UK 5 Year Antimicrobial Resistance (AMR) Strategy 2013-2018 - Measuring Success

Objectives

The strategic aim is to assess whether the United Kingdom five-year Antimicrobial Resistance Strategy is slowing the growth of resistance, while strengthening surveillance, improving antibiotic use, increasing awareness, and supporting coordinated national and international action through a One Health approach.[1][2][3]

• Develop standard methods and progressively stronger data sources to measure antimicrobial resistance and its clinical burden in humans and animals, enabling assessment of national and international interventions.[1][4]
• Monitor priority serious human infections, initially including bloodstream infections and gonorrhoea caused by Klebsiella species, Escherichia coli, Pseudomonas, Neisseria gonorrhoeae and Streptococcus pneumoniae, against specified antibiotics.[5]
• Strengthen animal surveillance by maintaining monitoring of Salmonella in poultry and pigs and introducing monitoring of Campylobacter jejuni from poultry and commensal E. coli from poultry and pigs, in line with European Union requirements.[4]
• Improve antibiotic prescribing in primary and secondary healthcare by reducing inappropriate use, particularly of critically important antibiotics, with initial prescribing objectives of returning to 2009 levels in primary care and 2012 levels in secondary care.[2]
• Improve public and professional understanding of appropriate antimicrobial use in order to reduce unnecessary public demand and support better prescribing in human and veterinary settings.[3]
• Strengthen global health security by securing international alignment and collaboration to reduce the global spread of antimicrobial resistance and address its effects on health, productivity, economic growth and security.[3][6]

Implementation

Delivery combines United Kingdom-wide governance, annual surveillance and reporting, stewardship interventions, public and professional engagement, and international collaboration. The UK Antimicrobial Resistance High Level Steering Group, comprising government departments and agencies, oversees and drives strategy delivery.[1]The source does not specify budgets, expenditure, funding allocations, or resource mobilisation arrangements, although it refers to innovative international financing and regulatory approaches for new antibiotics and rapid diagnostics.[6]

• Collect and collate annual national and regional data across England, Wales, Scotland and Northern Ireland on resistance in key bloodstream infections and gonorrhoea, using 2013 as the first reporting baseline and reviewing the priority infection list annually.[1][5]
• Measure non-susceptibility to priority treatments, including cephalosporins and carbapenems in Klebsiella species and E. coli, ciprofloxacin and gentamicin in E. coli, ceftazidime and carbapenems in Pseudomonas, ceftriaxone in N. gonorrhoeae, and penicillin in S. pneumoniae.[5]
• Expand healthcare surveillance in England by increasing laboratory participation from around 60 per cent of medical laboratories towards 75 per cent by March 2015, while recognising that outputs will initially support national and regional rather than robust local comparisons.[4]
• Collect comparable veterinary resistance and sales data, conduct additional testing of Salmonella and commensal E. coli resistant to carbapenems or cephalosporins, and publish annual findings in the Veterinary Antibiotic Resistance and Sales Surveillance report in a format comparable with human surveillance reports.[4]
• Monitor, from 2015, specified resistance mechanisms in E. coli from pigs and poultry, and test retail pork, chicken and beef for resistant E. coli isolates.[4]
• Link prescribing data for clinical commissioning groups with hospital data, use prescribing comparators and data-quality programmes, and track total antibiotic use alongside cephalosporin and fluoroquinolone use in primary care and total and carbapenem use in secondary care.[4][2]
• Track balancing measures, including hospital admissions for suppurative upper respiratory tract complications and general practitioner consultations, to identify unintended consequences of reduced prescribing or changes in treatment practice.[2]
• Support professional stewardship through the TARGET Antibiotics toolkit for clinical commissioning groups and the Start Smart Then Focus toolkit for National Health Service trusts, while monitoring uptake from 2015.[3]
• Survey adults in England from 2014 on antibiotic use, knowledge and attitudes, and evaluate United Kingdom European Antibiotic Awareness Day activity annually.[3]
• Use the Health Protection Advisory Group on Antimicrobial Resistance to review antibiotic-stewardship quality and assess whether the strategy is affecting resistance growth.[3]
• Work with the World Health Organization, Food and Agriculture Organization, World Organisation for Animal Health, Commonwealth partners and the Global Health Security Agenda; support global action-plan implementation, tripartite collaboration, laboratory twinning, internationally agreed indicators and longer-term assessment of Member States' action plans.[6]

