Antibiotic-resistant bloodstream infections fall for first time in five years

A report by the UK Health Security Agency has revealed that the overall proportion of infections resistant to one or more antibiotics in England has risen since 2016.

The number of antibiotic-resistant bloodstream infections in England fell between 2019 and 2020, the first time since 2016, likely owing to social distancing and hand washing measures during the COVID-19 pandemic, a report from the UK Health Security Agency (UKHSA) has revealed.

However, since 2016, the overall proportion of infections that were resistant to one or more antibiotics has increased, suggesting the potential for a rise in antibiotic-resistant infections once COVID-19 restrictions end.

The ‘English surveillance programme for antimicrobial utilisation and resistance‘ (ESPAUR) report, published on 17 November 2021, which highlights resistant infection and subsequent mortality data from between 2019 and 2020, showed that the number of antibiotic resistant bloodstream infections in England fell from 65,583 in 2019 to 55,384 in 2020.

The report also showed that the burden of resistance, measured as the estimated total number of bloodstream infections caused by pathogens resistant to one or more key antibiotics, increased by 4.9% between 2016 (14,829) and 2020 (15,549).

Antibiotic prescribing fell during the pandemic, from 18 defined daily doses (DDDs) per 1,000 inhabitants per day in 2019, to 16 DDDs per 1,000 inhabitants per day in 2020. This was driven by a reduction in antibiotics usually prescribed for respiratory infections, the report said.

The reduction in antibiotic prescribing was seen in all care settings, apart from dentistry, where there was an increase in use of 17.6%, likely owing to restricted access to dental care during the pandemic. Antibiotic prescribing continued to be greatest within general practice at 72.7% in 2020, although the reduction in antibiotic prescribing in general practice between 2019 and 2020 was greater than the reduction seen between 2016 and 2019 (reduced 1.96 DDDs per 1,000 hospital admissions compared with 1.27 DDDs).

Susan Hopkins, chief medical adviser at the UKHSA, said: “[Antimicrobial resistance] has been described as a hidden pandemic and its important that we do not come out of COVID-19 and enter into another crisis.

“It is likely that COVID-19 restrictions in 2020, including enhanced infection, prevention and control measures, also played a part in driving down antibiotic resistance and prescribing. While these measures were severe, serious antibiotic-resistant infections will rise once again if we don’t act responsibly, and that can be as simple as regular and thorough hand washing.”

Elizabeth Beech, regional antimicrobial stewardship lead for the south west at NHS England and NHS Improvement and one of the authors of the ESPAUR report, highlighted that the biggest reduction in prescribing in primary care during the pandemic was in the prescribing of amoxicillin in children.

“This just shows how much respiratory viral infections are transmitted in normal, pre-pandemic times, when [young people are attending] school and nurseries. Because there’s been a lot less attendance to those places … the consequence has been a reduction in community respiratory viral infections and a reduction in antibiotic use.”

However, she added, antibiotic use for urinary tract infections (UTIs) did not change during the pandemic, which she described as “reassuring” because it showed that people who had a UTI during that time were able to be appropriately treated.

“It does make one consider how much antibiotic use is for respiratory tract infections, many of which will be viral and will be reducible by good prevention control measures … such as frequent hand washing and maximising use of vaccination.”

The report also details an ‘Infection Prevention and Control and Antimicrobial Stewardship Domain’ — part of the NHS Pharmacy Quality Scheme for 2020/2021 — which aims to reduce the potential harm caused by antimicrobial resistance through the promotion of antimicrobial stewardship (AMS) activity in community pharmacy.

AMS activities include reinforcing the messages around appropriate use of antibiotics and the uptake of vaccinations, including the influenza vaccination, Beech said.

“We [also] need to really optimise the use of antimicrobials in people who have COVID-19 infection as per the new [National Institute for Health and Care Excellence] guidance — and that does say very clearly ‘don’t use antibiotics to prevent COVID-19 or treat COVID-19’; it’s really important that the workforce are aware of the guidelines so they can reinforce those messages in their work,” she added.

Read more: How to evaluate the clinical appropriateness of an antimicrobial

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Citation
The Pharmaceutical Journal, PJ, November 2021, Vol 307, No 7955;307(7955)::DOI:10.1211/PJ.2021.1.116353