New antibiotic resistance report identifies ongoing threat

Antimicrobial resistance shows little sign of abating, with some bacteria now resistant to last-resort treatments.

This is according to the Australia's most comprehensive report produced on our antimicrobial use and resistance trends.

‘Antimicrobial Use and Resistance in Australia 2019: Third Australian report on antimicrobial use and resistance in human health (AURA 2019)’, released by the Australian Commission on Safety and Quality in Health Care today, highlights a number of resistant bacteria as major healthcare problems.

The report found that antimicrobial use in the community is falling, but they continue to be overprescribed, while some dangerous bacteria are growing increasingly resistant to common antibiotics.

It warns that antimicrobial resistance shows little sign of abating and poses an ongoing risk to patient safety, with common pathogens such as E. coli, Salmonella, Neisseria gonorrhoeae and Neisseria meningitidis becoming increasingly resistant to major drug classes, and some organisms resistant to last-resort treatments.

Antimicrobial resistance is driven by the overuse and misuse of antibiotics. Encouragingly, AURA 2019 found that overall use of antibiotics in the community fell between 2015 and 2017 — the first decline in 20 years. This suggests ongoing and coordinated campaigns targeting GPs and consumers on the risks of using antibiotics inappropriately are beginning to cut through.

Despite these gains, almost half the samples of enterococci tested across Australia were resistant to the antibiotic vancomycin — a level higher than seen in any European country. AURA 2019 also found that community-associated methicillin-resistant Staphylococcus aureus (MRSA) has become the most common type of MRSA infection, particularly in aged-care homes and remote regions.

The report found that in 2017, more than 10 million Australians had a least one antibiotic dispensed in the community and more than 26.5 million prescriptions for antimicrobials were dispensed.

AURA 2019 key findings

23.5% of mirciobial prescriptions in hospitals were inappropriate. 11% decrease in 4 years in prescriptions for surgical prophylaxis beyond 24 hours (down from 41% to 30%). 92% of acute bronchitis patients were prescribed antibiotics despite no evidence of benefit. 1 in 10 aged-care home residents were prescribed at least one antimicrobial. More than half of antimicrobial prescriptions were for aged-care residents with no signs of symptoms. 50% of antibiotic prescriptions were ordered with repeats — and half filled within 10 days.

 

“While the downward shift in prescribing will help to slow the spread of resistance, these latest AURA findings indicate that the levels of inappropriate prescribing of antibiotics in hospitals and the community are still too high and there is more work to be done,” said Dr Kathryn Daveson, the AURA Clinical Director.

“AURA 2019 also identifies focus areas that need increased attention — including reducing inappropriate prescribing of broad spectrum antibiotics, particularly for urinary tract and skin infections; and improving the appropriateness of antibiotic prescribing for chronic obstructive pulmonary disease and other respiratory infections,” Dr Daveson said.

AURA 2019 provides a more comprehensive picture of antimicrobial resistance than previous reports because of the increased volume of data now captured by the AURA Surveillance System.

“The AURA reports are a key resource in Australia’s fight against the threat of increased antimicrobial resistances, including Critical Antimicrobial Resistances (CARs) that are resistant to last-line antibiotics,” said Professor John Turnidge AO, the commission’s Senior Medical Advisor.

“The expanded AURA Surveillance System allows us to identify and track national trends in antimicrobial use and antimicrobial resistance, and monitor the effect of changes in policy and clinical practice, to a level that has not previously been possible.

“This latest report is one of the most comprehensive of its type in the world. It will help give clinicians and health policymakers across Australia the data and information they need to develop targeted approaches to prevent and contain resistance,” Professor Turnidge said.

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