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

Transcription

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 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 Improved AMR surveillance, including for non-bacteraemia isolates Enhancement of antibiotic datasets: GP, dentists, Out-of-hours, Acute Trusts, Community, Mental Health, Independent sector Work on Quality Premium and CQUIN: evidence base, development and monitoring Measurement of impact of behavioural interventions Antibiotic stewardship curriculum (for healthcare professionals) implementation recommendations delivered to HEE Evaluated and updated AST toolkits (SSTF and TARGET) Developed Antibiotic Guardian campaign and national campaign Improved data access Partnerships external to PHE: universities (HPRU), Vets (VMD), ECDC, WHO, O Neill, Longitude Prize

5 Reports ESPAUR 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 6 ESPAUR : Year 2 Report

7 Rate per 100,000 population Bloodstream Infection rates, E. coli K. pneumoniae Pseudomonas spp. S. pneumoniae Enterococcus spp. S. aureus K. oxytoca Acinetobacter spp. ESPAUR 2014: Year 2 Report

8 % Non-susceptible E. coli BSI resistance, Ciprofloxacin Gentamicin Carbapenems 3rd-generation cephalosporins Piperacillin/Tazobactam 8 ESPAUR 2014: Year 2 Report

9 % Non-susceptible % Non-susceptible Klebsiella pneumoniae BSI resistance, K. oxytoca BSI resistance, Ciprofloxacin 3rd-generation cephalosporins Gentamicin Piperacillin/Tazobactam Carbapenems Ciprofloxacin 3-rd generation cephalosporins Gentamicin Piperacillin/tazobactam Carbapenems ESPAUR 2014: Year 2 Report

10 % Resistant Proportion of Enterococcal BSI resistant to Vancomycin, ESPAUR 2014: Year 2 Report

11 ESPAUR : Year 2 Report E. coli UTI

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13 Antibiotic Consumption (use) 13 ESPAUR : Year 2 Report

14 Total Antibiotic Use Total antibiotic consumption, expressed as DDD per 1000 inhabitants per day, England,

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17 DDD per 1000 inhabitants per day Carbapenems 0.4% of total use [ 0.34 to 0.37% from 2013 to 2014] 25% increase from 2011 to 2014 [31% increase 2010 to 2013] 99% hospital use [as 2013] Commonest use is Meropenem Consumption of carbapenems by General Practice and Hospitals, DID, Consumption of most commonly used carbapenems, DID, DDD per 1,000 inhabitants per day GP com IN OUT other Total Meropenem Ertapenem Imipenem and enzyme inhibitor _2010 _2011 _2012 _2013 _ ESPAUR 2014: Year 2 Report _2010 _2011 _2012 _2013 _2014 Doripenem

18 DDD per 1,000 inhabitants per day Quinolones ~2.4% total use [unchanged from 2013] 2% decrease 2011 to 2014 [6% decrease 2010 to 2013] 60% GP use [62% GP use in 2013] Hospital IP & OP increased (27% and 11%) from 2011 to 2014 [previously 20% & 5% from 2010 to 2013] Consumption of quinolone by General Practice, Dentists and Hospitals, DID, Consumption of most commonly used QUINOLONES, DID, DDD per 1,000 inhabitants per day Total GP com OUT IN other Ofloxacin Ciprofloxacin Norfloxacin Levofloxacin Moxifloxacin _2010 _2011 _2012 _2013 _2014 _2010 _2011 _2012 _2013 _2014 Year ESPAUR 2014: Year 2 Report Nalidixic acid

19 DDD per 1000 population per day (DID) Items per 100 population per year Community Dispensed Antibiotics DID & Items/ 100 population, prescriptions dispensed by community pharmacy, England, DDD Year Items Items less than European average Items almost double Sweden; half of France DDD just under EU average for this data BUT greater than EU mean when add hospital OPD prescribing 50-75% more than the 6 countries with lowest DDD Items staying the same and DDD increasing suggests increased dose per prescription ESPAUR 2014: Year 2 Report

