Belgium is gearing up to launch a new plan to combat antimicrobial resistance amid a global rise in infections resistant to common antibiotics.
Often called a “silent pandemic” by the World Health Organization (WHO), antimicrobial resistance, or AMR, refers to when microbes, such as bacteria or viruses, no longer respond to existing medicines, like antibiotics.
The phenomenon makes even common infections much harder to treat, amounting to additional costs for healthcare systems and threatening lives.
“AMR puts at risk the medical interventions that we take for granted,” said a WHO representative at a press conference last week. “It undermines the effectiveness of life-saving treatments and threatens the foundations of modern medicine.”
In Belgium, around 1,400 deaths in 2019 were directly attributed to AMR, while an additional 6,800 deaths were associated with it, according to figures cited by the Ministry of Health. Globally, AMR was linked to 1.14 million deaths in 2021, according to the WHO.
40% rise in five years
While bacteria can naturally become resistant over time, this process is often accelerated by the misuse or overuse of antimicrobials to treat or prevent infections in people, plants, or animals.
In a recently released report, the WHO found resistance to 22 antibiotics used to treat eight common bacteria, including E.coli and Salmonella.
The WHO highlighted that, between 2018 and 2023, antibiotic resistance within common infections rose by 40% worldwide.
Within the European Region, around one in ten bacterial infections were caused by a bacteria resistant to antibiotics in 2023, a positive trend compared to the global average of one in six.
Illustrative image of doctor pictured in the corridor of a hospital in Belgium. Credit: Belga/Dirk Waem
The Belgian scores varied depending on the bacteria. For example, regarding common intestinal E.coli, resistance to an antibiotic commonly used for serious infections was found in 9.2% of the samples studied, significantly below Europe’s 17.7% average.
Meanwhile, in bloodstream infections involving Salmonella bacteria, resistance was found in 45.7% of the cases, a higher proportion than the European average, where resistance was at 36.2%.
Despite the geographical variation in trends of resistance, the WHO underlined that AMR “knows no borders” and “affects and concerns everyone everywhere.”
Fragile patients in risky environments
In Belgium, a significant challenge remains “healthcare-associated infections with AMR bugs,” according to Dr Boudewijn Catry, the head of the Nosocomial Infections & AMR research unit at Belgium’s health institute, Sciensano.
For Catry, this is especially problematic because Belgium has a high rate of cancer survivors. This means that these particularly fragile patients often spend a long time in hospitals or other medical institutions, making them susceptible to healthcare-related infections.
“It has been estimated that around 70% of all AMR-related human infections are healthcare-associated,” he told The Brussels Times.
Illustrative image of a hospital room. Credit: Belga.
An additional issue for the expert is preserving last-line antimicrobials, which are typically used when all other antimicrobials fail. “A recent initiative from the Belgian medicines agency is taking care of this, with success,” he said.
Amid the list of hurdles, he notes there are delays in regional monitoring as well as key gaps in surveillance outside of human medicine, such as systematic AMR monitoring in veterinary pathogens.
Plan of action?
Despite challenges, Belgium does have several active projects which monitor the antimicrobial use and monitor resistance in both human and farm animal medicine, according to Dr Catry.
In addition, it has an “exceptional history of research and monitoring” of AMR in long-term care facilities such as nursing homes, he added.
The country is now set to launch its new National Action Plan against AMR (NAP-AMR), which will integrate several scientific institutes, laboratories and agencies.
Patient waiting at a hospital. Credit: Belga/Dirk Waem
Nonetheless, Dr Catry warns that progress to tackle AMR is impacted by a lack of understanding from political figures.
“Politicians are largely unaware that for research and public health, the administrative hurdles, given the current legislations (GDPR and NIS), are blocking efficiency and slowing down reaction time for new emerging threats and outbreaks,” he told The Brussels Times.
In addition, he calls for more up-to-date economic analysis and studies on the health impact and attributable mortality to healthcare-associated infections and AMR. “The last assessment of these indicators was alarming yet [they] are outdated,” he said.
'Trust your doctor'
While policies and experts are central to tackling AMR, citizens also have a crucial role, according to WHO’s Director of AMR, Dr Yvan JF Hutin.
In addition to preventing infection through regular basic hygiene and immunisation, such as with vaccines, he further urges people to understand the role of antibiotics in medicine.
“A fever does not automatically require an antibiotic…if the fever is, let’s say, due to a viral infection and you don’t receive an antibiotic, that’s completely okay,” he said. “Trust your doctor or your provider.”
