Aura 2016: first Australian report on antimicrobial use and resistance in human health



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AURA 2016

First Australian report on antimicrobial use and resistance in human health

© Commonwealth of Australia 2016

This work is copyright. It may be reproduced in whole or in part for study or training purposes, subject to the inclusion of an acknowledgement of the source.

Address requests and inquiries concerning reproduction and rights for purposes other than those indicated above in writing to:

AURA – Commonwealth Programs, Australian Commission on Safety and Quality in Health Care, GPO Box 5480, Sydney NSW 2001

or email AURA@safetyandquality.gov.au

Suggested citation: Australian Commission on Safety and Quality in Health Care (ACSQHC). AURA 2016: first Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC, 2016.

An online version of this report can be accessed at www.safetyandquality.gov.au.

ISBN: 978-1-925224-41-2 (print) 978-1-925224-42-9 (online)

Acknowledgements

Many individuals and organisations gave their time and expertise over an extended period to this report, and the Antimicrobial Use and Resistance in Australia (AURA) project, which were undertaken by the Commission. In particular, the Commission wishes to thank the Australian Government Department of Health, the Australian Group on Antimicrobial Resistance, the National Centre for Antimicrobial Stewardship, SA Health, Queensland Health, Pathology Queensland, Sullivan Nicolaides Pathology, NPS MedicineWise, the National Neisseria Network, the Australian Mycobacterium Reference Laboratory Network, and other key experts who have provided their time and considered advice. The involvement and willingness of all concerned to share their experience and expertise are greatly appreciated.

Members of the AURA Project Reference Group are Professor John Turnidge, Dr Phillipa Binns, Professor Marilyn Cruickshank, Dr Jenny Firman, Ms Aine Heaney, Mr Duncan McKenzie, Adjunct Professor Kathy Meleady, Dr Brett Mitchell, Professor Graeme Nimmo, Dr Alicia Segrave, Professor Karin Thursky, Dr Morgyn Warner, Professor Roger Wilson and Associate Professor Leon Worth.

The members of the Commission’s AURA team are also acknowledged for their significant contribution to the development of the AURA Surveillance System and this report.

Disclaimer

This report is based on the best data and evidence available at the time of development.

Edited and produced by Biotext Pty Ltd



Contents


Contents 3

Executive summary 4

What is antimicrobial resistance? 4

Key findings: antimicrobial use and appropriateness of prescribing 5

Antimicrobial use in hospitals 5

Antimicrobial use in the community – primary care 7

Antimicrobial use in the community – residential aged care facilities 9

Key findings: antimicrobial resistance 10

Resistance trends of concern 13

Key findings: international comparisons 14

Antimicrobial use in hospitals 14

Antimicrobial use in the community 15

Antimicrobial resistance 16

Future developments 20

Chapter 1 Introduction 22

Key messages 22

1.1 Background 22

1.2 Importance of antimicrobial resistance 23

1.3 Cost and impact of antimicrobial resistance to individuals and the community 23

1.4 Australian healthcare system context 24

1.5 Importance of surveillance 25

1.6 Developing the Antimicrobial Use and Resistance in Australia Surveillance System 29

Data collections contributing to the Antimicrobial Use and Resistance in Australia Surveillance System 31

1.7 AURA 2016 report 31



Chapter 2 Data sources and methods 33

Key messages 33

2.1 Types of data and information collected under the Antimicrobial Use and Resistance in Australia Surveillance System 33

