Antibiotic resistance is widespread across the whole of Europe. High resistance, often seen in the southern and eastern countries of the European Union, is also found in the eastern part of the European Region. In particular, resistant bacteria are spreading in hospitals and health care settings, putting patients at risk of contracting incurable diseases. This is the concerning picture painted by the second Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) report, published by WHO.
The aim of the report is to provide guidance and inspiration to countries that are building or strengthening their national AMR surveillance and to stimulate the sharing of data internationally. 19 non-EU countries are engaged in CAESAR (Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, the Republic of Moldova, the Russian Federation, Serbia, Switzerland, Tajikistan, the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan.)
More information about Anti-Microbial Resistance in Europe on the euro.who.int website
Antibiotic resistance presents one of the biggest threats to global health and development today – and the threat is growing. On any given day, about 80,000 patients – or 1 in 18 patients in hospitals – in the EU have at least one health care associated infection according to estimates from the European Centre for Disease Prevention and Control (ECDC) and these are often difficult to treat because the microorganisms that cause them are resistant to antibiotics. These infections are estimated to result in 16 million extra days spent in hospital and 37,000 attributable deaths, as well as contributing to an additional 110,000 deaths a year. Annual financial losses are estimated at approximately €7 billion (direct costs only).
Health professionals – including general practitioners, nurses, hospital prescribers, dentists and pharmacists – can help prevent and control the spread of antibiotic resistance by following five key recommendations from WHO:
- if you think a patient might need antibiotics, where possible test to confirm and find out which one;
- only prescribe antibiotics when they are truly needed, according to current guidelines;
- prescribe and dispense the right antibiotic at the right dose for the right duration;
- prevent infections by using safe hygiene practices to ensure that your hands, instruments and environment are clean; and
- keep your patients’ vaccinations up to date.
For more information about Antibiotic resistance on the euro.who.int website
The European Commission has recently published a report on the prudent use of antimicrobial agents in human medicine based on questionnaires completed by EU and EEA member states in 2015.
20 out of the 29 countries providing information had a strategy to promote prudent use and contain antimicrobial resistance (AMR), 6 were in the process of developing strategies and 3 had neither an AMR strategy nor a plan to create one.
In most countries action plans included measures regarding surveillance, prudent use, information and education along with detection and control of outbreaks and the use of rapid diagnostic tests. Nursing homes and long term care facilities were covered by 14 out of the 21 action plans.
Download the full report on antimicrobial agents in human medicine from the ec.europa.eu website
It is estimated that 131 million people are infected with chlamydia, 78 million with gonorrhoea, and 5.6 million with syphilis every year. These are the three most common sexually transmitted infections (STIs) and the WHO has issued new guidelines for their treatment in response to the growing threat of antibiotic resistance.
Chlamydia, gonorrhoea and syphilis are all caused by bacteria and are generally curable with antibiotics but they often go undiagnosed and are becoming more difficult to treat, with some antibiotics now failing as a result of misuse and overuse.
Resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options. Of the 3 STIs, gonorrhoea has developed the strongest resistance to antibiotics. Strains of multidrug-resistant gonorrhoea that do not respond to any available antibiotics have already been detected. Antibiotic resistance in chlamydia and syphilis, though less common, also exists, making prevention and prompt treatment critical.
When left undiagnosed and untreated, these STIs can result in serious complications and long-term health problems for women, such as pelvic inflammatory disease, ectopic pregnancy and miscarriage, and untreated gonorrhoea and chlamydia can cause infertility in both men and women. Infection with chlamydia, gonorrhoea and syphilis can also increase a person’s risk of being infected with HIV two- to three-fold. An untreated STI in a pregnant woman increases the chances of stillbirth and newborn death.
Download the guidance for treating these sexually transmitted infections from the who.int website
China, the world’s largest consumer of human and animal antibiotics, has pledged to step up research and development into new antimicrobials and to rein in overuse of existing medicines to counter growing global antimicrobial resistance.
