A report today from the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe shows antimicrobial resistance (AMR) is widespread throughout the region.
The joint report includes 2020 surveillance data collected by the European Antimicrobial Resistance Surveillance Network (EARS-Net) and the Central Asian and European Surveillance of Antimicrobial Resistance (CAERARS) network, which together cover 29 European Union/European Economic Activity (EU/EEA) and 12 WHO European Region countries, plus Kosovo. It's the first report in a series to be published jointly by ECDC and the WHO European Region, and it aims to bring AMR surveillance in Europe in 100% alignment.
"The resulting report is an essential element of ongoing surveillance efforts and, for the first time, provides an overview of the AMR situation in Europe and the information required for different actors across Europe to be able to take action against AMR," ECDC Director Andrea Ammon, MD, PhD, writes in a foreword to the report.
'Serious limitations' in treatment options
Among the topline findings from the joint report, which covers eight bacterial pathogens, are high levels of resistance to third-generation cephalosporins and carbapenems among Klebsiella pneumoniae isolates, with 30% of countries reporting carbapenem resistance at rates of 25% or higher. Carbapenem resistance was also common in Acinetobacter baumannii and Pseudomonas aeruginosa isolates.
"High percentages of resistance to third-generation cephalosporins and carbapenems in K. pneumoniae, and high percentages of carbapenem-resistant Acinetobacter spp. in several countries/areas, are of concern," the report states. "They suggest the dissemination of resistant clones in health-care settings and indicate the serious limitations in treatment options in many countries for patients with infections caused by these pathogens."
In addition, as in past reports, the surveillance data show a north-to-south and east-to-west gradient of resistance, with countries in southern and eastern Europe exhibiting higher rates of resistance, particularly among gram-negative bacteria. These trends are most evident for fluoroquinolone resistance in Escherichia coli, carbapenem resistance in K pneumoniae, and carbapenem resistance in Acinetobacter.
For example, while most countries in western Europe reported fewer than 1% of their K pneumoniae isolates were resistant to carbapenems, six countries in southern and eastern Europe reported that 50% or more of their K pneumoniae isolates were carbapenem-resistant.
"As antimicrobial-resistant bacterial microorganisms cannot be contained within borders or regions, these results underline the need for concerted action to combat AMR throughout the WHO European Region," the report states.
For most gram-negative bacteria under surveillance, changes in EU/EEA (excluding the United Kingdom) mean AMR percentages between 2016 and 2020 were moderate, with the exception of carbapenem resistance in E coli and K pneumoniae and vancomycin resistance in Enterococcus faecium, all of which saw significant increases over the period.
The report also notes that while large declines in community antibiotic consumption were reported in EU/EEA countries in 2020, concomitant large changes in AMR percentages were not observed in the EARS-Net data.
More commitment, resources needed
The report authors say that while 85% of European nations have committed to developing national action plans against AMR, many are only just starting to fund and implement effective interventions, high-level commitment is lacking, and programs to address infection prevention and control (IPC), antimicrobial stewardship, and surveillance are under-resourced.
"Public health action to tackle AMR remains insufficient, despite the increased awareness of AMR as a threat to public health and the availability of evidence-based guidance for IPC, antimicrobial stewardship and adequate microbiological capacity," they write. "AMR will be an increasing concern unless governments respond more robustly to the threat."
They also note that the COVID-19 pandemic is a "powerful reminder" that European governments will need more coordinated action and collaboration to combat AMR and other future public health threats.
Previous EU/EEA estimates indicate 670,000 infections each year on the continent are caused by resistant bacteria, and 33,000 people die as a result of those infections.