2.2 Sources of data for antimicrobial use and appropriateness 34

2.3 Sources of data for antimicrobial resistance 35

2.4 Considerations for interpreting the data 38



Chapter 3 Antimicrobial use and appropriateness 39

Key messages 39

Hospitals 39

Community 39

Residential aged care facilities 39

3.1 Antimicrobial use in hospitals 40

Volume of antimicrobial use in hospitals 41

Appropriateness of prescribing in hospitals 58

Commentary 66

Gaps and improvements 68

3.2 Antimicrobial use in the community – primary care 70

Antimicrobial use in primary care 70

Appropriateness of prescribing in primary care 83

Commentary 89

Gaps and improvements 92

3.3 Antimicrobial use in the community – residential aged care facilities 93

Antimicrobial use in residential aged care 93

Appropriateness of prescribing in residential aged care 97

Commentary 98

Gaps and improvements 99



Chapter 4 Antimicrobial resistance 100

Key messages 100

4.1 Introduction 101

Priority organisms for surveillance 101

Data on priority organisms 102

4.2 Acinetobacter baumannii 106

Health impact 106

Treatment 106

Types and impact of resistance 107

Key findings (Queensland) 107

4.3 Enterobacteriaceae 108

Health impact 108

Treatment 109

Types and impact of resistance 109

Key findings (national) 110

Jurisdictional rates 117

Additional findings from targeted surveillance 122

4.4 Enterococcus species 126

Health impact 126

Treatment 127

Types and impact of resistance 127

Key findings (national) 127

Jurisdictional rates 131

Additional findings from targeted surveillance 135

4.5 Mycobacterium tuberculosis 138

Health impact 138

Treatment 138

Types and impact of resistance 138

Key findings (national) 139

Jurisdictional rates 140

National trends 141

4.6 Neisseria gonorrhoeae 142

Health impact 142

Treatment 142

Types and impact of resistance 143

Key findings (national) 143

Jurisdictional rates 144

National trends 145

4.7 Neisseria meningitidis 146

Health impact 146

Treatment 146

Types and impact of resistance 146

Key findings (national) 146

National trends 147

4.8 Pseudomonas aeruginosa 148

Health impact 148

Treatment 148

Types and impact of resistance 148

Key findings (Queensland) 148

4.9 Salmonella species 150

Health impact 150

Treatment 151

Types and impact of resistance 151

Key findings (national) 151

Additional findings from targeted surveillance on blood culture isolates 153

4.10 Shigella species 155

Health impact 155

Treatment 155

Types and impact of resistance 155

Key findings (Queensland) 155

4.11 Staphylococcus aureus 156

Health impact 156

Treatment 157

Types and impact of resistance 157

Key findings (national) 157

Jurisdictional rates 164

4.12 Streptococcus agalactiae 169

Health impact 169

Treatment 169

Types and impact of resistance 169

Key findings (Queensland) 169

4.13 Streptococcus pneumoniae 170

Health impact 170

Treatment 170

Types and impact of resistance 170

Key findings (Queensland) 171

4.14 Streptococcus pyogenes 173

Health impact 173

Treatment 173

Types and impact of resistance 173

Key findings (Queensland) 173

Chapter 5 International comparisons 176

Key messages 176

5.1 Antimicrobial use 176

Community use 177

Hospital use 180

5.2 Antimicrobial resistance 182

Escherichia coli 182

Klebsiella pneumoniae 186

Staphylococcus aureus and Enterococcus faecium 189

5.3 Commentary 191



Chapter 6 Emerging issues 193

Key messages 193

6.1 Carbapenem use in Australian hospitals 193

Current guidelines 197

Potential actions 197

6.2 Carbapenemase-producing Enterobacteriaceae and carbapenem resistance 198

Management of carbapenemase-producing Enterobacteriaceae infections 198

Impact and spread of carbapenemases 198

International spread of carbapenemase-producing Enterobacteriaceae 199

Carbapenemase-producing organisms in Australia 199

Implications for Australia 199

Potential actions 200

6.3 Antimicrobial use and appropriateness in surgical prophylaxis 200

Surgical National Antimicrobial Prescribing Survey 200

Results 200

Potential actions 201



Chapter 7 Conclusions and future developments 202

Key messages 202

7.1 Lessons from AURA 2016 202

7.2 Next steps for the AURA Surveillance System 204

National alert system for critical antimicrobial resistances 204

7.3 Future AURA reports 206



Appendix 1 Data source description 208

A1.1 Antimicrobial use collections 208

National Antimicrobial Utilisation Surveillance Program 208

National Antimicrobial Prescribing Survey 209

Pharmaceutical Benefits Scheme 210

Additional data and analysis 210

MedicineInsight program 211

Report on government services 2015 212

Bettering the Evaluation and Care of Health program 213

Aged Care National Antimicrobial Prescribing Survey 213

A1.2 Antimicrobial resistance collections 214

Australian Group on Antimicrobial Resistance 214

National Neisseria Network 215

National Notifiable Diseases Surveillance System 216

OrgTRx and Pathology Queensland 217

Sullivan Nicolaides Pathology 218



Appendix 2 Priority organisms 219

Appendix 3 Resources 221

A3.1 Australian reports and resources 221

A3.2 International surveillance reports 221

Appendix 4 Terminology 222

A4.1 Acronyms 222

A4.2 Common terms 222

References 225






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