This week is World Antibiotic Awareness Week, with Saturday 18 November European Antibiotic Awareness Day, so it is fitting that Health Protection Scotland (HPS) has today (Tuesday 14 November) published the Scottish One Health Antimicrobial Use and Antimicrobial Resistance Report on antibiotic use and resistance in Scotland during 2016.
Dr Eleanor Anderson, Consultant Lead for the Control of Antimicrobial Resistance in Scotland (CARS) programme, Health Protection Scotland, said: "Antibiotic use and spread of infection in humans, animals and the environment all contribute to the development of resistant infections. The ‘One Health’ approach’ tackles antimicrobial resistance (AMR) and its drivers across all settings for sustainable AMR control.
The report shows a mixed picture in relation to antibiotic use in Scotland:
- The total use of antibiotics in 2016 decreased (3% lower than in 2012), driven mostly by a reduction in antibiotic use in primary care which accounts for around 80% of total antibiotic use.
- There were substantial reductions in dental prescribing of antibiotics in primary care (23.9% lower than 2012).
- Antibiotic use in acute hospitals increased (10.2% increase compared to 2012) .
- There was a reduction in the use of some of the key antibiotics that are reserved to treat infections that have become resistant to most other antibiotics.
- The fact that 29% of primary care patients were prescribed an antibiotic in 2016, represents a large burden of use and shows that more needs to be done to reduce antibiotic use and keep antibiotics working.
Dr Andrew Seaton, Consultant Physician and Chair of the Scottish Antimicrobial Prescribing Group, added: "Antibiotics are life-saving medicines so I am pleased that the efforts of clinicians across Scotland to keep antibiotics working are reflected in the reduction of antibiotic prescribing in primary care. In hospitals, clinicians have worked hard to improve use of the most valuable antibiotics to ensure they remain effective for those patients with the greatest need. The challenge for all of us is to build on these improvements and work together to reduce antibiotic use in hospitals."
Antibiotic resistance in human infections
The report also outlines that levels of a number of important resistant infections increased or remained high in 2016. Dr Mairi MacLeod from the Scottish Microbiology and Virology Network added: "It is important that we continue to detect and monitor antimicrobial resistant infections so that patients receive the correct treatment and we can put in place measures to stop the spread of infection."
Prof Jacqui Reilly, Lead Consultant for Healthcare Associated Infections (HAI), Antimicrobial Resistance (AMR) and Infection Prevention and Control (IPC) at Health Protection Scotland said: "Preventing infections is the best way to ensure care is safe and to preserve antibiotics. Health Protection Scotland is working with a range of organisations to prevent infections in hospitals, care homes and in the wider population level in the community. In recent years, real inroads have been made in reducing what was our key antibiotic resistant infection in Scotland, MRSA. However, there are new threats from organisms such as E. coli which mean we need to target new interventions and approaches to tackle these infections. Hand hygiene is one of the most important things we can all do to prevent infections and protect health."
Gonorrhoea isthe second most common bacterial sexually transmitted infection (STI) diagnosed in Scotland. Increased numbers of resistant gonorrhoea infections have been reported in recent years. Importantly, all gonorrhoea infections reported in Scotland in 2016 were able to be treated.
Professor David Goldberg, Lead Consultant, Bloodborne Virus and Sexual Transmitted Infection Programme, Health Protection Scotland, said: "It is important that the antibiotics used to treat gonorrhoea continue to be effective. Measures to prevent, detect and treat infection to stop onward transmission are essential."
Animal resistant infections
While animal infection surveillance systems are less developed than human ones, the animal data presented in the report have the potential to inform veterinarian prescribing and help us better understand the development and spread of AMR. Health Protection Scotland and partners have developed an online resource to support veterinary prescribing of antibiotics: Scotland’s Healthy Animals . Professor Dominic Mellor, Consultant Veterinary Public Health, Health Protection Scotland, explained: "The inclusion of animal resistance data in the SONAAR report demonstrates the commitment of Health Protection Scotland and partners to the ‘One Health’ approach and marks the beginning of One Health AMR surveillance in Scotland."
The Report shows that more needs to be done to keep antibiotics working. Detection and surveillance of resistant infections, infection prevention and control in the widest sense and antibiotic stewardship for both human and animals are all required.
Dr Michael Lockhart, Consultant Microbiologist Health Protection Scotland, said, "Antibiotics are life saving drugs, but unnecessary and inappropriate use reduces our ability to treat infections. All clinical, care staff, health protection teams and veterinarians need awareness and understanding of AMR. The public also has a part to play in keeping antibiotics working by following the advice of your healthcare professional (doctor, nurse, dentist or pharmacist) or vet for animals, regarding the need for antibiotics."
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Notes to the Editor
- The Scottish One Health Antimicrobial Use and Antimicrobial Resistance Report 2016 is available here: http://www.hps.scot.nhs.uk/pubs/detail.aspx?id=3378
- The Scottish One Health Antimicrobial Use and Antimicrobial Resistance Report (SONAAR) Report is intended to support NHS boards, hospitals and primary care in their long-term planning of antimicrobial prescribing. In particular, this report should be of use to Antimicrobial Management Teams (AMTs), Infection prevention and Control Teams (ICTs) and Microbiologists.
- Scottish Antimicrobial Prescribing Group (SAPG) guidance on prescribing is available at: http://www.scottishmedicines.org.uk/smc/6627.221.286.html
- Health Protection Scotland (HPS) is part of NHS National Services Scotland (NSS), providing services critical to frontline patient care and supportive of the efficient and effective operation of NHSScotland.
What are antimicrobials?
Antimicrobials is a term used to describe antibiotics and other medicines.
What is antimicrobial resistance?
Antibiotic resistance arises when bacteria evolve and develop traits which enable them to survive exposure to medicines that would normally kill them.
Why is antimicrobial resistance a problem?
Without effective antibiotics, serious infections cannot be treated. It is essential to preserve our remaining antibiotics.
What are carbapenems?
Carbapenems are a group of powerful antimicrobials which are used to treat a number of serious or antibiotic resistant infections.
What is meant by overuse and inappropriate use of antibiotics?
Inappropriate use might involve prescription of antibiotics unsuitable for the infection (including viral infections, such as the common cold, which are not cured by antibiotic treatment), or it may be that a patient does not finish their course of antibiotics, meaning that the bacteria are not all killed.