Monitoring & Evaluation

Monitoring and evaluation centre on measuring whether the United Kingdom’s five-year antimicrobial resistance strategy slows resistance growth, through reported infection data, resistance proportions and measures of clinical burden.[1]Annual data collection is intended to establish 2013 as the first reporting baseline and support longer-term assessment of interventions’ effectiveness and impact.[1][5]

• Monitor resistance in serious bloodstream infections and gonorrhoea across England, Wales, Scotland and Northern Ireland, collecting national and regional data and tracking the antibiotics used to treat these infections.[1][5][4]
• Focus initial national human surveillance on non-susceptibility in Klebsiella species, Escherichia coli, Pseudomonas, Neisseria gonorrhoeae and Streptococcus pneumoniae to specified antibiotics or classes.[5]
• Measure non-susceptibility to cephalosporins and carbapenems in Klebsiella species and Escherichia coli; ciprofloxacin and gentamicin in E. coli; ceftazidime and carbapenems in Pseudomonas; ceftriaxone in N. gonorrhoeae; and penicillin in S. pneumoniae.[5]
• Review key infections annually, develop indicators as improved data become available, and strengthen screening to enable future measurement of infections caused by resistant organisms.[1]
• Extend animal-health surveillance through continuing monitoring of Salmonella from poultry and pigs, introducing monitoring of Campylobacter jejuni from poultry and commensal E. coli from poultry and pigs, and collecting comparable resistance data across bacteria and antibiotic classes.[4]
• Test Salmonella and commensal E. coli isolates that are resistant to carbapenems or cephalosporins, and from 2015 monitor specified resistance mechanisms in E. coli from pigs and poultry and test retail pork, chicken and beef for resistant E. coli.[4]
• Publish veterinary antibiotic resistance and sales data in the annual United Kingdom Veterinary Antibiotic Resistance and Sales Surveillance report, including annual measures of the total weight of veterinary antibiotics sold by antibiotic class.[4][2]
• Expand England’s healthcare surveillance system and laboratory participation, which covered around 60 per cent of medical laboratories and was expected to reach 75 per cent by March 2015; until coverage improves, outputs support national and regional rather than robust local comparisons.[4]
• Link prescribing information for clinical commissioning groups with hospital data to assess effects of prescribing changes, and use strengthened data-quality programmes and prescribing comparators in primary and secondary care.[4][2]
• Review prescribing trends as a high-level indicator, covering total antibiotic consumption and cephalosporin and fluoroquinolone use in primary care, alongside total and carbapenem consumption in secondary care.[2]
• Track balancing measures, including hospital admissions for suppurative upper respiratory tract complications and general practitioner consultations, to detect unintended consequences or explain changes in prescribing.[2]
• Report refinements to prescribing measures in annual progress reports and use the Health Protection Advisory Group on Antimicrobial Resistance to review antibiotic stewardship quality and assess the strategy’s effect on resistance growth.[2][3]
• Monitor public awareness and behaviour from 2014 through an England survey of adults’ antibiotic use, knowledge and attitudes; from 2015, measure uptake of the TARGET Antibiotics and Start Smart Then Focus toolkits and annually evaluate European Antibiotic Awareness Day activities in the United Kingdom.[3]
• Assess international progress against milestones relating to implementation of the World Health Organization antimicrobial resistance resolution, the global action plan and indicators, tripartite collaboration, laboratory twinning and the Global Health Security Agenda; longer-term monitoring is intended to use internationally agreed indicators and assess Member States’ delivery of agreed action plans.[6]

Costing & Financing

Financing information is limited. No budgets, quantified expenditure, funding allocations, funding sources, resource-mobilisation arrangements, funding gaps or economic assumptions are specified for the surveillance, prescribing, public engagement or stewardship activities.[1][4][2]

• Support international work on innovative financing and regulatory approaches intended to stimulate development of new antibiotics and rapid diagnostics, although no financing mechanism, amount, allocation or time frame is specified.[6]
• Implement surveillance expansion, laboratory participation, data linkage, veterinary reporting and prescribing data-quality activities without specified associated costs or funding arrangements.[4][2]