English surveillance programme for
antimicrobial utilisation and resistance
(ESPAUR)

Between 2017 and 2021 there was a slight increase in rate of bloodstream infections (BSI)
caused by key pathogens. However, rates of Escherichia coli and Streptococcus pneumoniae
sustained the decline seen in 2020 into 2021; most likely due to the multifactorial effects of the
SARS-CoV-2 (COVID-19) pandemic.

The overall burden of antimicrobial resistance (AMR), decreased by 4.2% between 2017 and
2021, although the trend varied by key pathogen. The AMR burden in BSI had been steadily
increasing since 2017 before falling in 2020. This decline has been maintained in 2021 and
remains predominantly driven by the reduction in the incidence of E. coli BSI.

The AMR burden in BSI varies markedly across regions in England. The rate of resistant BSIs
was highest in London (55.5 per 100,000 population) followed by the North West (44.5 out of
100,000) and South East (41.1 out of 100,000). The lowest AMR burden in BSI rate was
recorded in the East Midlands (32.1 out of 100,000).

Ethnic minorities appear to be disproportionately affected by infections associated with AMR
with 33.0% (n = 1,243) of Asian or Asian British ethnic group patients with a key BSI contracting
a resistant BSI compared to 20.9% (n = 10,536) of White ethnic group patients.

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