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Despite antimicrobial use in the community continuing to fall, overprescribing and inappropriate prescribing remains an ongoing threat that is fuelling antimicrobial resistance to commonly prescribed antibiotics, according to the Fourth Australian report on antimicrobial use and resistance in human health (AURA 2021), released by the Australian Commission on Safety and Quality in Health Care today.

Antimicrobial resistance is driven by the overuse and misuse of antimicrobials, including antibiotics. It is forecast that between 2015 and 2050, more than 10,000 Australians will have died because of antimicrobial resistance.

The AURA 2021 report provides a comprehensive picture of surveillance reports of antimicrobial use and prescribing in settings such as hospitals, the community and aged care homes.

The Antimicrobial Use and Resistance in Australia (AURA) Surveillance System was developed by the Commission to support the containment and prevention of antimicrobial resistance (AMR) by tracking patterns and trends across the nation.

While the latest report found overall use in antibiotics among the community has continued to decline since 2015, Australia nevertheless prescribes antimicrobials at a much higher rate than most European countries, and Canada.

In 2019, more than 40% of the Australian population (just over 10 million people) had a least one antimicrobial dispensed in the community, and more than 26.6 million prescriptions were dispensed for antimicrobials. The 2020 data revealed a decline of more than 30% in dispensing of antimicrobials under the Pharmaceutical Benefits Scheme during COVID-19.

“The gradual decline in prescribing since 2015 will need to be sustained in order to slow the spread of resistance,” said Professor John Turnidge, the Commission’s AURA Senior Medical Advisor.

“It is extremely concerning that AURA 2021 shows that many patients continue to be prescribed antimicrobials for conditions for which there is no evidence of benefit – including more than 80% of patients with acute bronchitis and acute sinusitis,” he said.

The report shows antimicrobial use has increased in hospitals, and that the rate of overall appropriateness of prescribing has remained the same for some time. Researchers will now review the data more closely to identify potential causes and enhance response strategies.

“There has also been a static rate of inappropriate antimicrobial prescribing in hospitals, particularly for chronic obstructive airways disease (COPD) and other respiratory conditions,” said Professor Turnidge.

“AURA 2021 highlights the need for continued interventions to address the issue of inappropriate prescribing, and antimicrobial stewardship programs within hospitals are central to this effort.”

The report also highlights a longstanding high level of inappropriate antimicrobial use and multidrug-resistance in aged care homes, strengthening the need for effective infection control and antimicrobial stewardship in the sector.

Professor Turnidge said the information gives clinicians and health policy makers across Australia the data and information they need to develop targeted approaches to prevent and contain resistance and improve the safety of care provided to patients in hospitals, the community, and aged care.

Significantly, the report also warns that antimicrobial resistance poses an ongoing risk to patient safety, with common pathogens such as E. coli, which routinely causes urinary tract infections and may cause infections in the bloodstream, becoming increasingly resistant to major drug classes.

Just over 40% of enterococci tested in 2019 were resistant to the antimicrobial vancomycin – a small decrease compared with 2017, but still higher than seen in more than 30 European countries. AURA 2021 also found that community-associated methicillin-resistant Staphylococcus aureus (MRSA) continues to be the most common type of MRSA infection in remote regions generally, and in far northern Australia in particular.

“AURA 2021 clearly identifies focus areas that need increased and ongoing attention – including reducing inappropriate prescribing of antimicrobials, particularly for skin and asymptomatic urinary tract infections in aged care; and improving the appropriateness of antimicrobial prescribing for COPD and other respiratory infections,” said Professor Turnidge.

Access the AURA 2021 report here