ECDC calls for continued action to address antimicrobial resistance in healthcare settings

The findings show that practices in terms of antimicrobial use vary from country to country throughout Europe and that, overall, there is room for improvement. Furthermore, healthcare-associated infections remain a serious issue, with 8.9 million occurring each year in both hospitals and long-term care facilities. Overuse of antimicrobials – mostly antibiotics – and varying infection prevention and control practices may result in the increased emergence and spread of multidrug-resistant bacteria in the EU/EEA. 

Vytenis Andriukaitis, European Commissioner for Health and Food Safety, said:

“The rising number of   Europeans who are dying or who become disabled from infections that are resistant to antimicrobials is of great concern to me and to the European Commission. We can avoid many of these deaths by stopping the unnecessary use of antimicrobials in healthcare and in agriculture, and through better diagnosis and prevention of infection in healthcare settings and communities. I am proud of the work that our partners in EU Member States, together with the European Commission and the EU agencies, do to implement the European One Health Action Plan against Antimicrobial Resistance. I call on everyone who has influence on the prevention and treatment of infections to redouble their efforts to combat this threat”.  

The studies showed that there still are sources of unnecessary use of antimicrobials in hospitals and in long-term care facilities. In hospitals, the proportion of broad-spectrum antimicrobials used varied from 16% to 62% across Europe. These medicines are not always necessary and their use drives antimicrobial resistance. In addition, more than 50% of antimicrobial courses for surgical prophylaxis, i.e. antimicrobials given to patients to prevent infections in relation with surgical procedures, lasted more than one day although continuing antimicrobial prophylaxis after the end of intervention is not recommended. In long-term care facilities, 29% of antimicrobials were prescribed for prophylaxis, and 74% of those courses were given to prevent urinary tract infections. While this might reduce the risk of infection in women, there is no evidence about its effectiveness when applied widely to elderly patients.

The surveys also confirm that healthcare-associated infections remain a public health issue in the EU/EEA. ECDC estimates that on any given day one in 15 patients in European hospitals, and one in 26 residents in long-term care facilities, have at least one healthcare-associated infection. Many of them were caused by multidrug-resistant bacteria.  

Andrea Ammon, ECDC Director, stated:

“With 33000 deaths each year as a consequence of an infection due to bacteria resistant to antimicrobials and EUR 1 billion in annual healthcare expenditure, we need to ensure that these medicines are used prudently and that infection prevention and control measures are in place in all healthcare settings across Europe”. She added: “Since the rates of antimicrobial resistance, the rates of antimicrobial consumption as well as infection prevention and control practices vary from country to country, it is essential to tailor strategies to address specific needs. ECDC calls for continued action at all levels”.

Zsuzsanna Jakab, WHO Regional Director for Europe said:

“Human, animal, and environment health are all equally responsible for the correct use of antimicrobials and to avert the threat of antimicrobial resistance. As we strive to ensure that these medicines are rightly used in the community and in healthcare settings, one sector alone will not solve the problem. “One Health” brings together professionals in human, animal, food and environment health as one force, and as such is the only way to keep antimicrobials working. I call on all European countries to secure the highest commitment to this approach from the whole of society and the whole of government”.

Point prevalence surveys

A prevalence survey is a count of the number of patients with a particular condition/treatment (in this case either a healthcare-associated infection or an antimicrobial agent) at a particular time (in this case a day), as a proportion of the total number of patients who are hospitalised at that particular time. In 2016-2017, ECDC coordinated the second point-prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. the third point-prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities. The ECDC findings are available in the following Eurosurveillance articles.

Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill. 2018;23(46):1800393. Plachouras D, Kärki T, Hansen S, Hopkins S, Lyytikäinen O, Moro ML, et al.

Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill. 2018;23(46):1800394. Ricchizzi E, Latour K, Kärki T, Buttazzi R, Jans B, Moro ML, et al.

Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al.

Health burden of antibiotic resistance

An ECDC study on the health burden of antibiotic resistance, published on 5 November 2018, estimated that about 33000 people die each year in the EU/EEA as a direct consequence of an infection due to bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined. It also explains that 75% of the burden of disease is due to healthcare-associated infections (HAIs) and that reducing this through adequate infection prevention and control measures, as well as antibiotic stewardship, could be an achievable goal in healthcare settings.

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Antimicrobial resistance and antimicrobial consumption data