New data from the European Centre for Disease Prevention and Control (ECDC) indicates that the European Union (EU) is struggling to meet its targets for reducing antimicrobial resistance (AMR) and antibiotic consumption. According to the European Antimicrobial Resistance Surveillance Network (EARS-Net), AMR levels remained elevated across Europe in 2023. One of the most alarming findings was a nearly 60% rise in bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae compared to the baseline data from 2019.
Concerns Over Antibiotic Resistance and Hospital Infections
Alongside the concerning increase in AMR, monitoring antibiotic use at hospitals and in communities within the EU revealed that consumption levels have also risen since 2019. In 2023, both AMR and antibiotic usage exceeded the 2030 targets established by the Council of the European Union. At a press briefing, ECDC Director Pamela Rendi-Wagner, MD, highlighted that more than 35,000 EU residents die annually from drug-resistant infections, and over 4.3 million patients acquire a healthcare-associated infection—many involving antibiotic-resistant bacteria—during hospital stays.
“These figures emphasize the significant impact of AMR on patients and their families,” Rendi-Wagner stated, underscoring the urgency of addressing this escalating health threat.
Mixed Results from the Latest EARS-Net Report
The recent EARS-Net findings present a complex picture of progress and setbacks. Encouragingly, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections in 2023 decreased by 17.6% compared to 2019. Additionally, infections involving third-generation cephalosporin-resistant Escherichia coli showed a slight drop from 2019 levels.
However, the same report delivered some worrying news. Bloodstream infections from carbapenem-resistant Klebsiella pneumoniae, which are resistant to multiple classes of antibiotics and have limited treatment options, surged by 57.5% since 2019. This is significantly above the 2030 target. Infections involving third-generation cephalosporin-resistant E. coli also surpassed the target limits.
“This situation is a growing threat for hospital patients throughout the EU,” said Dominique Monnet, PharmD, PhD, head of the ECDC’s Antimicrobial Resistance and Healthcare-Associated Infections program. Monnet emphasized that most of these infections are related to healthcare environments, highlighting the need for hospitals to step up prevention efforts.
The report also noted increases in infections caused by other resistant bacteria, such as vancomycin-resistant Enterococcus faecium and strains of Pseudomonas aeruginosa resistant to piperacillin-tazobactam, ceftazidime, and carbapenems. While some countries in the EU have made strides in controlling AMR, others continue to struggle. The highest rates of drug-resistant infections are often seen in southern and southeastern parts of Europe.
“Overall, Europe is moving in the wrong direction,” warned Rendi-Wagner. She urged a coordinated, continent-wide effort to share successful strategies and enhance progress in combating AMR across member states.
Hospital and Community-Level Efforts to Tackle AMR
Healthcare-associated infections are responsible for 70% of AMR-related health burdens in Europe. To combat this, ECDC officials are calling for enhanced infection prevention and control measures in hospitals. These measures include simple but effective practices like improved hand hygiene, expanded patient screening for resistant bacteria, and increasing the capacity to isolate infected patients. There is also a need to hire more staff dedicated to infection prevention and control.
The Rise in Antibiotic Use Post-Pandemic
The European Surveillance of Antimicrobial Consumption Network (ESAC-Net) data revealed that antibiotic consumption increased by 1% from 2019 to 2023. This rise followed significant reductions in community antibiotic use during the first two years of the COVID-19 pandemic. The EU’s average total antibiotic consumption for systemic use in 2023 was 20.1 defined daily doses (DDD) per 1,000 people per day, which exceeds the 2030 target by 4.1 DDD/1,000 inhabitants per day. Notably, the community sector accounted for 90% of this antibiotic use, with penicillins being the most commonly prescribed group at 47%.
Hospitals showed lower, but still significant, levels of antibiotic use, with a weighted mean consumption of 1.6 DDD/1,000 inhabitants per day. As with AMR rates, antibiotic consumption trends varied across Europe. While some countries moved closer to achieving their 2030 targets, others saw substantial increases, with double-digit growth in certain regions between 2019 and 2023.
Steps Forward: Prevention and New Treatments
In response to the rising threat, ECDC Director Rendi-Wagner emphasized the importance of infection prevention in healthcare settings and the continued development of new antibiotics. She stressed the need for comprehensive antimicrobial stewardship programs, which promote the responsible use of antibiotics to minimize the emergence of resistance. These programs are vital both in hospitals and at the community level.
Furthermore, Rendi-Wagner called for increased public awareness campaigns about the dangers of AMR. She suggested that educational efforts need to go beyond basic health communication and incorporate social and behavioral strategies to change how antibiotics are perceived and used by the general population.
The Challenge Ahead
Despite some positive trends, Europe still faces a steep challenge in reversing the spread of antibiotic resistance and reducing antibiotic consumption. As antibiotic resistance continues to rise, the healthcare burden grows heavier, especially for hospitals dealing with resistant infections. The uneven progress across EU countries underscores the need for a unified and stronger approach to tackling AMR. The findings highlight the importance of not only focusing on infection control but also incentivizing the development of innovative antibiotics and exploring alternative treatments.
The push to reduce antibiotic use in both healthcare settings and everyday life will require collaboration between governments, health organizations, and communities. As Europe continues to navigate the complex landscape of AMR, the coming years will be crucial in determining whether the region can realign with its targets and safeguard public health.