The latest national surveillance data, announced at the UK Health Security Agency (UKHSA) annual conference in Leeds, shows that an estimated 58,224 people in England had an antibiotic resistant infection in 2022 – a rise of 4% since 2021 (55,792). Deaths due to severe antibiotic resistant infections also increased from 2021 to 2022 (from 2,110 to 2,202).
Antibiotic use in England declined from 2014 to 2020, with large drops in 2020 related to the pandemic. However, latest data now shows a reversal in this downward trend, with antibiotic use in all settings (apart from dental) increasing in 2022. Total prescribing rose by 8.4% in 2022 compared with 2021, although remains below 2019 pre-pandemic levels.
Inappropriate and excessive antibiotic use increases the risk of emergence of antibiotic resistant bacteria and associated increased in deaths related to these infections. The proportion of bloodstream infections that are resistant to one or more antibiotics (1 in 5) has remained stable since 2018, but there are concerning increases in antibiotic resistance in some bacteria.
Klebsiella pneumoniae – a cause of sepsis – is 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) and piperacillin with tazobactam (from 15.1% to 19.6%).
This year’s report provides additional analysis of differences in antibiotic resistance burden in England in different populations. Of all bloodstream infections detected, Asian or Asian British ethnic groups had almost double the proportion of antibiotic resistant infections (34.6%) compared to white ethnic groups (18.7%).
Antibiotic resistance occurs naturally, but inappropriate use and overuse of antibiotics can accelerate this process. Antibiotic-resistant bacteria are less likely to respond to treatment, causing serious complications, including bloodstream infections, sepsis and hospitalisation.
People who get a bacterial infection that is resistant to one or more antibiotics are more likely to die from their infection compared to those who have an antibiotic sensitive infection. This is why it is important to take antibiotics only when they are prescribed and necessary for the condition.
Professor Dame Jenny Harries, Chief Executive of UKHSA, 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.
"There are 2 things everyone can do to help keep antibiotics working. First you can help reduce or prevent infections in the first place by taking simple steps – staying away from vulnerable people if you are feeling unwell, washing your hands regularly and keeping rooms ventilated. This isn’t just about protecting your own health – it’s about helping everyone in our communities.
"Second, only take antibiotics if you have been told to do so by a healthcare professional. Do not save some for later or share them with friends and family. Antibiotics will not work for viruses such as cold, flu or COVID-19. Treat antibiotics with respect and they will be there to help us all in the future."
Professor Kamila Hawthorne, Chair of the Royal College of General Practitioners (RCGP), said: "Antimicrobial resistance (AMR) is one of the greatest public health challenges we face and something GPs and our teams have worked incredibly hard to reduce over many decades, so it’s very concerning to see this uptick. One reason is likely to be temporary changes to prescribing thresholds during recent infectious outbreaks, such as the strep A outbreak last Christmas.
"Antibiotics are very important drugs and we need them to remain effective – and everyone, from healthcare and public health professionals to patients, has a duty to use antibiotics responsibly and carefully, to help ensure this. GPs are always looking for ways to safely reduce use of antibiotics, and will only prescribe them in line with guidance and if we think they will be of benefit for the patient in front of us. The RCGP has worked with the UKHSA to develop our popular TARGET Antibiotics toolkit to support GPs and our teams in the appropriate prescribing of antibiotics."
There are many reasons behind the increase in prescribing, one of which is likely related to decreased immunity and exposure to infections during the COVID-19 pandemic that may have underpinned the increased transmission in co-circulating infections, namely:
- influenza (flu)
- respiratory syncytial virus (RSV)
- group A streptococcus (GAS)
