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.

The 2019 Q4 update of the indicators below is being postponed due to the COVID-19 response:

  • Primary care antibiotic prescribing indicators 
  • Antimicrobial Resistance (AMR): Testing and resistance indicators for E. coli blood stream and urinary tract infections 

New indicators

October 2019 - The following new indicators have been added to the Antibiotic Prescribing Domain, Area: Acute Trust-

  • Total antibiotic prescribing DDDs per 1000 admissions; by quarter and acute trust
  • Carbapenem prescribing DDDs per 1000 admissions; by quarter and acute trust
  • Proportion of total antibiotic prescribing from the "Access" category of the WHO Essential Medicines List AWaRe index; by quarter and acute trust

Updated indicators

March 2020 - The following indicators have been updated in the Profile: AMR Local Indicators

Profile: AMR local indicators, Domain: Antibiotic Prescribing, Area: All Trust-  

  • Total antibiotic prescribing DDDs per 1000 admissions; by quarter and trust
  • Carbapenem prescribing DDDs per 1000 admissions; by quarter and acute trust
  • Proportion of total antibiotic prescribing from the "Access" category of the WHO Essential Medicines List AWaRe index; by quarter and acute trust

Profile: AMR local indicators, Domain: Health Care Associated Infection, Area: All Trust-

E. coli bacteraemia cases counts and 12-month rolling rates of community-onset, by reporting acute trust and month
E. coli hospital-onset cases counts and 12-month rolling rates, by reporting acute trust and month
E. coli bacteraemia cases counts and 12-month rolling rates, by reporting acute trust and month
E. coli completion of risk factor information, by NHS acute trust
E. coli known risk factor information, by NHS acute trus
E. coli completion of antibiotic information, by NHS acute trust
E. coli known antibiotic information, by NHS acute trust
Klebsiella spp. bacteraemia cases counts and 12-month rolling rates, by reporting acute trust and month
Klebsiella spp. hospital-onset cases counts and 12-month rolling rates, by reporting acute trust and month
Klebsiella spp. bacteraemia cases counts and 12-month rolling rates of community-onset, by reporting acute trust and month
P. aeruginosa bacteraemia cases counts and 12-month rolling rates of community-onset, by reporting acute trust and month
P. aeruginosa hospital-onset cases counts and 12-month rolling rates, by reporting acute trust and month
P. aeruginosa bacteraemia cases counts and 12-month rolling rates, by reporting acute trust and month
MRSA bacteraemia all cases counts and 12-month rolling rates, by acute trust and month
MRSA cases counts and 12-month rolling rates of community-onset, by reporting acute trust and month
MRSA cases counts and 12-month rolling rates of hospital-onset, by reporting acute trust and month
MSSA cases counts and 12-month rolling rates of community-onset, by reporting acute trust and month
MSSA bacteraemia cases counts and 12-month rolling rates of hospital-onset, by reporting acute trust and month
MSSA total cases counts and 12-month rolling rates, by reporting acute trust and month
C. difficile infection Hospital-Onset Healthcare Associated (HOHA) counts and rates, by acute trust and financial year
C. difficile infection community-Onset Healthcare Associated (COHA) counts and rates, by acute trust and financial year
C. difficile toxin tests per 1,000 bed-days carried out by reporting acute trust and quarter

February 2020 - The following indicators have been updated in the Profile: AMR Local Indicators

Supporting NHS England Initiatives, Antimicrobial Stewardship and Antibiotic Prescribing Domain, Area: All Trust -  

  • Percentage of single dose surgical antibiotic prophylaxis prescriptions that meet the NICE NG125 guidance regarding the choice of antibiotic for patients who have undergone elective colorectal surgery; by quarter
  • Percentage of antibiotic prescriptions for lower UTI in older people meeting NICE NG109 guidance and PHE Diagnosis of UTI guidance in terms of diagnosis and treatment: by quarter

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. 

Indicators Archived

  • CQUIN Stewardship Indicators

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

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 reviewed within 72 hours with a continue decision documented; by quarter

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

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

  • CQUIN Prescribing Indicators

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

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

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

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

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

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

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

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

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

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

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

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

  • CQUIN Sepsis Indicators

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

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

Recent updates

December 2019

Surveillance of surgical site infections in NHS hospitals in England annual Report for 2018 to 2019 https://www.gov.uk/government/publications/surgical-site-infections-ssi-surveillance-nhs-hospitals-in-england

Article on “Trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae: a segmented regression analysis of data from the European Union/European Economic Area, 2001-2018”

Article on https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2018

November 2019

PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) has published it’s 2019 report https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report

Article on Implementing a toolkit for the prevention, management and control of carbapenemase-producing Enterobacteriaceae in English acute hospitals trusts: a qualitative evaluation.

World Antibiotic Awareness Week and European Antibiotic Awareness Day

World Antibiotic Awareness Week (18 - 24 November) and European Antibiotic Awareness Day (18 November) provide an excellent opportunity to engage with healthcare workers and the public on tackling antimicrobial resistance. Senior NHS and health system leaders invite[1] you to: 

  • Register AMR awareness activities using the online registration form.
  • Use the PHE National AMR ‘Keep Antibiotics Working’ campaign materials in your activities to raise awareness amongst the public. The WAAW/EAAD/AG resources toolkit provides information and signpost to resources (leaflets, posters, social media posts) that can be used for local campaigns.  Get further creative ideas for local action via the shared learning pages on the Antibiotic Guardian website that highlight recent local and regional projects/campaigns on AMR that were peer-reviewed and shortlisted for the 2018 Antibiotic Guardian awards.
  • Use professional and/or organisation’s social media channels to promote key messages on AMR throughout the winter season; using the hashtags #KeepAntibioticsWorking and #AntibioticGuardian.

[1] Letter from Senior NHS and health system leaders to colleagues in CCGs, Trusts, professional organisations and universities  asking for their help in promoting the annual World Antibiotic Awareness Week, taking place in November. https://www.england.nhs.uk/publication/world-antibiotic-awareness-week-letter-from-senior-nhs-and-health-system-leaders/

An article published in Lancet ID https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30273-7/fulltext?dgcid=raven_jbs_etoc_email

October 2019 

PHE has launched new Infectious Disease Strategy https://www.gov.uk/government/news/public-health-england-launches-new-infectious-disease-strategy 

Intervention planning for Antibiotic Review Kit (ARK) article https://www.ncbi.nlm.nih.gov/pubmed/31430366 

Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWARE article https://www.ncbi.nlm.nih.gov/pubmed/31361000 

Article on The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study

Article on Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modelling study

Article on National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017: Evidence of sub-optimal practice

Article on Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

Article on Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review

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.