21. Cephalosporins • Consumption of cephalosporins, by prescribing location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2014: Year 2 Report

22. Carbapenems • Consumption of carbapenems, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2014: Year 2 Report

23. Tetracyclines • Consumption of tetracyclines, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2014: Year 2 Report

24. Quinolones • Consumption of quinolones, by prescribing location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2010-2014: Year 2 Report

25. Macrolides • Consumption of macrolides, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2010-2014: Year 2 Report

26. Sulfonamides and Trimethoprim • Consumption of sulfonamides and trimethoprim, by prescriber location, England, expressed as DDD per 1000 inhabitants per day, 2010−2014 ESPAUR 2010-2014: Year 2 Report

27. Nitrofurantoin • Consumption of nitrofurantoin, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2010-2014: Year 2 Report

28. Glycopeptides • Consumption of glycopeptides, by prescriber location, expressed as DDD per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2010-2014: Year 2 Report

29. Prescriptions in the community Antibiotic items by prescribers, expressed as items per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2014: Year 2 Report

30. Prescriptions in the community • Key antibiotic groups prescribed by general practice, expressed as items per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2010-2014: Year 2 Report

31. Prescriptions in the community • Key antibiotic groups prescribed by dental practice, expressed as items per 1000 inhabitants per day, England, 2010−2014 ESPAUR 2010-2014: Year 2 Report

32. Prescriptions in Hospitals • Total antibiotic consumption in all NHS trusts, using defined daily doses (DDD) and denominators of admissions, bed-days and population, England, 2010−2014 ESPAUR 2010-2014: Year 2 Report

33. Prescriptions in Hospitals • Total antibiotic consumption by trust organisation type, using defined daily doses (DDD), England, 2014 ESPAUR 2010-2014: Year 2 Report

34. Prescriptions in Hospitals • Key antibiotic groups prescribed in hospital, expressed as DDD per 100 admissions per day, England, 2011−2014 ESPAUR 2010-2014: Year 2 Report

35. Summary Antibiotic Resistance • The rate of Escherichia coli and Klebsiellapneumoniae bloodstream infections (BSI) increased by 13.5% and 17.2% respectively from 2010 to 2014. • More individuals have had antibiotic resistant BSI with Gram-negative bacteria • 23% reduction in Streptococcus pneumoniaeBSI related to pneumococcal vaccination over last 5 years • Reduction, through effective IPC, in proporiton of Staphylococcus aureusBSI that are resistant to meticillin (MRSA) from 12% to 8% over the last 5 years ESPAUR 2014: Year 2 Report

36. Summary Antibiotic Use • Total antibiotic prescribing, measured using defined daily doses, a standardised measure of antibiotic consumption, continues to increase in the NHS • with a slower rate of increase from 2013 to 2014 than in previous years. • Antibiotic prescriptions in primary care, measured as the number of prescriptions dispensed, adjusted for the age and sex distributions in the population, has declined for the last two years and is now lower than the similar measure in 2011 (1.180 in 2014 compared to 1.233 in 2011), suggesting higher doses or longer course lengths in general practice prescriptions. ESPAUR 2014: Year 2 Report

37. Summary Antibiotic Use • The majority of antibiotic prescribing occurs in primary care but secondary care prescribes more broad-spectrum antibiotics (antibiotics that are effective against a wide range of bacteria). These antibiotics are more likely to drive antibiotic resistance than narrow spectrum antibiotics. Early evidence suggests that informing prescribers of their prescribing patterns and comparing them to their peer professionals may be a factor that helps reduce their antibiotic prescribing. • Continued focus by every individual who prescribes, administers and dispenses antibiotics is essential to continue to reduce antibiotic consumption. ESPAUR 2014: Year 2 Report