Tackling antimicrobial resistance is a top priority for the Commission and an integral part of many actions under the European Health Union, the European Commission announced on Friday ahead of the European Antibiotic Awareness Day.
The Awareness Day is European health initiative coordinated by the European Centre for Disease Prevention and Control (ECDC) and takes place across Europe each year on 18 November. It is part of the World AMR Awareness Week, which is organised annually by the World Health Organization (WHO) from 18 to 24 November.
This year’s focus is on the five targets for 2030 that were adopted by the Council last June on stepping up EU actions to combat antimicrobial resistance. These targets encompass a reduction in overall antibiotic consumption, specific antibiotic group preferences, and the mitigation of bloodstream infections caused by pathogens that are often resistant to several antibiotics at the same time.
Among others, the total consumption of antibiotics in humans should be reduced by 20 % compared to 2019. At least 65% of total antibiotic consumption in humans should be from the 'Access' group, as per WHO's AWaRe classification. Antibiotics in this group should be the first choice for common infections, as they contribute to a lesser extent to the emergence of antimicrobial resistance.
More than 35,000 people die from antimicrobial-resistant infections in the EU/EEA each year. The health impact of antimicrobial resistance (AMR) is comparable to that of influenza, tuberculosis and HIV/AIDS combined. A study carried out by the OECD, for the European Commission, warns that AMR costs EU/EEA countries around €11.7 billion a year.
“Tackling AMR is a public health priority and an economic necessity,” said Stella Kyriakides, Commissioner for Health and Food Safety. “The figures are concerning, showing that urgent and ambitious action is needed. We must work together, Member States, stakeholders as well as citizens to ensure that all necessary measures are taken to meet the agreed targets.”
She was referring to the latest data released by the ECDC on Thursday on antimicrobial resistance and antimicrobial consumption in the EU/EEA, as well as the EU progress on meeting AMR targets. ECDC also published infographics that summarise, for the EU and for each member state individually, progress towards the recommended targets to be achieved by 2030.
“While there has been slow progress in some areas, recent data suggest that antimicrobial resistance remains a significant challenge in the EU/EEA,” said ECDC Director Andrea Ammon at a digital press conference presenting the data.
Rebound of antibiotics after COVID-19
On the positive side, the total consumption of antibiotics in humans (community and hospital sectors combined) de decreased by 2.5% between 2019 and 2022, indicating slow progress towards the 20% reduction target by 2030. However, after the unprecedented reductions in 2020 and 2021, consumption rebounded in 2022.
This might indicate that the patterns of winter respiratory viruses, social contacts, hygiene habits and antibiotic-prescribing practices may now be similar to what they were before the COVID-19 pandemic, according to ECDC.
The pattern is the same in Belgium. As previously reported, antibiotics consumption in Belgium this year is lower than in 2016, but higher than in 2019, just before the pandemic, raising concerns that this will further drive resistance to treatments. Compared to other EU member states, Belgium has scored badly with regard to the average use of antibiotics and the use of second-line antibiotics.
Antimicrobial consumption is expressed as the number of defined daily doses (DDD) per 1 000 inhabitants per day. Figures vary widely by EU member states. The 2022 EU population-weighted mean total (community and hospital sectors combined) consumption of antibacterials for systemic use was 19.4 DDD per 1 000 inhabitants per day with a country range: 9.1–33.5.
Only nine EU member states have met or exceeded the target of 65% antibiotic consumption being from the 'Access' group, placing the EU overall at 59.8%. The number of EU member states at or above the 65% target has not changed since 2019. “EU progress can only be as good as the sum of the progress of each individual member states,” the ECDC Director emphasized.
The situation with resistant pathogens in many countries is alarming. She highlighted that the situation with carbapenem-resistant Klebsiella pneumoniae infections in the EU continues to deteriorate. The incidence of bloodstream infections with these bacteria increased by almost 50% between 2019 and 2022.
Klebsiella pneumoniae is a common cause of urinary tract, respiratory tract and bloodstream infections in healthcare, and is a frequent cause of hospital outbreaks if appropriate prevention and control measures are not taken. This is a concerning trend because there are very few effective treatments available for patients suffering these infections.
This goes against the goal of reducing these infections by 5% by 2030. “When looking at countries individually, the incidence varied widely between countries and 17 member states showed an increase rather than a decrease between 2019 and 2022,” said Dr Dominique Monnet, Head of Section, Antimicrobial Resistance and Healthcare-Associated Infections at the ECDC.
Are some infections antimicrobial resistant for all patients or does it also depend on their previous overconsumption of antibiotics?
Dr Monnet distinguishes between the risks on individual and population level. “The bacterial flora in the body is affected each time a person takes antibiotics,” he told The Brussel Times. “Many of the bacteria will become resistant and will stay resistant for some time which can last from 6 months to up to two years.”
There is no need to take antibiotics if they are not effective but if the situation deteriorates a physician should be consulted for advice, he added.
“On population level, there are areas, in particular in hospitals, where the care of patients depends on receiving effective antibiotics. These patients will receive more antibiotics and will become more resistant in the areas where they are treated. The higher the frequency of a percentage of the population receiving antibiotics, the higher the risk of infections becoming resistant to antibiotics.”
Antimicrobial resistance remains a major public health challenge in Europe and globally, concluded ECDC Director Ammon. “Antimicrobial resistance is a threat to human and animal health, as well as the environment, as microorganisms such as bacteria spread in and between all sectors. Therefore, this issue needs to be addressed with integrated action from multiple sectors, known as the One Health approach.”
M. Apelblat
The Brussels Times
