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

Abstract 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.