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ECDC-EMEA Joint Technical Report
Part I: Trends and burden of antimicrobial
resistance in the European Union
Zsuzsanna Jakab, Director
European Centre for Disease Prevention and Control
Jönköping, 6 July 2009
General background
Antimicrobial resistance (AMR) is still a growing European and
global health problem.
(Council Conclusions on Antimicrobial Resistance (AMR), Luxembourg, 10 June 2008)
 Prevention and control of AMR can be achieved
by:
– Prudent use of existing of antimicrobial agents
– Good hygiene practices (infection control)
– Novel antimicrobial agents active on resistant
bacteria
 Need to ascertain the perceived gap between:
– infections due to resistant bacteria
– development of novel agents aimed at treating
such infections
Background for ECDC-EMEA Joint Report
ECDC-EMEA Joint Working Group
(established February 2008)
 Mandate
– To produce a report on “the gap between the increasing
prevalence of multidrug-resistant bacteria and antibacterial
drug development aimed at treating such infections”
 Composition
– ECDC appointed experts
– EMEA appointed experts
– ECDC and EMEA staff
– Co-opted experts, e.g. from ReAct
– Observers: European Commission, ESCMID
Methods (1): Selected resistant bacteria
of public health importance
 Based on the most frequent bacteria responsible for
bloodstream infections
 Certain resistances were used as indicators for multidrug
resistance (resistance to multiple antibiotics)
 6 most frequent resistant bacteria:
Gram-positive-bacteria
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococcus faecium (VRE)
Penicillin-resistant Streptococcus pneumoniae
Gram-negative bacteria
Third-generation cephalosporin-resistant Escherichia coli
Third-generation cephalosporin-resistant Klebsiella pneumoniae
Carbapenem-resistant Pseudomonas aeruginosa
Source: EARSS & Biedenbach DJ et al., 2004.
Methods (2): Trends and burden of human
infections due to resistant bacteria
 Trends
– Data on resistant bacteria from bloodstream infections
(European Antimicrobial Resistance Surveillance System EARSS)
– 2002-2007
 Human burden
– Extrapolations for 4 main types of infection (bloodstream,
respiratory tract, skin and soft tissue, urinary tract)
– Extrapolations of burden parameters from published
literature (e.g.: attributable mortality, extra length of stay in
hospital)
 Economic burden
– Extra in-hospital costs
– Productivity losses due to absence from work because of
illness and premature death of infected patients
Percentage of resistant isolates in bacteria
from bloodstream infections, EU countries,
Iceland and Norway, 2007
No. of countries
 Country with a significant increase (2005-2007)
 Country with a significant decrease (2005-2007)
Methicillin-resistant S. aureus - MRSA (%)
3rd-gen. ceph.-resistant Escherichia coli (%)
Source: EARSS & ECDC, 2009
3rd-gen. ceph.-resistant Klebsiella pneumoniae (%)
Population-weighted, average %resistant
isolates among bacteria from bloodstream
infections, EU, Iceland and Norway, 2002-2007
10
2011
2010
2009
2008
2007
2006
0
2005
2011
2010
2009
2008
2007
2006
2005
2004
2003
0
20
2004
10
30
2003
20
40
2002
30
Gram-negative bacteria
Population-weighted average
proportion of resistant isolates (%)
40
2002
Population-weighted average
proportion of resistant isolates (%)
Gram-positive bacteria
Methicillin-resistant S. aureus (MRSA)
Third-gen. cephalosporin-resistant E. coli
Vancomycin-resistant E. faecium
Third-gen. ceph.-resistant K. pneumoniae**
Penicillin-resistant S. pneumoniae*
Carbapenem-resistant P. aeruginosa**
*Excluding Greece, which did not report data.
Source: EARSS & ECDC, 2009
**Excluding Belgium and Slovakia, which did not report data.
Burden of multidrug-resistant (MDR)
bacteria in the EU, Iceland and Norway
 Human burden
Infections (6 most frequent MDR bacteria, 4 main types of
infection)
approx.
Attributable deaths
400,000 / year
approx.
25,000
Extra hospital days
approx.
2.5 million
Extra in-hospital costs
approx.
€ 1 billion
Productivity losses
approx. € 600 million
/ year
/ year
 Economic burden
/ year
/ year
 Limitation: these are underestimates.
Source: ECDC, 2009
Conclusions
 Resistance to antibiotics is high in bacteria that
cause serious infections in humans.
 Resistance is increasing among certain bacteria
(i.e., Gram-negative bacteria).
 Infections caused by multidrug-resistant
bacteria are associated with excess morbidity
and mortality.
 These infections are associated with substantial
extra costs.