NATIONAL surveillance data published by the UK Health Security Agency today, show that antibiotic resistant infections in 2023 surpassed pre-pandemic levels. There were an estimated 66,730 serious antibiotic resistant infections in 2023, compared to 57,871 in 2022 and 62,314 in 2019.

Nationally, the burden of resistant infections rose by 3.5% between 2019 and 2023. In the North West region, however, the AMR burden rate showed improvement from 2022 to 2023, decreasing from 39.2 to 35.8 per 100,000.

Despite this improvement, the North West still reported the 2nd-highest AMR burden among English regions, with the 2023 rate representing 2,688 life-threatening, resistant bacteraemias (bacterial bloodstream infections). Out of a total of 12,611 bacteraemia in the North West in 2023, 1 in 5 was caused by bacteria resistant to 1 or more antibiotics from a defined group.

In 2023, London and North West regions continued (since October 2020, when mandatory reporting began) to report the largest number of acquired carbapenemase-producing Gram-negative bacteria.

The English Surveillance of Antibiotic Prescribing and Utilisation Report (ESPAUR) shows that the majority of antibiotic resistant bloodstream infections in the last 5 years (65%) were caused by E. coli – a common cause of urinary tract infections, diarrhoea, vomiting and fever.

Antibiotic resistant bacteria of any kind are less likely to respond to treatment, causing serious complications, including bloodstream infections, sepsis and hospitalisation. People who get a bacterial infection that is resistant to 1 or more antibiotics are more likely to die within 30 days compared to those who have an antibiotic sensitive infection.

Antibiotic resistance occurs naturally but managing antibiotic consumption and only using them when appropriate is essential to limiting the emergence of antibiotic resistant bacteria and associated deaths related to these infections.

This year’s report provides additional analysis of differences in antibiotic resistance burden in England in different populations and identifies geographical variation in the levels of antibiotics prescribed across England.

Nationally, total antibiotic consumption was 17.6 defined daily doses (DDDs) per 1,000 inhabitants per day (DID) in England in 2023, an increase of 2.4% in 2023 compared with antibiotic consumption in 2022.

Between 2019 and 2023, the greatest decrease in both total and secondary care antibiotic consumption was observed in the North West, by 5.1% and 13.9%, respectively.

With a rate of 18.4 DID in 2023, the North West is no longer the region with greatest level of antibiotic consumption.  

Most antibiotics in England are prescribed in primary care, with general practice accounting for 72% of overall prescribing in 2023. To strengthen antimicrobial stewardship in this key setting, UKHSA North West and NHS England North West delivered antimicrobial stewardship training (Treat Antibiotics Responsibly, Guidance Education and Tools) to 120 primary care prescribers across the region during 2023 and 2024. These trainers have now gone on to cascade the training to over 600 prescribers across the region, enabling clinicians to reduce inappropriate prescribing of antibiotics in general practice.

The problem of antimicrobial is not limited to bacteria resistant to antibiotics but also fungi and viruses resistant to antifungal and antiviral medicines, respectively.  

In 2023, the North West had the highest systemic antifungal prescribing rate and the highest reported incidence of fungaemia with 4.4 cases per 100,000 population.

Dr Will Morton, Consultant in Health Protection from UKHSA, said:- “Antibiotics are essential to treat serious bacterial infections, such as meningitis, pneumonia and sepsis but inappropriate use or overuse will mean they stop working against life-threatening conditions. Increasingly the first antibiotics that patients receive aren’t effective at tackling their infections. That’s not just an inconvenience – it means they are at greater risk of developing a severe infection and sepsis. This extends to everyone, as in the absence of effective antibiotics, cancer treatments and common surgeries like caesareans would become very high-risk procedures and for many people, could lead to infections that cannot be treated and may become fatal.  Our declining ability to treat and prevent infections is having an increasing impact, particularly on our poorest communities. While we work with partners to innovate new approaches and life-saving treatments, there are steps everyone can take. Take up the vaccinations you are eligible for, to help stop infections in the first place. Only take antibiotics if you have been told to do so by a healthcare professional. Do not save some for later or share them with friends and family. This isn’t just for your own health - it’s about protecting everyone in our communities and future generations.”

This latest data provides important insight into the scale of the problem we are facing and will help guide the goals set out in the new UK AMR National Action Plan 2024-2029 earlier this year. This includes ambitions to reduce total antibiotic use in human populations by 5% from the 2019 baseline and investments in new tools and technologies to develop long-lasting solutions.

Patient and campaigner, Caroline Sampson, explains how an antibiotic resistant infection has impacted her life:- “For 8 and a half years, I have had a chronic urinary tract infection (UTI). No form of antibiotics has successfully treated it. It has derailed by life in every possible way. I can no longer enjoy simple pleasures like eating out, going to the theatre or inviting friends over. The daily symptoms are debilitating and painful. Trying to accomplish the smallest task takes a huge amount of effort. The impact on my mental health has been enormous and I live with daily anxiety that the infection could develop into Urosepsis. I just want my life back. The threat of antibiotic resistant infections to us all cannot be underestimated.”