Antimicrobial Use and Resistance in Australia - New Report Findings

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Antimicrobial resistance (AMR) is a global concern. Consequently, the World Health Organization has encouraged countries to commit to comprehensive national plans to combat AMR.

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AMR occurs when antimicrobials which were once effective stop working against microorganisms like bacteria, viruses and fungi. As a result of AMR, standard medical treatments have become, and are becoming, ineffective and simple infections can cause significant harm. This increases the complexity of treatment and duration of hospital stay, and places significant burden on patients, healthcare providers and the health system.
While AMR to some extent is a natural phenomenon, high and inappropriate antimicrobial use has accelerated the process of increasing resistance worldwide, including in Australia.
As part of the Australian Government’s AMR Strategy (2015-19), the Australian Commission on Safety and Quality in Health Care (the Commission) is advancing the development of a nationally coordinated Antimicrobial Use and Resistance in Australia (AURA) Surveillance System as a significant platform to prevent and contain AMR across all health settings.
The AURA Surveillance System’s first report ‘AURA 2016: First Australian report on AU and AMR in human health’ (AURA 2016) includes valuable data and comprehensive analyses of AMR, antimicrobial use and appropriateness of prescribing in Australia across all healthcare settings. This report provides the most complete picture on antimicrobial use and resistance in Australia available to date and sets a baseline that will allow resistance and use trends to be monitored over time.
There is large variation in antimicrobial use between states and territories. Some of the more significant findings arising from AURA 2016 include:
Hospitals
• On any given day in 2014, around 38% of patients in Australian hospitals were receiving antimicrobial therapy. Around 23% of these prescriptions were considered inappropriate, and around 24% were noncompliant with guidelines
• Prescriptions for surgical prophylaxis are a significant concern – this indication is the most common reason for prescribing antimicrobials in hospitals (13% of all prescriptions), of which over 40% were deemed inappropriate.
Community
• Overall, antimicrobial prescribing is high in the community, with 46% of Australians being dispensed at least one antimicrobial in 2014
• More than 50% of people with colds and upper respiratory tract infections were prescribed antimicrobials unnecessarily in 2014.
Residential aged care
• In 2015, 11.3% of residents were on antimicrobial therapy, but only 4.5% had a suspected or confirmed infection
• 20% of antimicrobial prescriptions in 2015 were for residents who had no signs and symptoms of infection in the week before starting the antimicrobial.
Analysis of data has also firmly established there are a number of organisms in Australia of particular concern because of the significant impact they can have on health. For example, ampicillin resistance combined with vancomycin resistance in enterococci has emerged as an issue in Australia, with Enterococcus faecium caused serious infections showing resistance of between 4566% to vancomycin and 83-95% for ampicillin.
AURA data analysis has also confirmed that Carbapenem-producing Enterobacteriaceae (CPE) infections are almost always highly multi-drug resistant and require ‘last-line’ reserve agents such as colistin, an agent with significant toxicity.
Similarly, analysis shows that between 15.8% and 17.4% of Staphylococcus aureus infections are methicillin-resistant S. aureus (MRSA). Community strains of MRSA now cause a significant proportion of infections both in the community and in hospitals.
Not all AURA 2016 report findings are adverse. Antimicrobial use in hospitals has gradually been declining since 2010, in parallel with the introduction of antimicrobial stewardship programs around this time. Australia also has low rates of resistance to fluoroquinolones compared to other countries, possibly reflecting the restricted use of this antimicrobial class locally. Findings such as these can be used to inform and support strategies to prevent and contain AMR.
A key message arising from the AURA Surveillance System is that antimicrobial use is a key driver of antimicrobial resistance – the more we use antimicrobials, the more likely it is that resistance will develop. Appropriate use of antimicrobials can be life-saving, but inappropriate use needs to be monitored and minimised to prevent and contain AMR.
The AURA Surveillance System will continue to build on the AURA 2016 report by further exploring, enhancing and reporting on a range of data collections which examine the use and resistance patterns for antimicrobials in Australia.
To learn more about antimicrobial use and resistance, and the AURA Surveillance Program, visit www.safetyandquality.gov.au/nationalpriorities/amr-and-au-surveillance-project/.

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Reference
1. Office of the Chief Scientist. Meeting the Threat of Antibiotic Resistance: Building a New Frontline Defence. Occasional Paper Series. Canberra: Australian Government, 2013.
There are a number of surveillance programs integrated under AURA as the national system. These are:

1. Australian Group on Antimicrobial Resistance’s (AGAR) collection of resistance data


2. National Antimicrobial Prescribing Survey (NAPS) and the pilot Aged Care NAPs (acNAPS)


3. National Antimicrobial Utilisation Surveillance Program (NAUSP); and


4. The expansion of Queensland Health’s OrgTRx System to provide a national passive AMR surveillance system.

Other invaluable data sources include:
Pharmaceutical Benefits Scheme (PBS)
NPS MedicineWise
Office of Health Protection, National Notifiable Diseases Surveillance Branch
National Neisseria Network.
IN THE COMMUNITY more than 50% of people with colds and upper respiratory infections were prescribed antimicrobials unnecessarily.
IN HOSPITALS around 23% of antimicrobal prescriptions were considered inappropriate.
IN RESIDENTIAL AGED CARE around 20% of antimicrobial prescriptions were for people who had no signs or symptoms of infection.
CREDIT: AURA 2016: FIRST AUSTRALIAN REPORT ON AU AND AMR IN HUMAN HEALTH