About the AMR local indicators

Data have been uploaded across six domains:

  • Supporting NHS England Initiatives
  • Antimicrobial Resistance (AMR)
  • Antibiotic Prescribing
  • Healthcare-Associated Infections (HCAI)
  • Infection Prevention and Control (IPC)
  • Antimicrobial stewardship (AMS)

Antibiotic prescribing and antibiotic resistance are inextricably linked, as overuse and incorrect use of antibiotics are major drivers of resistance. AMR local indicators are publically available data intended to raise awareness of antibiotic prescribing, AMR, HCAI, IPC and AMS; and to facilitate the development of local action plans. The data published in this tool may be used by healthcare staff, commissioners, directors of public health, academics and the public to compare the situation in their local area to the national picture.

For further information about this profile, please click here to download the user guide.

New indicators

July 2019 - No new indicators have been added to the Fingertips website.

June 2019 - No new indicators have been added to the Fingertips website.

May 2019 - No new indicators have been added to the Fingertips website.

April 2019 - No new indicators have been added to the Fingertips website.

March 2019 - No new indicators have been added to the Fingertips website.

February 2019 - No new indicators have been added to the Fingertips website.

January 2019 - The following new indicators have been added to the "Supporting NHS England Initiatives" domain:

  • Quarterly proportion of patients admitted to inpatient departments who were screened for sepsis having met the appropriate criteria
  • Quarterly proportion of patients admitted to inpatient departments who received antibiotics within 1 hour of recognition of deterioration
  • Quarterly proportion of patients within the Emergency Department who were screened for sepsis having met the appropriate criteria
  • Quarterly proportion of patients who present with suspected sepsis to emergency departments and were administered intravenous antibiotics within 1 hour.

Updated indicators

Antibiotic Prescribing Domain-

August 2019 - The following have been updated in the Profile: AMR local indicator and within their respective Domains and Areas:

Defined daily dose of antibiotics dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 admissions

Defined daily dose of antibiotics dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 occupied bed-days

Defined daily dose of piperacillin/tazobactam dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 admissions

Defined daily dose of piperacillin/tazobactam dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 occupied bed-days

Defined daily dose of carbapenems dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 admissions

Defined daily dose of carbapenems dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 occupied bed-days

Four quarter rolling rate of total antibiotic prescribing per 1000 admissions; by acute trust

Four quarter rolling rate of piperacillin-tazobactam prescribing per 1000 admissions; by acute trust

Four quarter rolling rate of carbapenem prescribing per 1000 admissions; by acute trust and quarter

Proportion of total antibiotic prescribing from the "Access" category of the WHO Essential Medicines List AWaRe index

Total antibiotic prescribing DDDs per 1000 admissions; by quarter and acute trust

Carbapenem prescribing DDDs per 1000 admissions; by quarter and acute trust

Antimicrobial Stewardship Domain-

Percentage of antibiotic prescriptions with evidence of review within 72 hours; by quarter

Percentage of antibiotic prescriptions reviewed within 72 hours with a stop decision documented; by quarter

Percentage of antibiotic prescriptions reviewed within 72 hours with a stop, switch or IV to oral switch decision documented; by quarter

Percentage of antibiotic prescriptions reviewed within 72 hours with a continue decision documented; by quarter

Percentage of antibiotic prescriptions reviewed within 72 hours with an IV-oral switch decision documented; by quarter

Percentage of antibiotic prescriptions reviewed within 72 hours with a switch decision documented; by quarter

Percentage of antibiotic prescriptions with evidence of review within 72 hours by an appropriate clinician with a documented outcome plus an IV to oral switch assessment for IV prescriptions; by quarter

July 2019 - The following have been updated in the Profile: AMR local indicator and within their respective Domains and Areas:

