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The UK 5-year AMR Strategy - a brief overview -

Dr Berit Muller-Pebody National Infection Service Public Health England

Chief Medical Officer - Annual Report 2013

Antimicrobial resistance poses ‘catastrophic threat’

2 AMR Strategy BSAC Spring meeting

The UK 5 Year Strategy


•  Improve the knowledge

and understanding of AMR •  Conserve and steward the

effectiveness of existing treatments

•  Stimulate the development

of new antibiotics, diagnostics and novel therapies

Implementing the UK Strategy - The 7 key areas -


PHE Human health

Department of Health (DH) – High Level Steering Group

Defra Animal health DH

1.  Improving infection prevention and control practices

2.  Better access to and use of surveillance data

3.  Optimising prescribing practice 4.  Improving professional education,

training and public engagement

5. Improving the evidence base through research

6. Developing new drugs, treatments and diagnostics

7. Strengthening international collaboration

Improving infection prevention & control


•  Development of a National Strategy •  CPE Acute & Non-acute Toolkits •  Work with NICE to update guidelines

•  Quality Statement on prevention of HCAIs

Better access and use of surveillance data


•  Overall, AMR continues to increase, though with a slower rate of increase from 2013 to 2014 than in previous years

•  Total antibiotic prescribing, measured

using defined daily doses, continues to increase in all NHS areas, except Dental Practice

•  The majority of total prescribing occurs

in primary care but secondary care prescribes more broad-spectrum antibiotics


Information for action – PHE Fingertips

One Health approach


NICE Antimicrobial Stewardship Guidelines


Published in August 2015 Provides good practice recommendations on systems and processes for the effective use of antimicrobials. Recommends the use of two PHE/DH toolkits - TARGET and Start Smart – Then Focus Toolkits.

Quality and Innovation (CQUIN) & Quality Premiums

Improved antibiotic prescribing in primary and secondary care through payments to Hospital Trusts and Clinical Commissioning Groups (CCGs)

A reduction in the number of antibiotics prescribed in primary care

B reduction in the proportion of broad spectrum antibiotics prescribed in primary care

C secondary care providers validating their total antibiotic prescription data

D secondary care providers reviewing antibiotic prescribing within 72 hours of the beginning of treatment (NEW)


Behavioural Insights


Randomised Control Trial -reducing antibiotic prescribing through behaviour 1581 GP practices given marketing materials, CMO letter & TARGET leaflet or a combination of these plus a control group 73’406 fewer items dispensed, estimated saving of £92’356 Cheap, effective and scalable

Engaging the Public


e-Bug is a free educational resource for classroom and home use and makes learning about micro-organisms, the spread, prevention and treatment of infection fun and accessible for all students.

Public, professionals and organizations undertake a pledge to improve their antibiotic use.

World Antibiotic Awareness Week


The Years Ahead

•  Tackling AMR requires collaborative cross-sectoral approach, nationally and internationally

•  Surveillance a foundational tool for public health action

•  Shift from national level to supporting local action •  Focus on international work

•  Support development of national plans (WHO Global Action Plan)

•  Working to secure resolution on AMR at UN General Assembly


Acknowledgements


HCAI & AMR Dept, National Infection Service, PHE AMR programme board, PHE

ARHAI Antimicrobial Stewardship subgroup NHS Business Services Authority

Health and Social Care Information Centre IMS Health

NHS microbiology laboratories PHE regional information managers

PHE field epidemiology services Antimicrobial pharmacists across English NHS Trusts

East of England pharmacy network All members of ESPAUR oversight group

Antimicrobial Resistance

Bacteria Antibiotic Resistance (non-susceptibility) Metric

Proportion Resistant in

2014 (%)

2014 compared to 2010*

Escherichia coli

ciprofloxacin 18.7 ↔ cefotaxime and/or ceftazidime

11.1 ↑

gentamicin 9.6 ↔

imipenem and/or meropenem 0.1 ↔

co-amoxiclav 42.0 ↑ piperacillin/tazobactam 11.0 ↑

Klebsiella pneumoniae

ciprofloxacin 10.9 ↔

cefotaxime and/or ceftazidime

12.1 ↑

gentamicin

7.5 ↔

imipenem and/or meropenem 1.5 ↑ piperacillin/tazobactam 16.9 ↑

Pseudomonas spp. ceftazidime 7.4 ↔

imipenem and/or meropenem 11.5 ↔

Streptococcus pneumoniae penicillin 4.2 ↔

Enterococcus spp. vancomycin 14.2 ↑

Staphylococcus aureus methicillin 10.0 ↓

Acinetobacter spp colistin 3.5 ↔

Neisseria gonorrhoeae ceftriaxone 0.0 ↔

azithromycin 1.0 ↔ Mycobacterium tuberculosis

isoniazid 5.5 ↔

rifampicin and isoniazid 1.6 ↔


Antimicrobial Prescribing


General Practice Compared to 2010

NHS Trusts

Compared to 2010

Broad Spectrum Antibiotics

Penicillins & enzyme inhibitor 0.9 ↑ 0.9 ↑

Cephalosporins 0.26 ↔ 0.22 ↑

Carbapenems 0.001 ↔ 0.08 ↑

Quinolones 0.3 ↓ 0.2 ↔

Narrow Spectrum Antibiotics

Penicillins (without enzyme inhibitors) 6.2 ↑ 1.2 ↔

Tetracycline 4.5 ↑ 0.33 ↓

Macrolides 2.7 ↑ 0.5 ↑

Sulfonamides and Trimethoprim 1.2 ↔ 0.4 ↑

Proportion of Broad spectrum antibiotics/ total antibiotics 8.5% ↓ 33.3% ↑

Total Antibiotic use expressed as DDD per 1000 inhabitants per day 17.1 ↑ 4.2 ↑

Total Antibiotic Prescriptions expressed as items per STARPU^ 1.233 ↔ NA

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