Scottish One Health Antimicrobial Use and Antimicrobial Resistance in 2018

Abstract

Antimicrobial resistance (AMR) remains a major public health issue. AMR occurs when microorganisms, such as bacteria, adapt to survive exposure to a treatment that would normally kill them. Inappropriate and unnecessary antibiotic use speeds up the development of AMR. A ‘One Health’ approach is required to tackle AMR and its drivers across all settings (humans, animals and the environment). This report provides information relating to antimicrobial use and antimicrobial resistance in a range of human and animal infections in Scotland. This is the first time that the report has included animal antimicrobial use data from small animal veterinary practices and environmental antimicrobial resistance data. The report is intended to support planning, prioritisation and evaluation of initiatives to optimise antimicrobial use and to minimise antimicrobial resistance.
Main Points
Antimicrobial use in humans
• Reducing the Scottish population’s unnecessary exposure to antibiotics is critical to containing and controlling antimicrobial resistance
• Total antibiotic use in humans has decreased by 6.2% since 2014
• More than half of all antibiotic use in Scotland was Access antibiotics promoted by the World Health Organisation (recommended first line narrow spectrum agents)
• Antibiotic use in primary care has decreased by 10.2% since 2014; the lowest figure since data became available in 1993
• 27.3% of the Scottish population received at least one course of antibiotics prescribed in primary care
• One in ten antibiotics in primary care were prescribed by nurses; twice as many as five years ago
• Antibiotic use in acute hospitals has increased by 16.0% since 2014 (unadjusted for changes in patient population)
• The Scottish antimicrobial stewardship programme will continue to work with clinicians to improve patient outcomes and minimise antibiotic resistance through minimising inappropriate antibiotic use in humans
Antimicrobial use in animals
• For the first time, antimicrobial use data from a sample of small animal veterinary practices were available
• Nearly one in five consultations resulted in an antibiotic being prescribed; nine in ten of these were not from the group of antibiotics considered to be high priority critically important in humans
• Scotland’s Healthy Animals website provides guidance for vets and animal keepers on disease avoidance and antimicrobial stewardship
Antimicrobial resistance in humans
• There were an estimated 1,424 drug resistant bacteraemia during 2018; the majority caused by drug resistant Gram-negative bacteria
• The incidence of Gram-negative bacteraemia, including Escherichia coli bacteraemia, and associated resistance to key antibiotics has remained stable over the last five years
• The incidence of Escherichia coli and Klebsiella pneumoniae urinary tract infections and associated resistance to the majority of key antibiotics has remained stable over the last five years
• The incidence of carbapenemase producing organisms (CPO) has increased significantly since 2014 though there was no change between 2017 and 2018
• Resistance to vancomycin has significantly increased in Enterococcus faecium blood isolates with 43.2% of isolates non-susceptible
Health Protection Scotland
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• A focus on preventing all infections, but in particular Gram-negative infections, is required to reduce the emergence and transmission of AMR and it is important to remain vigilant to AMR across all species
• The National Infection Prevention and Control Manual provides infection prevention and control guidance to support clinicians involved in healthcare delivery
• 7.0% of cases of gonorrhoea were resistant to some extent to azithromycin, an antibiotic used to treat this infection. 2.1% of cases showed a high level of resistance to azithromycin
Antimicrobial resistance in animals
• Monitoring AMR in animals is a vital component of understanding and mitigating risk of AMR across the entire ecosystem
• Non-susceptibility for veterinary clinical isolates has been relatively stable since 2014
• Intelligence relating to AMR in animals will continue to be developed to inform the evidence base

Citation

Scottish One Health Antimicrobial Use and Antimicrobial Resistance in 2018. Health Protection Scotland (HPS)

• Report Type: Technical Report
• Online Publication Date: Nov 12, 2019
• Deposit Date: Mar 27, 2024
• Publisher: NHS Health Scotland
• Public URL: http://researchrepository.napier.ac.uk/Output/3578152
• Publisher URL: https://www.nss.nhs.scot/publications/scottish-one-health-antimicrobial-use-and-antimicrobial-resistance-in-2018/