Antimicrobial Resistance Domain-

  • Percentage of community E.coli urine specimens with susceptibility tests to trimethoprim; by quarter
  • Percentage of community E.coli urine specimens non-susceptibility to trimethoprim; by quarter
  • Percentage of community E.coli urine specimens with susceptibility tests to nitrofurantoin; by quarter
  • Percentage of community E.coli urine specimens non-susceptibility to nitrofurantoin; by quarter
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to a carbapenem; by CCG and by Quarter (2015 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to a 3rd Generation Cephalosporin (cefotaxime/ceftazidime/ceftriaxone/cefpodoxime); by CCG and by Quarter (2015 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to ciprofloxacin; by CCG and by Quarter (2015 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to gentamicin; by CCG and by Quarter (2015 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to piperacillin/tazobactam; by CCG and by Quarter (2015 Q1 onwards)
  • Rolling quarterly average proportion of E. coli blood specimens non-susceptible to at least 1 from key antimicrobials (gentamicin, ciprofloxacin, piperacillin/tazobactam, 3rd-generation cephalosporins, carbapenems; from English laboratories); by CCG and by Quarter (2015 Q4 onwards)
  • Rolling quarterly average proportion of 'multi-drug resistant' E. coli blood specimens from key antimicrobials (gentamicin, ciprofloxacin, piperacillin/tazobactam, 3rd-generation cephalosporins, carbapenems; from English laboratories); by CCG and by Quarter (2015 Q4 onwards)
  • Rolling quarterly average proportion of 3rd generation cephalosporin non-susceptible E. coli blood specimens (from English laboratories); by CCG and by Quarter (2015 Q4 onwards)
  • Rolling quarterly average proportion of ciprofloxacin non-susceptible E. coli blood specimens (from English laboratories); by CCG and by Quarter (2015 Q4 onwards)
  • Rolling quarterly average proportion of gentamicin non-susceptible E. coli blood specimens (from English laboratories); by CCG and by Quarter (2015 Q4 onwards)
  • Rolling quarterly average proportion of piperacillin/tazobactam resistant E. coli blood specimens (from English laboratories); by CCG and by Quarter (2015 Q4 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to gentamicin; by acute Trust and by Quarter (2016 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to a carbapenem; by acute Trust and by Quarter (2016 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to ciprofloxacin; by acute Trust and by Quarter (2016 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to piperacillin/tazobactam; by acute Trust and by Quarter (2016 Q1 onwards)
  • Percentage of E. coli blood specimens (from English laboratories) with susceptibility tests to a 3rd generation cephalosporin; by acute Trust and by Quarter (2016 Q1 onwards)
  • Rolling quarterly average proportion of ciprofloxacin non-susceptible E. coli blood specimens (from English laboratories); by acute Trust and by Quarter (2016 Q1 onwards)
  • Rolling quarterly average proportion of 3rd generation cephalosporin non-susceptible E. coli blood specimens (from English laboratories); by acute Trust and by Quarter (2016 Q1 onwards)
  • Rolling quarterly average proportion of piperacillin/tazobactam resistant E. coli blood specimens (from English laboratories); by acute Trust and by Quarter (2016 Q1 onwards)
  • Rolling quarterly average proportion of gentamicin non-susceptible E. coli blood specimens (from English laboratories); by acute Trust and by Quarter (2016 Q1 onwards)

Antibiotic Prescribing Domain, Area: CCGs (2018/19)

  • Total number of prescribed antibiotic items per 1000 resident individuals by quarter
  • Twelve month rolling total number of prescribed antibiotic items per 1000 individuals per day
  • Total number of prescribed antibiotic items per STAR-PU by quarter
  • Twelve month rolling total number of prescribed antibiotic items per STAR-PU
  • Percentage of prescribed antibiotic items from cephalosporin, quinolone and co-amoxiclav class
  • Twelve month rolling percentage of prescribed antibiotic items from cephalosporin, qunolone and co-amoxiclav class
  • Twelve month rolling proportion of trimethoprim class prescribed antibiotic items as a ratio of trimethoprim to nitrofurantoin

Area: GP

  • Total number of prescribed antibiotic items per 1000 registered patients by quarter
  • Total number of prescribed antibiotic items per STAR-PU by quarter
  • Percentage of broad spectrum prescribed antibiotic items (cephalosporin, quinolone and co-amoxiclav class) by quarter
  • Twelve month rolling proportion of trimethoprim class prescribed antibiotic items as a ratio of trimthoprim to nitrofurantoin

Area: Acute Trusts

  • Four quarter rolling rate of total antibiotic prescribing per 1000 admissions; by acute trust
  • Four quarter rolling rate of piperacillin-tazobactam prescribing per 1000 admissions; by trust
  • Four quarter rolling rate of carbapenem prescribing per 1000 admissions; by acute trust and quarter
  • Proportion of total antibiotic prescribing from the "Access" category of the WHO Essential Medicines List AWaRe index
  • Total antibiotic prescribing DDDs per 1000 admissions; by quarter and acute trust
  • Carbapenem prescribing DDDs per 1000 admissions; by quarter and acute trust
  • Defined daily dose of antibiotics dispensed by Acute Trustspharmacies to all inpatients and outpatients per 1000 admissions
  • Defined daily dose of piperacillin/tazobactam dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 admissions
  • Defined daily dose of carbapenems dispensed by Acute Trusts pharmacies to all inpatients and outpatients per 1000 admissions

Supporting NHS England Initiatives Domain, Area: Acute Trusts-

  • Quarterly proportion of patients admitted to inpatient departments who were screened for sepsis having met the appropriate criteria

  • Quarterly proportion of patients admitted to inpatient department who received antibiotics within 1 hour of recognition of deterioration

  • Quarterly proportion of patients within the Emergency Department who were screened for sepsis having met the appropriate criteria

  • Quarterly proportion of patients who present with suspected sepsis to emergency departments and were administered intravenous antibiotics within 1 hours

Infection Prevention and Control Acute Trust Domain, Area: Acute Trust-

  • Percentage of frontline healthcare workers vaccinated with the seasonal influenza vaccine

Financial year indicators by 1000 occupied bed-days – 92203, 92225 and 92223 will be published in August 2019

June 2019 - No new indicators have been updated on the Fingertips website.

