Antibiotic-resistant UTIs increasing in England

The burden of antibiotic-resistant urinary tract infections (UTIs) and Gram-negative bloodstream infections continues to rise, according to the fourth and latest report from the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR).

ESPAUR was established by Public Health England in 2013 in order to monitor the progress of the UK Five-Year Antimicrobial Resistance Strategy. Its role is to gather and disseminate data relevant to antimicrobial use and stewardship in England and to measure the impact of improvements on antimicrobial resistance.

The ESPAUR report shows that antibiotic prescribing (measured as defined daily doses per 1000 inhabitants per day) reduced by 5% overall between 2012 and 2016. The number of prescriptions dispensed in the GP setting decreased by 13% over the same time period; however, secondary care showed no sustained reduction in total antibiotic prescribing.

Despite this overall reduction in antibiotic prescribing, the proportion of UTIs caused by antibiotic-resistant bacteria continues to increase, and resistance is now common, says the report. Over a third (34%) of bacteria in over one million UTI samples analysed in NHS laboratories in England in 2016 were found to be resistant to trimethoprim, compared with 29% in 2015. Trimethoprim used to be the first-line antibiotic for the treatment of UTIs in the community before Public Health England recommended nitrofurantoin as the drug of choice prior to laboratory results being available. More reassuringly, the proportion of UTI samples that were resistant to nitrofurantoin remained stable at only 3%.

ESPAUR also reports that in 2016, the proportion of Escherichia coli (the most common cause of bloodstream infections) resistant to co-amoxiclav (the commonest antibiotic used to treat infections in hospitals) remained high at 41%, (compared with 42% in 2015). Almost one in five of these bacteria were also resistant to at least one other key antibiotic, although encouragingly multidrug resistance (ie resistance to three or more antibiotics) was still uncommon (<5%). Halving the number of healthcare-associated Gram-negative bloodstream infections by March 2021 was a key action in the Review on Antimicrobial Resistance (AMR), in order to help reduce the demand for antibiotics.

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