What surveillance do we have for AMR? Dr Berit Muller-Pebody AMR Section Lead, HCAI & AMR Department National Infection Service, Public Health England
Better access and use of surveillance data English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Established as part of PHE s response to the Government s AMR Strategy in 2013 Develop and improve surveillance systems to measure AMR and antimicrobial usage Measure the impact of resistance on safety of patients and the general public 2 AMR Surveillance BSAC Spring Meeting 2018
AMR Surveillance
PHE s Voluntary laboratory surveillance Second Generation Surveillance System (SGSS) All clinically significant infections e.g. bacterial, viral, fungal, protozoan, helminthic From various specimen sites (e.g. blood, CSF, urine, sputum, stool) Web Mining and Analysis Reporting Laboratory text files (preferred method) sftp BI Security layer Role based model based on requirement / permission to view patient level or aggregate data Bespoke Excel format (CDR and AMR) Web Upload SGSS Laboratory Data Import SGSS Operational Database Business Intelligence Layer (BI) Legacy CoSurv/ Amsurv files Email SGSS Data Warehouse Laboratory Person External networks Web Data Entry HPZone PHE network API 98% (121/124) of NHS laboratories reporting AMR 87% of laboratories daily reporting 84% of laboratories having fully automated feeds to SGSS 4 AMR Surveillance BSAC Spring Meeting 2018
Monitoring of key drug-bacteria combinations 5 AMR Surveillance BSAC Spring Meeting 2018
PHE s mandatory surveillance schemes 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 S. aureus bacteraemia (quarterly) MRSA bacteraemia (quarterly) MRSA bacteraemia (enhanced) MSSA bacteraemia (enhanced) MRSA post-infection review C. difficile ( 65y, quarterly) C. difficile ( 2y, enhanced, real-time) E.coli bacteraemia (enhanced) E. coli bacteraemia (sentinel scheme) Klebsiella spp. bacteraemia Pseudomonas aeruginosa bacteraemia Surgical Site Infection (orthopaedics)* 6 AMR Surveillance BSAC Spring Meeting 2018
7 AMR Surveillance BSAC Spring Meeting 2018 Response to emerging threats
Better access to AMR surveillance data
Information for action PHE Fingertips 9 AMR Surveillance BSAC Spring Meeting 2018
Information for action reports and data appendices 10 AMR Surveillance BSAC Spring Meeting 2018
Better use of AMR surveillance data
Bloodstream isolates of E. coli (mandatory surveillance) and the proportions non-susceptible to indicated antibiotics (SGSS) Need to investigate prescribing and resistance pattern in the community 12 AMR Surveillance BSAC Spring Meeting 2018
E. coli urine isolates susceptible or resistant to recommended UTI treatment options, England 2016 (ESPAUR Report 2017) Proportion E. coli urine samples 100% 80% 60% 40% 20% 0% Acute Community Acute Community Acute Community Acute Community Acute Community Acute Community Nitrofurantoin Trimethoprim Co-Amoxiclav Quinolones* Mecillinam Fosfomycin *99% ciprofloxacin Not tested Susceptible Non-susceptible 13 AMR Surveillance BSAC Spring Meeting 2018
Linkage of AMR data to antibiotic prescribing data a) Antibiotic prescription combination T T T T T T T T T T T Row Oct '13 Oct '14 Trim R T T T T T T T T T T T R Nitro S R b) T T T T T T T T T T T T c) T T T T T T T T T T T T d) N N N N N N N N N N Trim T T R T T T T T T T T T T Nitro S Trim T R T T T T T T T T T T T Nitro S Oct '13 Aug '14 Oct '14 Trim R S S Nitro S N N N N N N N N N N R S e) f) g) h) i) j) N N N N T N T T N T T N T N T T N N N T T N T N T N T T N T N T Trim R T T Nitro N S N N N Jul '14 Trim T T T R Nitro N N S Trim T T R Nitro N S N Dec '13 Trim S T T Nitro S N N N Dec '13 Trim S T T T Nitro R N N Sep '14 Trim T T T R Nitro N N S Before 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 February 2014 March 2014 April 2014 After Key: T Trimethoprim prescription N Nitrofurantoin prescription R Resistant urine isolate S Sensitive urine isolate 14 Linking AMR Surveillance English antibiotic BSAC prescribing Spring Meeting and microbiology 2018 data
International AMR surveillance networks
European AMR Surveillance (EARS-Net) Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa Acinetobacter species Streptococcus pneumoniae Staphylococcus aureus Enterococcus faecalis Enterococcus faecium 16 AMR Surveillance BSAC Spring Meeting 2018
Global AMR Surveillance System (GLASS) 17 AMR Surveillance BSAC Spring Meeting 2018
Thank you for listening 18 AMR Surveillance BSAC Spring Meeting 2018