National report antimicrobial use and resistance in Australia

Prof. Thursky at AURA launch.

Prof. Thursky at AURA launch.

Seventeen years after a national enquiry recommended action against antimicrobial resistance, today we saw a significant step forward, with the release of the first report into antimicrobial use and resistance in human health in Australia.

I was at the launch today at Concord hospital. Speakers included Professor Chris Baggoley (Australia’s CMO), Professor Karin Thursky (Director NCAS) and Professor John Turnidge (ACSQHC) It was also great to see Sophie Scott from the ABC take an interest in this topic.

The report is detailed and certainly for those working in the health field, worth a good read. There are also plenty of key messages not only for healthcare workers and those that prescribe antimicrobials, but also the wider public.

Here are some of the points I particularly found interesting and worrying. (These might encourage you to read the report in more detail)

  • In 2014, almost half the Australia population took at least one course of antibacterials in the year
  • More than 50% of patients who were identified as having a cold or upper respiratory tract infection had an antimicrobial prescribed when it was not indicated.
  • In residential and aged care, 11.3% of patient on any given day were on an antimicrobial, with only 4.5% suspected or having a confirmed infection. Incredibly 31% of antimicrobial prescriptions were started more than 6 months before the audit date. (You read correctly!)
  • Volumes of antimicrobials are increasing in Australia

How does Australia compare and what about geographical variation within Australian I hear you ask?

  • Antimicrobial usage in Australian hospital is high, but lower than England and Scotland. Rates have been declining since 2010.
  • Antimicrobial usage in the Australian community is very high, the highest of any country where comparable data was available
  • The prevalence of antimicrobial usage in residential and aged care in Western Australia was 27% compared to Queensland at 6%.

Finally, what about resistance?

  • ESBLs were found in 7-12% of E.Coli and 4-7% of Klebsiella pneumoniae
  • Resistance to some key antimicrobials is low in Australia, compared to European countries
  • However, resistance to methicillin (in S.aureus) and vancomycin (E.faecium) are very high. Around 45% resistance to vancomycin, the highest in any comparable country. This compares to resistance rates of <5% in countries like France, Spain, Sweden and the Netherlands.

Where to from here?

Like any good surveillance program, it provides data for action and reinforces the need for more national surveillance. This is the (very) difficult part. The report highlights key areas to be addressed and demonstrates the importance of the need for ongoing and enhanced work in the area of antimicrobial usage and resistance.

Further as we see higher rates of antimicrobial resistance, particularly in a global community, infection prevention and control measures will become even more important. Now is the time to invest further in health services research that focusses on the effectiveness and cost-effectiveness of infection prevention and control strategies.

Brett Mitchell

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