Key facts
• Each year, over 35 000 people in the European Union (EU) die from infections resistant to antimicrobials. The mortality caused by these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined.*
• Each year, 4.3 million patients in the European Union/European Economic Area (EU/EEA) acquire at least one healthcare-associated infection during their stay in a hospital and many of these infections are resistant to antimicrobials.**
• On any given day, about 7%, or 1 in 14 patients in hospitals in the EU/EEA have at least one healthcare-associated infection.
1 in 3 microorganisms detected in healthcare-associated infections are bacteria resistant to important antibiotics, thus limiting options for treating infected patients
About the antimicrobial resistance (AMR) targets
A Council Recommendation*** adopted on 13 June 2023, outlines five targets related to antimicrobial consumption and resistance to be reached by 2030 by the EU and individual Member States, with 2019 as the baseline year.
EU Targets
• Reduce the total consumption of antibiotics in humans by 20%;
• At least 65% of the total consumption of antibiotics in humans comes from the ‘Access’ group of antibiotics as defined in the AWaRe classification of the WHO;
• Reduce the total incidence of bloodstream infections with:
• Meticillin-resistant Staphylococcus aureus (MRSA) by 15%;
• Third-generation cephalosporin-resistant Escherichia coli (E. coli) by 10%;
• Carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae) by 5%.
The recommended targets are an effective way of monitoring progress and achieving goals related to the prevention and reduction of antimicrobial resistance. They are concrete, measurable goals for the EU and for each EU Member State according to their individual situations.
Note: Antimicrobials are agents that target various microorganisms (bacteria, viruses, fungi, parasites), while antibiotics specifically target bacteria. In this document, the terms are used to focus on bacterial resistance. ‘Access’ group antibiotics are mostly first-line and second-line therapies that offer the best therapeutic value, while minimising the potential for antimicrobial resistance
Is the EU progressing towards the antimicrobial resistance targets?
There has been slow progress, and the latest data show regress in many areas, indicating that AMR remains a serious challenge in the EU/EEA. We need to strengthen and accelerate efforts to reduce unnecessary antimicrobial usage and improve infection prevention and control practices to achieve all the targets by 2030.
Total consumption of antibiotics in humans (community and hospital sectors combined)
The EU population-weighted mean total consumption of antibiotics was 1% higher in 2023 compared to 2019 (baseline year), thus indicating a regress from the 20% target reduction for the EU by 2030.
After unprecedented reductions during 2020 and 2021, antimicrobial consumption across the EU/EEA rebounded in 2022 and 2023 with consumption rates overall, and individually for the community and the hospital sector, close to 2019 levels. It is possible that factors related to the COVID-19 pandemic had an impact on consumption of antimicrobials in the previous years, such as the implementation of non-pharmaceutical interventions (e.g. lockdowns, teleworking, school closures, etc.) resulting in changes to communicable disease transmission, healthcare-seeking behaviour and antibiotic prescribing practices. With the COVID-19 pandemic having reached a phase of lower intensity, patterns of communicable diseases, social contacts, hygiene habits and antibiotic-prescribing practices may now be closer to what they were before the COVID-19 pandemic.
Percentage of total consumption of antibiotics in humans belonging to the “Access” group of antibiotics
The EU population-weighted mean percentage of ‘Access’ group antibiotics consumed was 61.5% in 2023, which was 0.4 percentage points higher than in 2019 (baseline year) and 3.5 percentage points below the 2030 target of 65%.
Only eight Member States have already reached the 2030 target of > 65% in 2023; however, all these countries already were at or above the target in 2019 (baseline year).
Incidence of bloodstream infections with meticillin-resistant Staphylococcus aureus (MRSA)
In 2023, the estimated EU incidence of MRSA bloodstream infections was 17.6% lower than in 2019 (baseline year), which means that the 15% reduction target was reached. For the EU overall, a statistically significant decreasing trend was detected between 2019 (baseline year) and 2023.
Incidence of bloodstream infections with third-generation cephalosporin-resistant Escherichia coli
The estimated EU incidence of third-generation cephalosporin-resistant E. coli bloodstream infections was 3.6% lower than in 2019 (baseline year). This represents progress towards the 10% reduction target by 2030.
