The English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2024-25

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Abstract Foreword: Since its introduction in 2013, the annual publication of the ESPAUR report has provided a comprehensive analysis of trends in the prevalence of infections caused by resistant pathogens, levels of antimicrobial prescribing, as well as evidence-based interventions developed and implemented in England.1,2 The 2024-25 report highlights that, while levels of antibiotic use have declined by 2% from pre-pandemic levels, the number of reported antibiotic-resistant infections has risen by 13% over the last 5 years. Key developments include the continued rise of resistant Escherichia coli and the emergence of ceftriaxone-resistant gonorrhoea and dual-resistant Mycoplasma genitalium. In 2024, over 66,000 serious antibiotic-resistant infections were recorded, surpassing pre-pandemic levels, with associated mortality rising to nearly 2,400 deaths. The burden and impact of infectious disease is often not felt equally across society and the latest ESPAUR report shows that inequalities are linked to both the burden of antimicrobial resistant (AMR) bloodstream infections, as well as antimicrobial consumption. For example, the rate of resistant bacteraemia is 47% higher in the most compared to the least deprived Index of Multiple deprivation quintile, a gap that has widened by 18% since 2019. National antimicrobial stewardship, professional education, training, and public engagement initiatives that aim to improve antimicrobial use and management, including policy actions, are included. For example, NHS England implementation and delivery of improvement and assurance schemes that support local systems to deliver measurable progress are outlined as well as the TARGET toolkit, the new UK-adapted AWaRe antibiotic categories, World AMR Awareness Week, the Antibiotic Guardian campaign and e-Bug. An overview of the broad range of research projects in healthcare-associated infections and AMR that were conducted by UKHSA and their academic partners are also reported. Much of this research contributes to key objectives set out in the 2024 to 2029 UK National Action Plan for AMR (NAP). Furthermore, the report contains information on actions being taken by ESPAUR’s contributors and audience to combat the rise of AMR and provides examples of knowledge mobilisation in practice and reflections on how it is being used by healthcare professionals, including frontline clinicians. The 2024-25 report details concerning trends in AMR, foreshadowing the considerable challenges ahead. However, despite the backdrop of increasing infections, improvements in prescribing have been seen. Improved understanding of these trends and the factors which shape them will assist the further development and targeting of key interventions to help redress these increases; a key focus of the 2024 to 2029 AMR NAP. Continued strengthening of capabilities to monitor and mitigate AMR and coordinated action across our healthcare system will be essential to this endeavour.

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