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Despite the use of antibiotics falling for the first time in two decades, they continue to be overprescribed, leading to numerous dangerous bacteria growing increasingly resistant to common antimicrobials.

In 2017, more than 10 million Australians had at least one antibiotic dispensed in the community and more than 26.5 million prescriptions for antimicrobials were dispensed.

The findings emerge from the Australian Commission on Safety and Quality in Health Care’s latest report – Antimicrobial Use and Resistance in Australia 2019: Third Australian report on antimicrobial use and resistance in human health (AURA 2019) – launched in Sydney today.

The AURA 2019 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.

Data in the report pinpoints priority organisms for Australia, the volume of antimicrobial use, the appropriateness of antimicrobial prescribing, emerging issues for antimicrobial resistance and how Australia compares to other countries.

The report warns antimicrobial resistance, driven by the overuse and misuse of antibiotics, shows no signs of slowing down and is having a major impact, especially on seriously ill patients in hospitals that demands greater efforts to control spread.

It lists common pathogens such as E.coli, salmonella, Neisseria gonorrhoea and Neisseria meningitides as becoming increasingly resistant to major drug classes, with some organisms resistant to last-resort treatments.

Positively, the report found that the overall use of antibiotics in the community fell between 2015 and 2017 for the first time in 20 years, which it attributes to ongoing and coordinated campaigns targeting prescribers and consumers on the risks of using the medications inappropriately.

Nevertheless, it found almost half the samples of enterococci tested across Australia were resistant to the antibiotic vancomycin and that community-associated methicillin-resistant Staphylococcus aureus (MRSA) has become the most common type of infection, particularly in nursing homes.

“While the downward shift in prescribing will help slow the spread of resistance, these latest AURA findings indicate that the levels of inappropriate prescribing of antibiotics in hospitals and the community are still too high and there is more work to be done,” said Dr Kathryn Daveson, AURA Clinical Director.

Some key findings on antimicrobial use from AURA 2019 show:

  • In Australian hospitals in 2017, 23.5% of antimicrobial prescriptions assessed were found to be inappropriate
  • Antibiotics used in surgery are often not required and given for too long
  • Cefalexin and amoxicillin-clavulanic acid recorded the highest rates of inappropriate prescribing in Australian hospitals that contributed to the National Antimicrobial Prescribing Survey (NAPS)
  • A national shortage of piperacillin-tazobactam in 2017 impacted on patterns of antibiotic use in hospitals, including increased use of cephalosporins
  • There is a high rate of use of antimicrobials for unconfirmed infections in aged care homes, with more than half of the prescriptions for residents who had no signs or symptoms of infections
  • A large percentage of patients participating in MedicineInsight practices were prescribed antibiotics for conditions for which there is no evidence of benefit, including influenza (52.2%) and acute bronchitis (92.4%)

The findings from the report have triggered numerous focus areas for improved action, including reducing inappropriate prescribing of broad spectrum antibiotics, particularly for urinary tract and skin infections, and improving antibiotic prescribing for chronic obstructive pulmonary disease and other respiratory infections.

In aged care, the report says enhanced infection prevention and control, and antimicrobial stewardship efforts in nursing homes and hospitals can improve the safety of care provided to residents.

Professor John Turnidge, the Commission’s Senior Medical Advisor, said the report provided a key resource for clinicians and health policymakers in Australia’s fight against the threat of increased antimicrobial resistance, particularly Critical Antimicrobial Resistances (CARS), resistant to last-line antibiotics.

“The expanded AURA Surveillance System allows us to identify and track national trends in antimicrobial use and antimicrobial resistance, and monitor the effect of changes in policy and clinical practice to a level that has not previously been possible.”

Read the full report