20 Hospital Dispensed Antibiotics Year Total DDD DDD/100 admissions DDD/ 100 bed-days DDD/ 100 population Difference b/n 2010 and % 6% 24% 11% Different denominators result in different results. With reducing admissions, & increased hospital activity overall DDD per 100 admissions probably most suitable. Reduced DDD/ 100 admissions between 2013 and ESPAUR 2014: Year 2 Report

21 DDD per 100 admissions DDD per 100 bed-days Hospital type important DDD per 100 admissions and bed-days by Trust-type, DDD per 100 admissions 2013 DDD per 100 admissions 2014 DDD per 100 beddays 2013 DDD per 100 beddays 2014 Bed-days and admissions closely related for the Acute Trusts. Not as closely related in Specialist Trusts Unrelated in Mental Health and Community Trusts (related to prolonged hospital admissions) ESPAUR 2014: Year 2 Report

22 DDD per 100 admissions Carbapenem use in hospitals Year Total DDD DDD/100 admissions DDD/ 100 bed-days DDD/100 population Difference b/n 2010 and % 36% 59% 42% Difference b/n 2013 and % 4% 6% 8% ESPAUR 2014: Year 2 Report Year ACUTE - LARGE ACUTE - MEDIUM ACUTE - SMALL ACUTE - TEACHING COMMUNITY MENTAL HEALTH Specialist - Cancer Specialist - Chest/Heart Specialist - Children Specialist - Ortho/Rheum Specialist - Other Carbapenem use highest in Chest/ Heart and Cancer Specialist Hosptials.

23 Piptazobactam use in hospitals DDD/100 admission s DDD/ 100 Year Total DDD bed-days Difference b/n 2010 and % 55% 81% 62% DDD/100 population Difference b/n 2013 and % 7% 8% 11% Similar differentiation in prescribing by hospital ESPAUR 2014: Year 2 Report

24 APQM: primary Care Calandar Year Quarter Practices (n) Items (n) Items per STAR-PU Items per 1000 population Broad-spectrum items per antibacterial item

25 SSTF and TARGET Need more implementation work Education programme often lacking Insufficient audit Lack of MDT input in stewardship teams ESPAUR : Year 2 Report

26 ESPAUR : Year 2 Report Antibiotic Guardian

27 27 AMR Local Indicator

28 Domains Click these to change between domains, note that indicators will only display if there is an indicator for the Area type chosen All indicators that are available for Acute Trusts and CCGs are available in the All Trust and All CCGs domains. AMR Local Indicator

29 Some indicators display a coloured background on their values. This is to denote a comparison to the benchmark value. A legend is provided by the system at the top. AMR Local Indicator

30 Scatterplots to be drawn between different health indicators. Indicators are chosen from the drop down menu AMR Local Indicator You can highlight individual GP, CCG, Trusts

31 Additionally, users can view a single area or multiple areas within a region simultaneously. AMR Local Indicator

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

33 Summary Antibiotic Use Total antibiotic prescribing, measured using defined daily doses, a standardised measure of antibiotic consumption, increased year on year. 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 in 2011), suggesting higher doses or longer course lengths in general practice prescriptions. Quality Premium and now CQUINs should energise change ESPAUR 2014: Year 2 Report

34 Conclusion

35 Acknowledgements Diane Ashiru-Oredope, Berit Muller-Pebody, Alan Johnson Emma Budd, Alex Bhattacharya Rebecca Guy, Sarah Gerver, Dean Ironmonger, Richard Puleston, Katie Hopkins, Rachel Freeman, Neil Woodford Graeme Rooney, David Ladenheim, Miroslava Mihalkova, Katherine Henderson, Chris Fuller, Peter Stephens, Mehdi Minaji, Anna Sallis, Cliodna McNulty, David Ladenheim, Elizabeth Beech, Stuart Brown, Philip Howard Members of the ESPAUR oversight group and PHE AMR delivery board, in particular Russell Hope, Mark Wilcox, Fran Husson, Carole Fry, David Livermore and Anthony Kessel. Health Protection Research Units, NHS BSA, HSCIC, NHS Trusts, GPs, CCGs, DH, CMO, NHS England.