The Australian Commission on Safety and Quality in Health Care (ACSQHC) recently released AURA 2016 – Australian report on antimicrobial use and resistance in human health. This detailed report analyses diverse existing national sources of data and underpins Australia’s recently released ‘One-Health‘-style National Antimicrobial Resistance Strategy 2015-2019 and will serve as an important baseline for future AMR control efforts.
AURA 2016 includes:
- Antimicrobial prescribing and dispensing in the community
- Antimicrobial use in hospitals, residential aged care facilities and multipurpose services
- Appropriateness of antimicrobial prescribing in hospitals, general practice, residential aged care facilities (RACFs) and multipurpose services
- Rates of resistance for a set of priority microbes
- Overall rates of use of aminoglycosides, cephalosporins, fluoroquinolones and macrolides (the four classes most likely to drive AMR) have declined in larger hospitals but vary widely by State and facility for unexplained reasons
- The most commonly prescribed antimicrobials are amoxicillin+clavulanate, followed by flucloxacillin, cefazolin and amoxycillin
- The 2014 NAPS surveys showed that 23% of antibiotic prescriptions in hospitals were judged to be inappropriate, most commonly in the categories of surgical prophylaxis and lower respiratory tract infection. Furthermore, 24.3% of prescriptions were noncompliant with guidelines.
- 46% of Australians were dispensed at least one antimicrobial in 2014 under the PBS (not including private prescriptions).
- More than 50% of patients who identified as having a cold or other upper respiratory infection were unnecessarily prescribed an antimicrobial.
- GPs generate the majority of prescriptions in the community (88%) with other prescribers including dentists, optometrists, midwives and nurse practitioners.
- Generally, rates were highest in areas of lowest socioeconomic status, consistent with decreasing socioeconomic status being associated with poorer health and higher infection rates.
Residential aged care facilities
- 11.3% of residents were on antimicrobials but only 4.5% had a suspected or confirmed infection
- Urinary tract infection (including asymptomatic bacteriuria) and unspecified skin and soft tissue infection were the commonest inappropriate indications
- Detailed analyses are provided concerning a large range of bacterial species of importance including tuberculosis
- Resistance in gram-negative organisms (E. coli, Klebsiella pneumoniae etc) are comparatively lower than most other countries in contrast to the incidence of resistant gram-positives (Staphylococcus aureus –MRSA, Enterococcus faecium-VRE) which is high to very high. Australia has one of the highest rates of healthcare-associated vancomycin resistant enterococci (VRE) in the world (see below).
- Resistance of ceftriaxone and azithromycin in Neisseria gonorrhoeae are low in Australia (5% and 2% respectively) but are slowly trending upwards.
- Australia has low rates of Gram negative resistance to fluoroquinolones compared with other countries, reflecting the restricted community use of this antimicrobial class in Australia.
Australian Commission on Safety and Quality in Health Care. AURA 2016 – First Australian report on antimicrobial use and resistance in human health. (June 16, 2016).