35 000 annual deaths from antimicrobial resistance in the EU/EEA

“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, ECDC Director. “Each day, nearly 100 people die from these infections in the EU/EEA. Further efforts are needed to continue to reduce unnecessary antimicrobial use, improve infection prevention and control practices, design and implement antimicrobial stewardship programmes and ensure adequate microbiological capacity at national level.” 

Overall, the latest data show significantly increasing trends in the number of infections and attributable deaths for almost all bacterium–antibiotic resistance combinations, especially in healthcare settings. In 2021, the number of reported cases of Acinetobacter species resistant to different antimicrobial groups was more than double (+121%) than the average for 2018−2019. Another example is the percentage of Klebsiella pneumoniae cases that are resistant to carbapenems – an antibiotic often used as a last resort - of which there was a 31% increase in 2020 and a further 20% increase in 2021. These are pathogens that are difficult to eradicate once established in healthcare settings. Moreover, the number of Candida auris reported cases nearly doubled between 2020 and 2021 and were considerably higher than in previous years. Candida auris is a fungal pathogen that causes outbreaks of invasive healthcare-associated infections and can be resistant to multiple antifungal agents. 

A decrease of 23% in total antimicrobial consumption in humans, in the primary care and hospital sectors combined, was observed in the EU/EEA during the period 2012–2021. Although this represents an achievement, there has been an increase in the proportion of ‘broad-spectrum’ antibiotics that were used, in particular in hospitals. Between 2012 and 2021 in hospitals, consumption of ‘broad-spectrum’ antibiotics increased by 15%, consumption of carbapenems by 34% and the proportion of ‘Reserve’ antibiotics – that is antibiotics that should be reserved for treatment of confirmed or suspected multidrug-resistant infections - more than doubled in the same timeframe.  

The reported AMR percentages varied widely among countries for several bacterial species–antimicrobial group combinations. In general, the lowest AMR percentages were reported by countries in the north of Europe, and the highest by countries in the south and east of Europe. 

Notes to the editor

• Klebsiella 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 with additional resistance to carbapenems and are often limited to combination therapy and older antibiotics, such as colistin, an antibiotic from the polymyxins group.

• Acinetobacter species cause healthcare-associated infections and often result in hospital outbreaks if appropriate prevention and control measures are not implemented. They can persist in the healthcare environment and are difficult to eradicate once established.
   
• Candida auris poses a risk for patients in healthcare facilities due to its ability to cause infections in critically ill patients. Candida auris can be resistant to multiple antifungal agents, which makes infections difficult to treat.

• Patients hospitalised with severe COVID-19 are at risk of healthcare-associated infections, including Acinetobacter spp. and Candida spp. bloodstream infections, and various outbreaks of Candida auris among COVID-19 patients have been reported worldwide.

• The latest ECDC data are released in connection with the European Antibiotic Awareness Day (EAAD), a European health initiative coordinated by ECDC, which provides a platform and support for national campaigns on the prudent use of antibiotics. Each year, EAAD is marked by national campaigns on or around 18 November. Please visit http://antibiotic.ecdc.europa.eu for more information and follow the discussion on social media. Follow the hashtags #EAAD and #AntibioticResistance.

• EAAD takes place in partnership with the World Antimicrobial Awareness Week (WAAW), a WHO initiative which takes place between 18 and 24 November each year. Follow the hashtags #WAAW #AntimicrobialResistance see http://www.who.int/campaigns/world-antibiotic-awareness-week/en/ for more information.