Antibiotic-resistant infections rise in England but still below pre-Covid levels

Giving leftover antibiotics to friends and family risks fuelling a surge in infections resistant to the drugs, officials have warned, as data shows a rise in related cases in England – with people of Asian heritage at greater risk than those who are white.

While severe antibiotic-resistant infections – such as bloodstream infections, UTIs, surgical site infections and respiratory infections – remained below 2018 levels last year, the latest estimates suggest there was a 4% rise between 2021 and 2022, from 55,792 to 58,224. The uptick follows a notable decline during the height of the Covid pandemic.

There was also a rise in the number of deaths attributed to severe antibiotic-resistant infections, from 2,110 in 2021 to 2,202 in 2022.

However, it appears the increases reflect a wider uptick in all infections since Covid restrictions were lifted, with data showing that the proportion of bloodstream infections resistant to one or more antibiotics has remained steady since 2018, at around one in five.

Dr Colin Brown, the deputy director for antimicrobial resistance at UK Health Security Agency (UKHSA), said the findings reflected a shift back towards pre-pandemic life.

“We are probably returning to more usual healthcare utilisation, more usual complexity of services being offered, and more usual numbers of infections as people also go about more normal activity,” he said.

“I think it’s a combination of those [factors] that is increasing the number of infections compared to what we saw during the core pandemic period, and that is subsequently increasing the number of resistant infections.”

There are signs that at least some microbes involved in bloodstream infections are becoming more resistant to antibiotics, including the bacteria Klebsiella pneumoniae and E coli.

The report of the English surveillance programme for antimicrobial utilisation and resistance (Espaur) says there was an 8.4% increase in the number of prescriptions for antibiotics between 2021 and 2022. But the total is still below 2019 levels.

Experts at UKHSA suggest the increase could reflect a rise in circulating infections – possibly as a result of decreased exposure and immunity during the peak of the pandemic – and a lowering of thresholds for prescribing antibiotics during situations such as the strep A outbreak last winter.

The 2022 data shows that adults aged over 64 and infants under one year had the highest rate of antibiotic-resistant bloodstream infections, while rates were also higher for more deprived communities.

The proportion of bloodstream infections that were resistant to antibiotics was around twice as high for Asian or Asian British ethnic groups, at 34.6%, as for white ethnic groups, at 18.7%.

“There is a likelihood that people with close community ties back and forth to countries where there are higher risks of drug resistance are more likely to have, in their communities, levels of greater drug resistance,” Brown said, although he added that further work was needed to test the hypothesis.

The Espaur report says people with antibiotic-resistant bloodstream infections have a 19% chance of dying over a 30-day period, compared with a 16% chance of death for those with a strain that is susceptible to antibiotics.

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The report reveals that there have also been increases in other types of antimicrobial-resistant infections, with a 23.2% increase in bloodstream infections caused by a type of fungus called candida between 2019 and 2022. Such infections had been falling before the pandemic.

Experts have stressed that inappropriate and excessive antibiotic use is a key driver of antibiotic resistance. While efforts are under way to reduce prescribing, they say there are also measures that everyone can take.

“We can all take steps to prevent infections in the first instance,” said Prof Diane Ashiru-Oredope, the lead pharmacist for antimicrobial resistance at UKHSA.

“And that can come through regular hand washing, keeping up to date with vaccinations, keeping rooms ventilated and staying away from vulnerable people if we’ve become unwell.”

Ashiru-Oredope said it was also important only to take antimicrobials such as antibiotics if advised by a healthcare professional, stressing that the medications should not be shared with others. Experts have previously said sharing prescription drugs is illegal.

“Antibiotics will not work for viruses such as cold, flu or Covid-19,” said Prof Jenny Harries, the UKHSA chief executive. “Treat antibiotics with respect and they will be there to help us all in the future.”


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