Incidence of bloodstream infections with carbapenem-resistant Klebsiella pneumoniae
On the other hand, there was an increase by nearly 60% in the estimated EU incidence of carbapenem-resistant K. pneumoniae bloodstream infections between 2019 and 2023. This represents a worrying statistically significant increasing trend as, instead of progressing towards the 5% reduction target by 2030, the situation in the EU has worsened since 2019.
This is a worrying trend, given that very few therapeutic options remain available for patients infected with carbapenem-resistant K. pneumoniae, and those that are available are often limited (e.g. few new, recently approved antibiotics or combinations, as well as older antibiotics such as colistin). This trend points towards the need for strengthened and accelerated efforts to improve infection prevention and control to prevent further spread of carbapenem-resistant K. pneumoniae as well as other resistant pathogens in healthcare settings.
Other key messages related to the latest data
• The poor progress towards the EU targets on antimicrobial consumption and the continued increase in the consumption of WHO ‘Reserve’ and ‘broad-spectrum’ antibiotics highlights the need to strengthen efforts to address unnecessary and inappropriate antimicrobial use at all levels of healthcare (i.e. community, hospital and long-term care sectors) in the EU/EEA.
• Increases in the estimated EU incidences of bloodstream infections with resistant bacteria were observed not only for two of the above-mentioned AMR-pathogen combinations with an EU target, but also for many other bacteria and antimicrobial groups under surveillance. Some examples include antimicrobial-resistant K. pneumoniae (other than carbapenem-resistant), vancomycin-resistant Enterococcus faecium and piperacillin-tazobactam-, ceftazidime-, or carbapenem-resistant Pseudomonas aeruginosa.
• Moreover, for most gram-negative bacteria under surveillance, except for Acinetobacter spp., the recent changes in the estimated EU incidences of bloodstream infections with AMR indicate that, in the absence of stronger, swifter public health action, further increases may be expected in the coming years.
• The reported AMR percentages, and often also the estimated incidences of bloodstream infections with AMR, varied widely among EU/EEA countries. The highest estimated incidences of antimicrobial-resistant bloodstream infections were generally reported from countries in the south or south-east of Europe and the highest AMR percentages were generally reported by countries in the south and east of Europe.
• Overall, as in previous years, AMR levels remained high in the EU/EEA in 2023. In the absence of stronger and swifter public health action, it is unlikely that the EU will reach all its AMR targets by 2030. The consequence will be an increased number of infections with antimicrobial-resistant bacteria that will be more difficult to treat, leading to increasing challenges for patients and AMR-related deaths.
Infection prevention and control. What can be done?
• Good infection prevention and control practices in hospitals and healthcare settings are a must, starting with hand hygiene. Over 70% of the health burden of antimicrobial resistance in the EU/EEA is due to healthcare-associated infections with multidrug-resistant bacteria, half of which could be prevented through adequate infection prevention and control measures.
• Strengthening infection and prevention control measures, starting with hand hygiene and the use of alcohol-based hand rub for hand disinfection. This can be done by making sure that alcohol-based hand rub dispensers are available at bed side.
• Ensuring an adequate number of specialised infection control personnel, with up to 1 infection prevention and control nurse per 100 hospital beds.
• Ensuring, in each hospital, a sufficient number of single rooms, so there is capacity to isolate patients with multidrug-resistant bacteria. This point should be taken into account when building hospitals.
• In the community, many infections can be prevented through hand hygiene, vaccination and other measures such as respiratory etiquette and physical distancing, potentially resulting in a decreased need for antibiotics.
Prudent use of antibiotics
• Establishing and strengthening antimicrobial stewardship programmes in healthcare settings to ensure appropriate use of antibiotics, including prudent use of broad-spectrum antibiotics and further reduction of prolonged antibiotic use after surgical interventions.
• 90% of total human consumption of antibiotics is in the community sector, or outpatient setting. Avoiding antibiotics when they are not needed (such as viral illnesses) reduces the chance of bacteria becoming resistant to future treatments.
• Antibiotics are not effective against infections caused by viruses such as COVID-19, common colds or influenza. They should only be used to treat bacterial infections.
