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Antimicrobial Use and Resistance in Australia Surveillance System

During 2019–20, the Commission continued operating the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System, which provides vital data and information to support Australia’s response to AMR. The Australian Government Department of Health has contracted the Commission since 2013 to establish and operate the AURA Surveillance System.

The AURA Surveillance System provides valuable data and reports to the public and private health systems, across the acute sector and community-based services, including aged care. This information provides an increasingly strong foundation for informed policy and clinical practice to prevent and contain AMR. Patient safety issues that were identified and reported in 2019–20 through the AURA Surveillance System include the following:

  • Community-associated multidrug-resistant Staphylococcus aureus is increasing, and is now the dominant cause of multidrug-resistant S. aureus bacteraemia reported to the Australian Group on Antimicrobial Resistance
  • Continuing increases in other AMRs were reported to the Australian Group on Antimicrobial Resistance; these reduce the effectiveness of common antibiotics for severe and multidrug-resistant infections, particularly non-susceptibility to ceftriaxone and fluoroquinolones in Escherichia coli, and vancomycin non-susceptibility in Enterococcus faecium
  • Overall low, but increasing, numbers of the critical AMRs were reported to the National Alert System for Critical Antimicrobial Resistances (CARAlert) during 2019, particularly carbapenemase-producing Enterobacterales
  • Reports of multidrug-resistant Shigella species to CARAlert increased by 218% in 2019 compared with 2018, which is concerning because empirical antimicrobial therapy choices for shigellosis may not be reliable
  • Minimal improvement in overall appropriateness of antimicrobial prescribing was reported to the Hospital National Antimicrobial Prescribing Survey (NAPS) between 2013 and 2018 – approximately one-quarter of prescriptions were inappropriate
  • Overall, compliance with national or local antimicrobial prescribing guidelines reported to the Hospital NAPS declined between 2013 and 2018
  • Although the appropriateness of surgical prophylaxis reported to the Hospital NAPS improved between 2013 and 2018, a little under one-third (28%) of surgical prophylaxis was inappropriately given for longer than 24 hours
  • The highest proportions of prescriptions assessed as inappropriate in the Hospital NAPS were for chronic obstructive pulmonary disease (COPD), surgical prophylaxis, non-surgical wound infections, community-acquired pneumonia and cystitis
  • Use of many broad-spectrum antibacterials reported to the National Antimicrobial Utilisation Surveillance Program (NAUSP) increased from 2016 to 2018, which is concerning because of the proportion of inappropriate prescribing of these agents in hospitals
  • The Aged Care NAPS found that

– almost 10% of aged care home residents were prescribed an antimicrobial in 2018; only 35.4% of these prescriptions were for residents with documented signs and/or symptoms of a suspected infection

– more than one-third of all prescriptions were for topical antimicrobials

– more than one-fifth were for prn (‘as needed’) administration

– there was poor compliance with documentation of indication for prescribing, and review and stop dates

– the majority of antimicrobials prescribed for prophylaxis were for urinary tract conditions, including asymptomatic bacteriuria, for which antimicrobial treatment is not recommended.

These findings mean that careful assessment of patients is required as they transfer between hospitals and the community, including aged care homes, to ensure that appropriate infection prevention and control measures and treatments are used. The Commission will continue to work with states, territories, the private hospital and aged care sectors, and relevant colleges and specialty societies to respond to these patient safety issues, with particular focus on guidance and support for improved prescribing in regard to COPD, inappropriate prescribing in aged care homes, and continued monitoring of surgical prophylaxis prescribing.