The annual English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report, published by the UK Health Security Agency (UKHSA) recently, shows a substantial increases in rates of priority pathogens and antibiotic use during 2022 with the lifting of pandemic mitigations and the return to pre-pandemic levels of health activity.
The latest national surveillance data shows that an estimated 58,224 people in England had an antibiotic resistant infection in 2022 – a rise of 4.4% since 2021 (55,792). Deaths due to severe antibiotic resistant infections also increased from 2021 to 2022 (from 2,110 to 2,202). Antibiotic resistant bloodstream infections occurred in 16,643 people in 2022 – a drop of 4.6% since 2018 though this is most likely due to pandemic restrictions rather than a true reduction in antibiotic resistance. The proportion of bloodstream infections that are resistant to one or more antibiotics – 1 in 5 – has remained stable since 2018.
There is considerable regional and demographic variation in England, related to underlying health conditions, deprivation, ethnicity and healthcare delivery. People in the lowest socioeconomic group more likely to acquire a resistant infection compared to the highest socioeconomic group. Asian or British Asian people are the most likely population in England to acquire an antibiotic resistant infection.
The overall estimated number of key pathogen bloodstream infections increased between 2018 and 2019 (86,060 to 88,851), then declined in 2020 (to 79,466) before increasing again in 2022 (to 84,685). The number of resistant key pathogen bloodstream infections by calendar year for the same period indicates that resistant key pathogen infections increased between 2018 and 2019 (17,437 to 18,259), then declined in 2020 (to 16,043) before increasing again in 2022 (to 16,643).
Total antibiotic use in England had declined each year since ESPAUR was established. However, in 2022 there was an increase of 8.4% compared with 2021 – although this did remain below pre-pandemic levels – highlighting the need for continued efforts to reduce inappropriate antibiotic use.
Primary care accounts for 80.2% of all antibiotics prescribed. Despite a decreasing trend since 2018, there was an increase of 13.0% in primary care antibiotic usage between 2021 and 2022 (from 1.49 to 1.68 items per 1,000 inhabitants per day).
In financial year 2022 to 2023, 29% of NHS England acute trusts (40 out of 137) achieved the NHS Standard Contract expectation to reduce antibiotic prescribing (from WHO ‘Watch’ and ‘Reserve’ categories adapted for England) by 4.5% – from a 2018 baseline – to maintain trajectory towards the National Action Plan 10% reduction target.
ESPAUR was established by Public Health England in 2013 in response to the cross-government five-year antimicrobial resistance strategy (encompassing antibiotics) published earlier that year.
The full report can be accessed at https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report.