ECDC-EMEA Joint Technical ReportPart I: Trends and burden of antimicrobial resistance in the European UnionZsuzsanna Jakab, DirectorEuropean Centre for Disease Prevention and Control

Jönköping, 6 July 2009

General background

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

Antimicrobial resistance (AMR) is still a growing European and global health problem.(Council Conclusions on Antimicrobial Resistance (AMR), Luxembourg, 10 June 2008)

Background for ECDC-EMEA Joint Report

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

ECDC-EMEA Joint Working Group (established February 2008)

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

pneumoniaeCarbapenem-resistant Pseudomonas aeruginosa

Methods (1): Selected resistant bacteria of public health importance

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

Country with a significant increase (2005-2007)

Country with a significant decrease (2005-2007)

Methicillin-resistant S. aureus - MRSA (%)

3rd-gen. ceph.-resistant Klebsiella pneumoniae (%)

3rd-gen. ceph.-resistant Escherichia coli (%)

Source: EARSS & ECDC, 2009

No.

of

countr

ies

Gram-positive bacteria Gram-negative bacteria

0

10

20

30

40

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Po

pu

lati

on

-wei

gh

ted

ave

rag

e p

rop

ort

ion

of

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t is

ola

tes

(%)

Third-gen. cephalosporin-resistant E. coli

Third-gen. ceph.-resistant K. pneumoniae**

Carbapenem-resistant P. aeruginosa**

Population-weighted, average %resistant isolates among bacteria from bloodstream infections, EU, Iceland and Norway, 2002-2007

*Excluding Greece, which did not report data. **Excluding Belgium and Slovakia, which did not report data.

Source: EARSS & ECDC, 2009

0

10

20

30

40

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Po

pu

lati

on

-wei

gh

ted

ave

rag

e p

rop

ort

ion

of

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t is

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(%)

Methicillin-resistant S. aureus (MRSA)

Vancomycin-resistant E. faecium

Penicillin-resistant S. pneumoniae*

Human burden

Economic burden

Limitation: these are underestimates.

Burden of multidrug-resistant (MDR) bacteria in the EU, Iceland and Norway

Source: ECDC, 2009

Infections (6 most frequent MDR bacteria, 4 main types of infection)

approx. 400,000 / year Attributable deaths approx. 25,000 / year Extra hospital days approx. 2.5 million / year

Extra in-hospital costs approx. € 1 billion / year Productivity losses approx. € 600 million / year

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.