A new report from the European Centre for Disease Prevention and Control (ECDC) suggests that as many as 35,000 residents of the European Union die each year from complications caused by antimicrobial resistance (AMR).
The report was based on data collected from 2016 through 2020, with increasing deaths in each year—most notably among antibiotics of last resort.
With AMR causing roughly 100 deaths per day in the region, it’s more deadly than influenza, tuberculosis, and HIV/AIDS combined, the ECDC said.
"We see concerning increases in the number of deaths attributable to infections with antimicrobial-resistant bacteria, especially those that are resistant to last-line antimicrobial treatment," said Andrea Ammon, MD, MPH, the ECDC director, in a press release.
70% of infections healthcare-related
To gauge the impact of AMR on the region, the authors used annual rates of bloodstream infections (BSI) with antibiotic-resistant bacteria, adjusted the data with population coverage-corrected number of BSIs to other types of infections, and deducted the estimated number of secondary BSIs.
Between 2016 and 2020, the annual number of cases of infections with the included bacterium- antibiotic resistance combinations in the EU/European Economic Area ranged from 685,433 (95% uncertainty interval [UI], 589,451 to 792,873) in 2016 to 865,767 (95% UI, 742,802 to 1,003,591) in 2019. The authors said the annual number of attributable deaths ranged from 30,730 (95% UI, 26,935 to 34,836) in 2016 to 38,710 (95% UI, 34,053 to 43,748) in 2019.
Also of note, 70.9% of infections with antibiotic-resistant bacteria (95% confidence interval (CI), 68.2 to 74.0%) were healthcare-associated.
The largest burden of disease was caused by third-generation cephalosporin-resistant Escherichia coli, followed by methicillin-resistant Staphylococcus aureus and third-generation cephalosporin-resistant Klebsiella pneumoniae. Greece, Italy, and Romania had the highest burdens, after adjusting for population.
Rates higher in Southern Europe
AMR rates varied greatly by region. "As observed in previous regional reports, there is a north-to-south and west-to-east gradient of resistance, with higher rates observed in the southern and eastern parts of the European Region," the authors said. "This was particularly evident for third-generation cephalosporin and carbapenem resistance in K. pneumoniae and carbapenem resistance in Acinetobacter spp."
Though rates of AMR infections and deaths are increasing in Europe, there was a significant dip in 2020 to 2021, the authors say, largely because of behavior changes that took place during the first year of the COVID-19 pandemic.
Less community use of antibiotics was noted, and many elective surgeries and in-patient procedures were delayed, leading to a decrease in healthcare-associated infections.
Despite the overall decrease, cases of infections due to carbapenem-resistant Acinetobacter spp. increased during the first year of the pandemic. The authors said it is likely that resistance to this pathogen will continue to grow in 2022 and 2023.
"These findings imply that the situation with Acinetobacter spp. in the EU/EEA has deteriorated for the second year in a row. Acinetobacter spp. in healthcare is problematic since it can persist in the healthcare environment for long periods and is notoriously difficult to eradicate once established," the ECDC said.