A new report from Public Health England (PHE) shows an increase in antibiotic-resistant infections in England, despite a decline in antibiotic consumption.
According to PHE's latest English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report, there were an estimated 60,788 antibiotic-resistant infections in England in 2018, a 9% increase from 2017, when 55,812 drug-resistant infections were reported. That's the equivalent of 165 new antibiotic-resistant infections every day.
The ESPAUR report also found that the number of bloodstream infections caused by seven priority bacterial pathogens rose by 15,000 from 2014 through 2018, an increase of 21%. And the number antibiotic-resistant bloodstream infections grew by more than 4,100—an increase of 32%—over that period.
In particular, increased resistance to ciprofloxacin and third-generation cephalosporins in Escherichia coli—the most common cause of bloodstream infections in England—and Klebsiella pneumoniae were noted. That increase was associated with increased use of cephalosporin and quinolone antibiotics.
Also of note is an increase in the detection of the most dangerous antibiotic-resistant pathogens, carbapenemase-producing Enterobacteriaceae (CPE), which rose from 72 isolates in 2009 to 4,028 in 2018. An analysis of 202 CPE infections identified between 2015 and 2019 found a 30-day mortality rate of 23.8%.
Antibiotic consumption falling
The rise in antibiotic-resistant infections comes despite the fact that overall antibiotic consumption in England fell by 9% from 2014 through 2018, from 20 to 18.2 defined daily doses per 1,000 inhabitants per day. That decline was driven in part by a 16.7% drop in antibiotics prescribed in primary care, and a 25% drop in dental antibiotic prescriptions. Antibiotic use in hospitals increased by 2.8% from 2014 through 2018, but the rate of increase was slower than the previous 5-year period.
The ESPAUR data do show some declines in resistance associated with decreased antibiotic use. In particular, analysis of isolates from urinary tract infections (UTIs) found decreases in resistance to trimethoprim (34.9% to 31%) and fosfomycin (11.6% to 7.9%) from 2015 through 2018. The authors of the report say changes are likely linked to an increased emphasis on nitrofurantoin as a first-line treatment for UTIs. Use of trimethoprim for UTIs fell by 40.5% from 2016 through 2018.
Still, PHE officials expressed concern about the rise in antibiotic-resistant infections.
"The decrease in consumption of antibiotics is good news but the rise in resistant infections shows the threat is increasing and so there is more to be done," PHE chief medical officer Chris Whitty, CB, DSc, said in an agency press release.
Keep Antibiotics Working campaign
In light of the report, PHE says it will re-launch the Keep Antibiotics Working campaign, initially launched in October 2017 to raise the public's awareness of antibiotic resistance and the need to reduce inappropriate antibiotic prescribing, which has been linked to patient demand for antibiotics when they aren't needed. The key messages of the campaign are that taking antibiotics when you don't need them means they will be less effective when they're really needed, and that patients should heed the advice of healthcare professionals.
"Antibiotic resistance is not just a matter for clinicians—the public also have a crucial role to play in helping to preserve these vital medicines," Whitty said.
The Keep Antibiotics Working campaign was one element of the United Kingdom's 5-year national action plan to combat rising antibiotic resistance, an effort that began in 2013. ESPAUR was also part of that effort. Its aims are to monitor and report trends in antibiotic use and resistance (particularly in priority drug/bug combinations), measure the impact of antibiotic stewardship strategies, and optimize antibiotic prescribing across healthcare settings. PHE says future ESPAUR reports will include more data on how resistant infections are affecting morbidity and mortality.
For its second 5-year national action plan, introduced earlier this year, the British government has called for 10% reduction in antibiotic resistant infections by 2025, and a 15% decrease in antibiotic use.
Oct 31 ESPAUR Report 2018-2019
Oct 31 PHE press release