An annual antibiotic resistance surveillance report from Europe shows a spike in serious carbapenem-resistant infections, and a related assessment from the region's national experts suggests the problem is even more widespread, the European Centre for Disease Prevention and Control (ECDC) reported today.
The group released the reports as part of a yearly campaign to raise awareness about the antibiotic resistance threat. Both sets of findings are worrisome, because carbapenems are among the last-line antibiotics used to treat healthcare-associated infections.
News of the rise in carbapenem-resistant infections follows an ECDC report last year saying that carbapenem use rose significantly in European countries from 2007 to 2010, likely fueled by an overall rise in multidrug-resistant infections.
In the new surveillance report, the ECDC said the proportion of Klebsiella pneumoniae bloodstream infections climbed above 5% in five countries between 2009 and 2012. The experts' assessment, compiled through a self-assessment survey, revealed a serious new concern, the emergence and spread of carbapenem-resistant Acinetobacter infections, which exceed 35% in 8 of 18 countries that report data. The trend points to even more limited options for treating patients with those infections.
ECDC officials added Acinetobacter to the surveillance list last year after several countries noted increasing drug resistance, according to the full report. Of 30 countries, 18 reported data, with the percentage of carbapenem-resistant Acinetobacter ranging from zero to 88%.
Marc Sprenger, MD, PhD, ECDC director, said in a press release that since 2009, hospitals have been increasingly faced with treating patients who have carbapenem-resistant infections that often require use of older and more toxic drugs. "Given their very high proportion of carbapenem resistance, Acinetobacter infections already are a serious problem for hospitals in many European countries," he said.
For several antibiotic-resistant organisms, the ECDC saw lower percentages from the north and higher percentages from southern and eastern Europe, which it said could reflect geographic differences in infection control practices and antibiotic use.
Surveillance showed a continuing 4-year decline in methicillin-resistant Staphylococcus aureus (MRSA) infections, but the ECDC said MRSA remains a public health priority because the percentage is still about 25% in seven of 30 reporting countries.
The ECDC's self-assessment survey involved national experts from 38 countries; it included a wider scope of infections, not just the bloodstream ones detailed in the surveillance report. With other illnesses such as respiratory and urinary tract infections factored in, almost all countries reported carbapenem-resistant cases, with some reporting regional, inter-regional, or endemic spread.
The survey also asked about the availability of national guidance for controlling carbapenem-resistant infections. Just over half the countries had guidance documents in place, but 17 still lack such recommendations, and only 2 have guidance specific to managing resistant Acinetobacter infections.
Sprenger said in the ECDC statement that the need for national guidance documents is urgent so hospitals that detect carbapenem-resistant infections have a game plan for controlling the spread and minimizing the impact of outbreaks. "Together with infection control measures, improving antibiotic use is the most important action needed to greatly slow the very worrying development and spread of antibiotic-resistant bacteria," he stated.
The unveiling of the ECDC reports is part of its European Antibiotic Awareness Day activities, one of several global efforts to draw attention to the resistance threat. The US and Canadian governments both have antibiotic awareness week activities that start Nov 18.
See also:
Nov 15 ECDC statement
Nov 15 ECDC press release
ECDC 2012 report "Antimicrobial resistance surveillance in Europe," released Nov 15
ECDC 2013 technical report (survey of experts) "Carbapenemase-producing bacteria in Europe," released Nov 15
CDC "Get Smart About Antibiotic Week" Web page
Canadian "Antibiotic Awareness Week" Web page