May 2019 - No new indicators have been updated on the Fingertips website.

April 2019 - The following have been updated within their respective Domains:

  • All quarterly trust level indicators within the antibiotic prescribing and antimicrobial stewardship domains
  • All Sepsis CQUIN indicators within the Supporting NHS initiatives domain
  • Annual Antibiotic Guardians per 100,000 population by CCGs
  • Quarterly Antibiotic Guardians per 100,000 population by CCGs

March 2019 - The following have been updated within the Healthcare-Associated Infections Domain:

  • All monthly counts and rolling rates within the HCAI domain has been updated.

February 2019 - The following have been updated within the Healthcare-Associated Infections Domain:

  • Annual Surgical Site Infection Hip Prosthesis by acute NHS Trust and financial year 
  • Annual Surgical Site Infection Knee Prosthesis by acute NHS Trust and financial year

January 2019 - The following have been updated:

  • All monthly counts and rolling rates within the HCAI domain
  • All quarterly indicators within the antibiotic resistance, antibiotic prescribing and trust level antimicrobial stewardship domains

If you have any queries about the data shown on the AMR local indicators profile please email: AMR@phe.gov.uk

Interventions to reduce AMR

There are a number of actions that can be taken to reduce the burden of AMR. These include improved antibiotic prescribing as well as enhanced infection prevention and control, both for healthcare-associated and community-onset infections. The AMR resource handbook identifies current national policy, guidance and supporting materials in relation to antimicrobial stewardship and the infection prevention and control of healthcare associated infections in order to aid the reduction of antimicrobial resistance. 

Recent updates

August 2019

The 2019MRSA, MSSA and Gram-negative bacteraemia and CDI: annual reportwas published.

July 2019

The assessment of impact of participating in national SSI surveillance is published in a new issue, Journal of Hospital Infection here.

June 2019

Journal of Antimicrobial Chemotherapy published an article about Antibiotic prescribing for residents in long-term-care facilities across the UK here.

Measuring Appropriate Antibiotic Prescribing in Acute Hospitals: Development of a National Audit Tool Through a Delphi Consensus; Antibiotic Prescribing Appropriateness Measures (APAM) subgroup of the national Advisory Committee on Antimicrobial Resistance, Prescribing and Healthcare Associated Infection (ARPHAI) Antibiotics 2019, 8(2), 49; can be found here.

Antibiotic Guardian Campaign you can pledge to do your part to help reduce antibiotic resistance here.

May 2019

WHO has published a report that calls for urgent action to prevent antimicrobial resistance crisis - https://www.who.int/news-room/detail/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis 

April 2019

NHS England have published the specification for the 2019/20 CQUIN.  Supporting resources developed by NHS Improvement and PHE are available here.

NHS England have also published the NHS Standard Contract for 2019/20, this includes a service condition for NHS acute Trusts to continue reducing total antibiotic consumption.

December 2018

PHE has published surveillance of surgical site infections in NHS hospitals in England: 2017 to 2018.

October 2018

PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) has published its 2018 report.

Thirty-day all-cause fatality subsequent to MRSA, MSSA and Gram-negative bacteraemia and C. difficile infection: 2017 to 2018 has been published by PHE

PHE has re-launched the national "Keep Antibiotics Working" campaign for the 2018/19 winter season.

World Antibiotic Awarensss Week (12 to 18 Nov) and European Antibiotic Awareness Day (18 Nov) will soon be upon us.  Find supporting resources here.

July 2018

MRSA, MSSA and E. coli bacteraemia and C. difficile infection: annual epidemiological commentary published by PHE.

June 2018

The European Centre for Disease Control (ECDC) has published Clostridium difficile infections - Annual Epidemiological Report for 2016

ECDC has published a rapid risk assessment on the emergence of resistance to ceftazidime-avibactam in carbapenem-resistant Enterobacteriaceae

April 2018

PHE has published a study estimating the incidence and 30-day all-cause mortality rate of Escherichia coli bacteraemia in England by 2020/21

February 2018

Studies attempting to quantify the appropriateness of antibiotic prescribing in primary care published by PHE and research partners.