Table 2.1 Data sources for the AURA 2016 report Subject Type of surveillance Data source Type of data Setting Coverage Antimicrobial use Targeted – community acNAPS Appropriateness of prescribing, prescribing pattern Australian residential aged care facilities National (pilot covered 186 residential aged care facilities) Antimicrobial use Targeted – community MedicineInsight Appropriateness of prescribing, prescribing pattern Australian general practice National (182 general practices) Antimicrobial use Targeted – community ROGS Appropriateness of prescribing Australian general practice National (1000 general practitioners) Antimicrobial use Targeted – hospital NAPS Appropriateness of prescribing, prescribing volume Australian public and private hospitals National (248 hospitals; 44.2% of all hospital beds) Antimicrobial use Passive – community PBS/RPBS Dispensed volume Trends Australian general practices and community health services National (30 million prescriptions) Antimicrobial use Passive – hospital NAUSP Dispensed volume Australian public and private hospitals National (129 hospitals; >90% of principal referral hospitals and 82% of total beds in public hospitals with >50 beds) Antimicrobial resistance Targeted – community NNDSS of resistance, trends Australian general practices and community health services National (5 reference laboratories) Antimicrobial resistance Targeted – community NNN Rates of resistance, trends Australian general practices and community health services National (9 reference laboratories) Antimicrobial resistance Targeted – community AGAR of resistance, 30-day all-cause mortality Australian public and private hospitals (community National (28 laboratories) Antimicrobial resistance Targeted – hospital AGAR of resistance, 30-day all-cause mortality Australian public and private hospitals (hospital onset) National (28 laboratories)
2.4 Considerations for interpreting the data The AURA Surveillance System continues to develop the breadth and capacity of AMR and AU surveillance data for the hospital and community sectors. Although this report offers access to a range of data not previously available, a number of considerations should be noted: Limited data is currently available for AMR in the community, including residential aged care facilities. Data on AMR in public hospitals is from the OrgTRx passive surveillance system. For 2014, this includes data from public hospitals and health services from Queensland only. The OrgTRx system has recently expanded to include a large private sector laboratory service in Queensland and data captured by ACT Pathology (in the Australian Capital Territory). Further expansion of passive AMR surveillance through OrgTRx is under way, with discussions on including services in New South Wales, Tasmania, the Northern Territory and Victoria, and some other private sector laboratories. Future reports will therefore represent a greater breadth of data in this area. AMR data from private hospitals, residential aged care facilities and the community is from SNP. For 2014, this includes data from SNP services in Queensland and northern New South Wales only. The AURA Surveillance System has identified Salmonella and Shigella as priority organisms for surveillance. Data for these organisms is currently being captured through passive surveillance. The expansion of OrgTRx will increase the capacity to review and report on Salmonella and Shigella. At this stage of development of the system, while some elements of surveillance can be analysed for trends over time, there is insufficient longitudinal data to undertake time-series analyses across the board.
(restricted to infections resistant to amoxicillin) 7.1 Sinusitis (15%) Acute URTI (14%) Otitis (10%) Skin and wound infections (~10%) Higher use in cities, and patients with COPD or asthma 58% of prescriptions ordered with one or more repeats (often for COPD, sinusitis or bronchitis). Wide variation between practices in repeats for URTI Negligible private use Roxithromycin (general benefit) 3.4 URTI (30%) Lower respiratory tract infections (13%) Bronchitis (12%) Higher use in older patients, and patients with COPD or asthma. Higher use in Victoria and major cities 50% of prescriptions written with repeat. Repeats more common for COPD, tonsillitis, bronchitis or sinusitis. Wide variation in repeat prescribing across practices Negligible private use. Private prescriptions ordered for courses of longer duration than PBS courses Doxycycline (general benefit, restricted for some indications) 3.3 PBS/RPBS use: acne (16%), sinusitis (14%) Private use: travel (74%) Higher use in inner regional areas, and patients with COPD or asthma 50% of prescriptions had repeat (commonly for acne or COPD) 14% private use. Private prescriptions more likely to have longer duration of treatment Azithromycin (restricted benefit) 0.7 PBS/RPBS use: Chlamydia infections (55%); ear, eye, Highest use in Higher use in Western 7% of PBS/RPBS prescriptions and 18% of private prescriptions 42% private use
4.4 Enterococcus faecalis and E. faecium OrgTRxa – Queensland public hospitals and health services SNPa – Queensland and northern NSW communities, private hospitals and residential aged care facilities AGARb – national public and private hospitals 4.5 Mycobacterium tuberculosis NNDSSc,d – national hospitals and community health services 4.6 Neisseria gonorrhoeae NNNe – national hospitals and community health services 4.7 Neisseria meningitidis NNN – national hospitals and community health services
Pharmaceutical Benefits Scheme (PBS) An Australian Government program that subsidises medicines. principal referral hospital Major city hospitals with more than 20 000 acute casemix-adjusted separations per year, and regional hospitals with more than 16 000 acute casemix-adjusted separations per year. Repatriation Pharmaceutical Benefits Scheme (RPBS) An Australian Government program that subsidises medicines for veterans. targeted surveillance Data collection designed for a specific and targeted purpose. In this report, it refers to collections specifically designed for the surveillance of organisms. therapeutic group or class Categorisation of drugs that have similar chemical structure and spectrum. topical (medication) A medication that is applied to body surfaces such as the skin or mucous membranes; includes creams, foams, gels, lotions and ointments.