UK Antimicrobial Registry: Virtual Registry-an innovative surveillance approach for monitoring the real-world use and effectiveness of newly licensed antimicrobials in Scotland

Background: Monitoring the real-world use of recently licensed antimicrobials (RLAs) is critical for antimicrobial stewardship. Traditional surveillance systems are resource-intensive and limited in scope. Objectives: The UK Antimicrobial Registry: Virtual Registry (UKAR:V) was established to determine whether routinely collected electronic healthcare data can generate robust, national-level evidence on the utilization, effectiveness and safety of RLAs in Scotland. Methods: This registry used linked data from Scotland’s Hospital Electronic Prescribing and Medicines Administration system and national datasets. Adults (≥18 years) prescribed any of 11 RLAs (cefiderocol, ceftazidime/avibactam, ceftolozane/tazobactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, eravacycline, ceftaroline, ceftobiprole, dalbavancin, delafloxacin, oritavancin) between June 2019 and June 2023 were included. Descriptive analyses summarized patient characteristics, prescribing patterns, infection types, microbiology results and outcomes. Results: Overall, 308 patients received 353 RLA prescriptions. Dalbavancin was commonly prescribed (70.5%), followed by ceftazidime/avibactam (13.3%). Microbiology results were available for 35% of patients. Pseudomonas aeruginosa (43.7%) and Klebsiella pneumoniae (19.5%) were the most common isolates for Gram-negative RLAs, while Staphylococcus aureus (50%) predominated among Gram-positive RLAs. Gram-negative RLAs were mainly used for severe respiratory and sepsis cases, whereas dalbavancin was used for skin, soft-tissue and device-related infections. Median treatment duration ranged from 7 to 12 days for Gram-negative RLAs and one dose for dalbavancin. Twenty-eight-day readmission was 25%–40% for Gram-negative RLAs and 29.8% for Gram-positive RLAs, while 6-month relapse ranged from ∼38% to 67% and 51.7%, respectively. No major linkage issues/failures were identified. Conclusions: UKAR:V shows that linked electronic data can support real-world RLA surveillance. With appropriate data linkage, this model offers a scalable, low-burden approach to monitoring utilization/outcomes providing a sustainable foundation for stewardship/policy and assessment of innovative reimbursement models.