Antimicrobial Resistance trends in England, 2019 to 2024: ESPAUR Report 2024-25

Abstract

Introduction

Antimicrobial resistance (AMR) is a continuing concern globally; surveillance is essential to track the epidemiology and identify potential interventions to tackle AMR.

Methods

Laboratory surveillance data were analysed and used to describe AMR trends in bacteraemia and fungemia.¹ Burden of resistance (“AMR burden”) was estimated from reports of bacteria of public health importance from blood isolates resistant to one or more critical antibiotics (Table 1), with the detailed methods published within the ESPAUR report 2024-25 annex.²  

Table 1.

Bacteria of public health importance due to association with antibiotic resistance, and selected resistance profiles used to estimate AMR burden

Pathogens	Antibiotic class resistance
Gram-negative bacteria
Escherichia coli	carbapenems, third-generation cephalosporins, aminoglycosides, or fluoroquinolones
Klebsiella pneumoniae	carbapenems, third-generation cephalosporins, aminoglycosides, or fluoroquinolones
Klebsiella oxytoca	carbapenems, third-generation cephalosporins, aminoglycosides, or fluoroquinolones
Acinetobacter spp.	aminoglycosides and fluoroquinolones, or carbapenems
Pseudomonas spp.	3 or more antimicrobial groups, or carbapenems
Gram-positive bacteria
Enterococcus spp.	glycopeptides
Staphylococcus aureus	methicillin
Streptococcus pneumoniae	penicillin and macrolides, or penicillin alone

Results

AMR burden rates rose by 13.1% between 2019-2024, with most of the increase observed since 2023 (+9.3%). Enterobacterales accounted for 85.1% of the AMR burden in 2024, driving most of the increase since 2019. The pathogens with the largest increase in AMR burden rates between 2019-2024 were Klebsiella pneumoniae (+39.9%) and Staphylococcus aureus (+33.0%) (Figure 1).

Figure 1.

Annual estimated total burden of AMR bacteraemia episodes, England 2019-2024

The AMR burden varied by demographic factors. Rates (episodes per 100,000 population) were highest in London and lowest in the North East, and highest among individuals aged ≥74 years. Although most bacteraemia episodes caused by resistant pathogens (77.3%) occurred in the White ethnic group, the group with the highest resistance rate in bacteraemia episodes was the Asian or Asian British group, followed by the Black, African, Caribbean and Black British group. The proportion of bacteraemia episodes caused by resistant pathogens was higher in the Asian or Asian British population than in the White population across all age and sex groups, reaching 48.7% in females aged ≥74 years compared with 22.0% in the same group in the White population. Rates of resistant bacteraemia were highest in those living in the most deprived areas (most deprived quintile); 47.2% higher than those in the least deprived quintile (55.9 vs. 29.4 per 100,000). This 47.2% gap has increased from 29.0% in 2019 (Figure 2).

Figure 2.

Rate of resistant bacteraemia per 100,000 population in the most and least deprived IMD quintiles and gap between quintiles, England, 2019-2024. Permission for use granted by UKHSA ESPAUR team.

Between 2019 and 2024, reports of E. coli and K. pneumoniae resistant to multiple antibiotics increased, including resistance to third-generation cephalosporins, piperacillin-tazobactam and aminoglycosides. Rates of reported carbapenemase-producing organisms (CPOs) increased since mandatory reporting began in 2020, with isolates from sterile sites increasing by 123.9%¹.

Rates of fungaemia increased by 15.4% between 2020-2024, likely reflecting a combination of factors, including changing patient demographics, increasing numbers of at-risk patients, and improved detection and reporting. Candida albicans and Nakaseomyces glabratus (formerly Candida glabrata) accounted for 40% and 27% of yeast fungaemia reports, respectively. Rates of Candidozyma auris, both colonisation and infection, remained low but have risen steadily since 2020 (212 first-patient detections in 2024). This rapidly emerging, multidrug-resistant fungal pathogen has been linked to several large hospital outbreaks in 2024, concentrated in London and the South East, with most cases representing colonisation.

Conclusions

The burden of AMR and fungaemia increased in 2024 compared with 2023, surpassing pre-pandemic levels. Bacteraemia due to resistant pathogens continues to disproportionately affect populations in London, older age groups, individuals from non-White ethnic groups and those residing in the most deprived areas of England. Understanding resistance drivers, addressing inequalities and implementing targeted interventions will be essential to reduce the burden of AMR.