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Susan Hopkins Consultant Infectious Diseases & Microbiology, Royal Free

The role of the English Surveillance Programme on Antimicrobial Use & Resistance in improving stewardship. Susan Hopkins Consultant Infectious Diseases & Microbiology, Royal Free Healthcare Epidemiologist, Public Health England Hon Snr Lecturer, UCL.

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Susan Hopkins Consultant Infectious Diseases & Microbiology, Royal Free

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  1. The role of the English Surveillance Programme on Antimicrobial Use & Resistance in improving stewardship Susan Hopkins Consultant Infectious Diseases & Microbiology, Royal Free Healthcare Epidemiologist, Public Health England Hon Snr Lecturer, UCL

  2. UK AMR Strategy:Seven Key Areas for Action • Improving infection prevention and control practices • Optimising prescribing practice • 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 AMR research needs • Strengthened international collaboration The

  3. Antimicrobial stewardship programmes • aim to improve quality of prescribing • usage data required to monitor impact • must be related to AMR epidemiology

  4. PHE ESPAUR: English Surveillance Programme for AMU & AMR • Support antimicrobial stewardship by monitoring antimicrobial use • Monitor key drug-bug combinations • Enhance data analysis and advice on use of carbapenemens & critically important drugs • Develop & measure quality measures for optimal antimicrobial prescribing • Develop methods to monitor the clinical outcomes/ unintended consequences • Develop initiatives to change public and professional behaviour • Input into national antimicrobial guidance

  5. Top 6 Blood stream infections, Voluntary surveillance, 2002-11

  6. Staphylococcus aureus: MRSA & MSSA

  7. Escherichia coli bacteraemia 25% were diagnosed ≥2 days after hospital admission Increased AMR in hospital associated cases

  8. Resistance in Klebsiella, Blood, 2004-2013 N~8,000/year Resistance in E coli, Blood, 2004-2013 N~30,000/year Declines in resistance to Ciprofloxacin & Ceftriaxone Increases in resistance to Piperacillin-Tazobactam & Carbapenems ? Ecological Pressure

  9. Rapid spread of resistance Antimicrobial resistance Image from slides produced by McKinsey & Company, based on earlier image from Nature, 13th July 2013

  10. PHE confirmed carbapenemase producers

  11. Changes 2007-2012 Trends in Prescribing of Antibacterials , excluding penicillins, in General Practice in England AMP Key Trends Diane Ashiru-Oredope

  12. AMP Key Trends Diane Ashiru-Oredope

  13. AMP Key Trends Diane Ashiru-Oredope

  14. Carbapenem usage for English Hospitals, 2007-2012

  15. Carbapenem usage as % of total use in English hospitals in 2011-2012

  16. UCLp Hospitals & Point Prevalence Survey • First national prevalence antimicrobial use survey 2011 • Many UCLp hospitals participated • Overall England Prevalence 35% • Variation across hospital type • Variation with age, sex, comorbidity, specialty, history of surgery

  17. Point prevalence Survey: Antimicrobial use AMP Key Trends Diane Ashiru-Oredope

  18. Variation in AMU prevalence, SAUR

  19. Proportion of AMU by drug

  20. Can use influence national AMR? • Until 2007, major increases in cephalosporin and quinolone resistance amongst Escherichia coli &Klebsiella spp • Plateau/ fall in resistance was from 2007 (LabBase/ BSAC) • Fall in resistance coincides with the large reduction in cephalosporin and quinolone use • due to national antimicrobial stewardship guidance to reduce Clostridium difficile infections nationally • Replacement have been penicillin/b-lactamase inhibitors which may have another impact Livermore D M et al. J. Antimicrob. Chemother. 2013;jac.dkt212

  21. Conclusion • AMR major threat to future healthcare • AMU recognised driver of resistance • ESPAUR a national surveillance programme developed by PHE will • focus on integrating data • develop & measure quality measures • UCLpkey role • working across hospitals to support initiative • validate data and • be a national leader

  22. Acknowledgements: • Diane Ashire-Oredope • Jonathan Cooke • Sue Faulding • Russell Hope • Alan Johnson • Cliodna McNulty • Pete Stephens • Neil Woodford • GPs, microbiology, pharmacy, infection prevention & control teams

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