The 2018 ESPAUR Report: progress but worrying trends

The 2018 English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report has just been released by Public Health England (PHE) and, as with most reports the results show a mixed picture. The good news is that total antibiotic consumption has fallen by 6% over the past four years and is [now] at the lowest level since 2011. The majority of antibiotics continue to be prescribed in primary care (72%), with hospital inpatients making up 12% of the total. Further progress is possible, as PHE estimate that 20% of antibiotics are being prescribed inappropriately, with the vast majority of this being in primary care.

These encouraging figures however are tempered by the not-so-good news that gram-negative bacteria with a detected carbapenemase have increased year-on-year to around 3,000 cases in 2017. The figures show that there has been a 35% increase from 2013 to 2017 in the detection of carbapenemase-producing bacteria. This increasing burden of infections that are extremely difficult to treat means that prevention of infections becomes even more critical. Prevention is coming to the fore, with the report stating that “It is clear that more work needs to be done to both prevent serious infections and reduce the pressure of antibiotic use for the selection of antibiotic-resistant bacteria”. It is pleasing to see that the number one future action for ESPAUR will be to emphasise the importance of infection prevention and control with the objective of reducing the numbers of antibiotic-resistant infections. In the coming years as resistance continues to increase, prevention of infections will not only help reduce morbidity and mortality, it will mean that resistant organisms are not selected out by widespread use of the decreasing list of effective antibiotics that we still have.