As part of a national action plan unveiled on 26 August, the Chinese central government said that it would mobilize the efforts of 14 ministries and departments including health, food and drugs, and agriculture. By 2020, the government aims to develop new antimicrobials, make sales of the drugs by prescription only, ramp up surveillance of human and veterinary usage, and increase training and education for both medical professionals and consumers on their proper use.
For more information about China and AMR on the sciencemag.org website
Antimicrobial resistance is a global crisis that threatens public health and modern medicine. The discovery and development of novel antibiotic products are critical components in combating it. Many international, EU and national initiatives address the scientific, regulatory and economic barriers to antibiotic innovation. This study identifies, reviews and critically assesses these initiatives, and provides policy recommendations for improving the global and European agendas for research and development of antibiotics.
To download the report on antibiotic drug discovery and development from the euro.who.int website
Unhealthy levels of meat consumption and production are simultaneously driving climate change, diet-related chronic diseases and resistance to antibiotics, according to the European Public Health Alliance.
They argue that a transition towards sustainable diets is necessary for a realistic climate strategy and represents the agricultural sector’s main climate mitigation opportunity.
Studies suggest that realistic changes in eating patterns in high income countries could reduce per capita greenhouse gas emissions by 25-50%.
To read the full article on meat consumption and climate change on the epha.org website
The European Health Parliament is a platform of 55 young professionals from across Europe, which aims to deliver high-level policy-oriented recommendations to positively influence and change the future of healthcare in Europe. It has just published ‘Rethinking European Healthcare: recommendations by the next generation’.
It covers proposals on:
- antimicrobial resistance
- climate change and health
- digital skills for health professionals
- migration and health
- prevention and self-care
For more information and to download the full report or the executive summary of Rethinking European Healthcare from the healthparliament.eu website
Global consumption of antibiotics in human medicine rose by nearly 40% in the decade from 2000 and in 2007 25,000 people a year in the EU were dying from an infection due to antibiotic-resistant bacteria.
Infections due to these multi-drug resistant bacteria are estimated to cost the EU at least €1.5 billion a year in extra healthcare costs and lost productivity. If current trends continue, over the next 35 years 300 million people worldwide are expected to die prematurely because of drug resistance.
As part of its wider strategy to combat antimicrobial resistance (AMR), the European Commission has published a Special Eurobarometer survey, showing a decrease of 6% in the consumption of antibiotics but at the same time a persistent lack of awareness on their effects.
According to the report, over a third of Europeans took antibiotics in the twelve months preceding the survey, yet 57% of Europeans were unaware that antibiotics are ineffective against viruses. The survey clearly demonstrates that there exists a direct link between better information and lower consumption.
For more information on EU action on antimicrobial resistance on the ec.europa.eu website
About one third of hospital patients are prescribed antibiotics and up to 50% of their use is unnecessary or inappropriate. Whilst some EU countries have made significant strides in the control of drug-resistant infections, overuse and the spread of Antimicrobial Resistance (AMR) urgently need to be addressed in others. As drug-resistant infections are not contained by national borders, the approach must be strict, consistent and coordinated at European and international level.
Antimicrobial stewardship (AMS) was a topic at the 21st Congress of the European Association of Hospital Pharmacists in Vienna where great emphasis was placed on the importance of establishing well-trained, multidisciplinary teams supported by committed leadership. As medicines experts with knowledge of infection control, hospital pharmacists play an important role as educators of other healthcare workers and patients.
AMS can be described as a series of multi-professional interventions across all care settings. Alongside infection control and decontamination action it has become an essential strategy deployed in hospitals across Europe to fight multi-drug resistant ‘superbugs’.
Efficient AMS programmes hinge on first-rate management skills across hospital and community settings, and the availability of local guidance. This must go hand in hand with surveillance data on antibiotics use and occurrence of resistance so that compliance with guidance can be measured, and its impact evaluated.
To read more about Antimicrobial Stewardship on the epha.org website