Antimicrobial Stewardship Activities across Primary and Secondary Care Sectors in England: ESPAUR report 2024-25

Le résumé fourni par la source

Abstract Background One of the main drivers of antimicrobial resistance (AMR) is the misuse and overuse of antimicrobials. Antimicrobial stewardship (AMS) is key to ensuring the appropriate use of antimicrobials and reducing the emergence and transmission of resistance. This abstract outlines key AMS activities undertaken within England between 2024 and 2025 across primary and secondary care settings. Examples of AMS interventions Adding to the TARGET How to series, evidence-based resources that align with national guidance have been developed to support primary care staff in the prevention and management of recurrent urinary tract infection (UTI). The TARGET cycle of stewardship has also been developed to support the implementation of AMS interventions (Figure 1).Figure 1.TARGET cycle of Antimicrobial Stewardship. Permission for use granted by UKHSA ESPAUR team. An evaluation of UK Health Security Agency (UKHSA) AMS tools demonstrated widespread use with tool host websites receiving 71,588 visits over a 4 year period. Seven of the twelve tools identified had evidence of use in secondary care and eleven tools had evidence of impact in the UK, such as impact on guidance from UK national organisations (Figure 2.).Figure 2.Summary of findings from scoping review conducted to determine the extent to which the national AMS tools developed by UKHSA for use in secondary care are being used and implemented to support AMS activities in secondary care in England. Permission for use granted by UKHSA ESPAUR team. Following the publication of the UK-adapted AWaRe categories in 2025,1 knowledge mobilisation activities were carried out across England, including a press release for the publication and subsequent articles in trade journals, Fingertips news webpage update, dissemination via key stakeholders, the Antibiotic Guardian newsletter, and sharing by ESPAUR Oversight Group stakeholder organisations. Immediate use of the UK-adapted AWaRe categories was evident with the .gov website receiving 1,130 unique visits in the two-months following publication. Social media activity to support awareness of the publication on Facebook, LinkedIn, Instagram, and X had 84,577 total impressions and 3,456 engagements with a 4.1% engagement rate. A rapid systematic review was conducted to determine which indicators are being used to assess antibiotic prescribing appropriateness. Most of the articles (n=119) described patient-level indicators that considered one or more factors relating to indication, drug and/or patient characteristics. Around a quarter of the articles (n=35) described proxy-indicators that estimated appropriateness based on population-level data. Initial findings highlight the complexity of defining appropriateness and the required knowledge of the drug and diagnosis to be able to correctly determine appropriateness of prescribing. Another review, conducted to ascertain pharmacists’ role in outbreaks, prevention and preparedness, revealed several key roles at the micro, meso, and macro-level including supply of patient advice, collaborating with regional partners for vaccinations, and development of national treatment guidance. Fewer roles in recovery were identified with examples including organisational level root cause analyses and research to learn from previous outbreaks. Stewardship of Antifungals In May 2024, a survey was conducted within NHS hospital trusts to explore the status of antifungal stewardship (AFS) initiatives across England and any barriers to implementation. Survey results were compared to baseline data collected in 2016. Just over a third of respondents (35%, 15/43) had an AFS programme compared to 54% in 2016. Among trusts with AFS programmes, 87% had access to fungal guidelines compared to 76% in 2016, although guidelines were more likely to be unavailable for paediatric populations. The main barriers to AFS, lack of staff time and competing priorities, remained the same as 2016. Planned Future Work Future AMS work will focus on evaluating and strengthening national strategies to optimise antibiotic use, in line with the UK 5 year AMR National Action Plan. This includes, but is not limited to, assess AMS tool utilisation in secondary care, examining how the review on appropriateness of antibiotic prescribing can be used to inform policy, and exploring the evolving role of pharmacists in outbreak management beyond COVID-19.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.