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Antibiotic Resistance Increased Postpandemic, Figures Show

Antibiotic resistance increased in 2022 following declines during the COVID-19 pandemic, with more dangerous strains of bacteria spreading in hospitals and in the community, newly released figures showed.

The latest national surveillance data from the UK Health Security Agency (UKHSA) showed that an estimated 58,224 people had an antibiotic-resistant infection last year—a rise of 4% on the 55,792 figure for 2021.

Deaths due to severe antibiotic-resistant infections also increased, rising from 2110 to 2202—an increase of 4.4% over the same period.

Antibiotic Prescribing Increased by 8.4% in 2022

Antibiotic use in England fell from the year 2014 to 2020, with a large decline in 2020 related to the pandemic. However, the latest data, released at the UKHSA's annual conference in Leeds today, showed a reversal in the downward trend, with antibiotic use in all settings, apart from dental, increasing in 2022.

Total antibiotic prescribing increased by 8.4% last year compared with the previous 12 months, although it remained below prepandemic levels. Professor Diane Ashiru-Oredope, lead pharmacist for antimicrobial resistance at the UKHSA, told a briefing: "We think there may be some links to the group A strep outbreak that we had last year." However, "once we got through the main period of the lockdown, we started to see an increase in antibiotic prescribing", and that was across all sectors, she added.

Dr Colin Brown, deputy director for antimicrobial resistance at the UKHSA, said: "Unfortunately, we've not yet made a dent in the proportion of infections that are resistant—and that remains quite resolute, about one in five bloodstream infections—and we are seeing concerning rises in resistance linked to some antibiotics that are used to tackle bloodstream infection, and sepsis."

The proportion of bloodstream infections that are resistant to one or more antibiotics has remained stable since 2018. However, public health officials said it was "concerning" that Klebsiella pneumoniae—a cause of sepsis—was becoming increasingly resistant to a range of antibiotics traditionally used as first-line treatments, particularly third-generation cephalosporins (from 13.5% resistant in 2018 to 17.4% in 2022), piperacillin with tazobactam (from 15.1% to 19.6%), and ciprofloxacin (from 15.4% to 16.4%).

"We know that people are more likely to die when they have a drug-resistant infection," said Dr Brown. "So, patients infected with a strain that are resistant to one or more antibiotics in 2022 had a higher crude 30-day all-cause mortality rate. So that essentially means if you had a drug-resistant infection, compared to someone with a susceptible strain, your 30-day chance of dying is about 20%, compared to those with a drug-susceptible strain, at 16%."

People over the age of 64 years had the highest rate of bloodstream infections caused by resistant pathogens (157 per 100,000 in those over 74 years old, and 64.2 per 100,000 for those aged 64-74 years old), followed by children under 1 year old (46.5 per 100,000).

This year's report also provided for the first time information on antibiotic resistance among different populations in England. Of all bloodstream infections detected, Asian or Asian British ethnic groups had almost double the proportion of antibiotic-resistant infections (34.6%) compared with White ethnic groups (18.7%). 

Action Plan to Reduce Antimicrobial Resistance

In 2019, the Government set out a 5-year action plan to support its vision of combating antimicrobial resistance through collaboration, research, and implementation of measures to preserve the effectiveness of antibiotics and other antimicrobial drugs. Reducing the burden of antimicrobial resistance is one of the UKHSA's six priorities set out in a 3-year strategic plan published in July of this year.

UKHSA Chief Executive Dame Jenny Harries said: "Antimicrobial resistance is not a crisis of the future, but one that is very much with us right now. We expect that if we get a bacterial infection, an antibiotic will be available to treat us—but sometimes, already, that is simply impossible. 

"Unless action is taken, the availability of life-saving treatments will only diminish and our ability to drive down infections will decrease, most likely impacting those in the poorest social circumstances worst."

The English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) is now in its tenth year.