• Patients suffering from viral infections rarely develop bacterial infections as a complication, but if they do, they will require treatment with antibiotics. Antibiotics should be reserved for these situations and should not be taken without the advice of a medical doctor.
• Antibiotics do not work like painkillers and cannot relieve headaches, aches, pains or fevers. Taking antibiotics for the wrong reasons will not aid recovery, and may even cause side-effects such as diarrhoea, nausea or skin rashes.
• If symptoms persist, or if there are concerns about a person’s health, it is important to seek medical advice.
• If a healthcare professional, usually a medical doctor, confirms that antibiotics are necessary, they should be taken responsibly - i.e. at the correct dosage and intervals, ensuring that the course is completed.
What is antimicrobial resistance and why is it an issue?
• Antimicrobial resistance is the ability of bacteria to combat the action of one or several antimicrobials. Humans and animals themselves do not become resistant to antimicrobials, but the bacteria they carry can do so.
• Antimicrobials – mostly antibiotics – are commonly prescribed for the treatment or prevention of infections. Unnecessary use of antibiotics further contributes to the emergence of antimicrobial resistance, as bacteria can develop resistance when they are exposed to antibiotics.
• The situation with antimicrobial resistance is getting worse, and new bacterial strains are emerging that are resistant to several antibiotics at the same time (known as multidrug-resistant bacteria). A major antimicrobial resistance problem, especially in hospitals, is the emergence of bacteria that are resistant to last-line antimicrobials, which severely limits treatment options for infected patients. Such bacteria may eventually become resistant to all existing antimicrobials.
• Without effective antibiotics, we could return to the ‘pre-antibiotic era’, and it would be difficult, if not impossible, to safely perform organ transplants, cancer chemotherapy, intensive care or other medical procedures. Bacterial diseases which were once preventable would spread and it would no longer be possible to treat infections.
Information on specific bacteria
• Klebsiella pneumoniae (K. pneumoniae) is a common cause of urinary tract, respiratory tract and bloodstream infections and is a frequent cause of hospital outbreaks, if appropriate prevention and control measures are not taken. Very few therapeutic options remain available for patients infected with multidrug-resistant K. pneumoniae that have additional resistance to carbapenems. Options are often limited to new, recently approved antibiotics or combinations, as well as older antibiotics such as colistin - an antibiotic from the polymyxins group.
• Escherichia coli (E. coli) is one of the most frequent causes of bloodstream infections and community- and healthcare-associated urinary tract infections worldwide.
• Acinetobacter is a group of bacteria commonly found in the environment (e.g. in soil and water). The most common cause of infections in humans is Acinetobacter baumannii, which can cause infections in the blood, urinary tract, and lungs (pneumonia), or in wounds on other parts of the body. Acinetobacter can also ‘colonise’ or live in a patient without causing infections or symptoms, especially in respiratory secretions (sputum) or open wounds. Very few therapeutic options remain available for patients infected with multidrug-resistant Acinetobacter baumannii. Options are often limited to new, recently approved antibiotics or combinations, as well as older antibiotics such as colistin - an antibiotic from the polymyxins group.
• Streptococcus pneumoniae (S. pneumoniae) is often found in the nose and throat, and spreads through droplets produced by an infected person when coughing or sneezing. S. pneumoniae invasive infections are those where bacteria are found in normally sterile sites, such as the blood, and these infections cause more serious issues such as sepsis, meningitis, and osteomyelitis. These infections have the highest impact on young children and the elderly.
Turning the tide on antimicrobial resistance
We all have a responsibility to use antimicrobials prudently - both patients and the public at large. As we are all potential users of antimicrobials at some point in our lives if we contract an infection, it is vital to retain the ability to treat these infections.
Healthcare professionals have an additional responsibility because they prescribe (doctors, veterinarians), dispense (pharmacists), administer (nurses) or use antimicrobials. Policymakers, governmental and non-governmental organisations also have a role to play in the responsible use of antimicrobials.
Ensuring that antimicrobials remain effective now and in the future is a shared responsibility for us all, as patients, parents, doctors, policymakers, nurses, pharmacists, healthcare personnel, veterinarians, farmers and individuals.
Notes:
*35 000 annual deaths from antimicrobial resistance in the EU/EEA
**Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals – 2022-2023
***Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach (2023/C 220/01)
