English surveillance programme for antimicrobial utilisation and resistance (ESPAUR)

In 2022, with the lifting of pandemic mitigations and the return to pre-pandemic levels of health
activity, there were substantial increases in rates of priority pathogens and antibiotic use.

From 2018 to 2022, there was a 11.7% increase in patient episodes of bloodstream infections
(BSIs) and/or fungaemia in England. However, over this period, the estimated overall burden of
antimicrobial resistance (AMR) infections decreased by 1.6% and priority pathogen AMR BSIs
decreased by 4.6%.

The AMR burden in BSI varied markedly across regions in England with the rate of resistant
BSIs almost double in the highest (London) compared to the lowest (South West) region.

For Escherichia coli and Klebsiella pneumoniae causing BSI, there were significant increases in
the percentage resistance to piperacillin/tazobactam between 2018 and 2022. Carbapenem
resistant Enterobacteriaceae BSI remained low and stable; in 2022, 152 carbapenemase
producing Gram-negative sterile site infections were formally notified to UKHSA.

In 2022, the overall crude case fatality rate for 30-day all-cause mortality in patients with priority
Gram-negative bacterial BSI was 16.9% with a higher all cause crude case fatality rate for
antibiotic resistant BSI (19.1%) compared to those with antibiotic susceptible BSI (16.2%).

While the highest number of BSIs were detected in White ethnic groups; the proportion that
were antibiotic resistant was almost double in in Asian or Asian British ethnic groups (34.6%)
compared to white ethnic groups (18.7%).