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The UK Health Security Agency’s (UKHSA) COVID-19 therapeutics programme was commissioned by the Department of Health and Social Care with the remit to evaluate the use and role of COVID-19 treatments. COVID-19 therapeutics data were assessed from two main data sources: novel therapy requests via Blueteq and medicines supply data via Rx-info. The five COVID-19 therapies in use in England between 1 October 2021 and 31 March 2022 included nirmatrelvir plus ritonavir, remdesivir, molnupiravir, sotrovimab, and casirivimab with imdevimab. During this time period, treatment requests for novel therapies against COVID-19 were submitted for nearly 52,000 patients in England. The UKHSAs COVID-19 therapeutics programme has been key to supporting the deployment of novel COVID-19 therapies in England by undertaking genomic, virological, and epidemiologic surveillance, through both national surveillance systems and academic collaboration. Effective therapies are particularly important for protecting the health of patients at greater risk of developing severe COVID-19. This national surveillance and stewardship programme was successfully rolled out at pace at the start of the pandemic and leads on work nationally to reduce the development of resistance. These findings were presented at the ESPAUR Report webinar on 23 November 2022.

Purpose: The objective of this prospective, observational study was to describe the treatment, severity assessment and healthcare resources required for management of patients with acute bacterial skin and skin structure infections who were unsuitable for beta-lactam antibiotic treatments. Methods: Patients were enrolled across five secondary care National Health Service hospitals. Eligible patients had a diagnosis of acute bacterial skin and skin structure infection and were considered unsuitable for beta-lactam antibiotics (e.g. confirmed/suspected methicillin-resistant Staphylococcus aureus , beta-lactam allergy). Data regarding diagnosis, severity of the infection, antibiotic treatment and patient management were collected. Results: 145 patients with acute bacterial skin and skin structure infection were included; 79% ( n = 115) patients received greater than two antibiotic regimens; median length of the first antibiotic regimen was 2 days (interquartile range of 1–5); median time to switch from intravenous to oral antibiotics was 4 days (interquartile range of 3–8, n = 72/107); 25% ( n = 10/40) patients with Eron class 1 infection had systemic inflammatory response syndrome, suggesting they were misclassified. A higher proportion of patients with systemic inflammatory response syndrome received treatment in an inpatient setting, and their length of stay was prolonged in comparison with patients without systemic inflammatory response syndrome. Conclusion: There exists an urgent need for more focused antimicrobial stewardship strategies and tools for standardised clinical assessment of acute bacterial skin and skin structure infection severity in patients who are unsuitable for beta-lactam antibiotics. This will lead to optimised antimicrobial treatment strategies and ensure effective healthcare resource utilisation.

This study developed a patient-level audit tool to assess the appropriateness of antibiotic prescribing in acute National Health Service (NHS) hospitals in the UK. A modified Delphi process was used to evaluate variables identified from published literature that could be used to support an assessment of appropriateness of antibiotic use. At a national workshop, 22 infection experts reached a consensus to define appropriate prescribing and agree upon an initial draft audit tool. Following this, a national multidisciplinary panel of 19 infection experts, of whom only one was part of the workshop, was convened to evaluate and validate variables using questionnaires to confirm the relevance of each variable in assessing appropriate prescribing. The initial evidence synthesis of published literature identified 25 variables that could be used to support an assessment of appropriateness of antibiotic use. All the panel members reviewed the variables for the first round of the Delphi; the panel accepted 23 out of 25 variables. Following review by the project team, one of the two rejected variables was rephrased, and the second neutral variable was re-scored. The panel accepted both these variables in round two with a 68% response rate. Accepted variables were used to develop an audit tool to determine the extent of appropriateness of antibiotic prescribing at the individual patient level in acute NHS hospitals through infection expert consensus based on the results of a Delphi process.