From ESPAUR to GLASS: A Three-Layer Comparative Analysis of AMR Surveillance and Stewardship Across England, 55 LMIC Member States, and Three High-Burden Countries (2019–2024)

Antimicrobial resistance (AMR) requires surveillance that connects national trends with global participation and local antimicrobial stewardship practice. This study compared England, 55 South Centre member states, and Bangladesh, Nigeria and India to identify shared threats, capacity gaps and priorities for UK Health Security Agency (UKHSA) international partnership. Three nested analyses were undertaken: secondary analysis of ESPAUR 2024–2025 data covering resistant bloodstream infections, antibiotic consumption, WHO AWaRe categories and National Action Plan targets; analysis of WHO GLASS enrolment among 55 South Centre member states as of November 2024; and evidence synthesis from PRISMA 2020 systematic reviews of antimicrobial stewardship in Bangladesh, Nigeria and India, covering 38 studies and 38,903 participants. England achieved two of four 2019–2024 National Action Plan targets, with Access antibiotics accounting for 63.2% of use. Total antibiotic consumption remained at 17.53 defined daily doses per 1,000 inhabitants per day, above the target of 16.92. Among the 55 states, 60% participated in AMR surveillance and 38% in antimicrobial use surveillance, with a 77% decline in enrolment during 2020–2021. Evidence from the three countries indicated Watch antibiotic use of 64–78.7%, culture-guided prescribing of 31–40%, substantial demand for training, and underused audit and feedback. The analysis identified three partnership priorities: adapting ESPAUR-style standardised dashboards for low- and middle-income countries; strengthening linked AMR and antimicrobial use surveillance; and developing postgraduate research and supervision partnerships to support stewardship capacity.