New data released today by the European Centre for Disease Prevention and Control (ECDC) indicate that the European Union (EU) is not on track to meet targets for reducing antimicrobial resistance (AMR) and antibiotic consumption.
The data from the European Antimicrobial Resistance Surveillance Network (EARS-Net), released in conjunction with European Antibiotic Awareness Day, show that AMR levels remained high across the continent in 2023. Most troubling was a nearly 60% increase in bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae compared with the baseline year of 2019.
Surveillance of hospital and community-level antibiotic consumption in the EU, meanwhile, showed an increase from 2019. Levels of AMR and antibiotic consumption in 2023 were both above 2030 targets set by the Council of the European Union.
At a press conference, ECDC Director Pamela Rendi-Wagner, MD, noted that estimates based on EARS-Net data indicate that more than 35,000 people in the EU die each year from a drug-resistant infection, and more than 4.3 million European hospital patients acquire a healthcare-associated infection—many of them antibiotic-resistant—during their hospital stay.
"These numbers show one thing: that the problem is indeed huge," Rendi-Wagner said. "AMR takes a tremendous toll on patients and their families."
A 'growing threat' to hospital patients
The EARS-Net report contains both good and bad news. On the positive side, the estimated EU incidence of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections in 2023 (4.64 per 100,000 population) was 17.6% lower than 2019 and 0.15/100,000 lower than the 2030 target. Incidence of third-generation cephalosporin-resistant Escherichia coli bloodstream infections (10.35/100,000) was 3.6% lower than 2019.
But incidence of carbapenem-resistant K pneumoniae bloodstream infections (3.97/100,000), which are resistant to multiple antibiotic classes and have severely limited treatment options, was 57.5% higher than 2019 and 1.58/100,000 higher than the 2030 target. And incidence of third-generation cephalosporin-resistant E coli bloodstream infections was 0.68/100,000 higher than the 2030 target.
"This poses a growing threat to patients in hospitals across the EU, in almost all member states," said Dominique Monnet, PharmD, PhD, head of the ECDC's Antimicrobial Resistance and Healthcare-Associated Infections program. "These are primarily healthcare-associated infections."
EARS-Net data also show increases in bloodstream infections caused by other resistant pathogens, including vancomycin-resistant Enterococcus faecium and piperacillin-tazobactam-, ceftazidime, and carbapenem-resistant Pseudomonas aeruginosa.
As in past years, the situation varies across the continent. While some EU countries have made progress, others are lagging. The highest estimated incidence of drug-resistant bloodstream infections was generally reported in countries in south or southeast Europe.
"Europe is, overall, trending in the wrong direction," Rendi-Wagner said. "We really need to make a concerted effort to harmonize progress across member states, to share our experiences, and to share solutions."
With healthcare-associated infections accounting for 70% of the AMR-related health burden in Europe, ECDC officials are calling on hospitals to prioritize infection prevention and control measures. These include basic steps like improving hand hygiene, along with increasing hospital screening of patients for carriage of resistant bacteria, increasing the capacity to isolate such patients, and boosting the number dedicated infection prevention and control staff.
Uptick in antibiotic consumption
The European Surveillance of Antimicrobial Consumption Network (ESAC-Net) report, meanwhile, shows that antibiotic consumption in 2023 rose by 1% from 2019, despite sharp declines in community antibiotic use in the first 2 years of the COVID-19 pandemic. The EU population-weighted mean total consumptions of antibiotics for systemic use in 2023 was 20.1 defined daily doses (DDD) per 1,000 inhabitants per day—4.1 DDD/1,000 inhabitants per day higher than the 2030 target, which calls for a 20% reduction in systemic antibiotic use.
The community sector accounted for 90% of that use, with 18.3 DDD/1,000 inhabitants per day. The most consumed subgroup of antibiotics in the community was penicillins (47%). In the hospital sector, population-weighted mean consumption of antibiotics was 1.6 DDD/1,000 inhabitants per day.
Europe is, overall, trending in the wrong direction....We really need to make a concerted effort to harmonize progress across member states, to share our experiences, and to share solutions.
As with AMR levels, progress across the continent on antibiotic consumption was uneven. While nine countries reported progress toward reaching their 2030 target, 14 countries regressed, with some seeing double-digit increases in antibiotic consumption from 2019 to 2023.
In addition to calling to for renewed focus on infection prevention and control in hospitals, Rendi-Wagner said the ECDC will also continue to urge development of and access to new antibiotics and promote antimicrobial stewardship efforts, both in hospitals and at the community level.
"Public health awareness campaigns targeting AMR are needed more than ever, and these should be complemented by social and behavioral interventions," she said.
