News and Opinions  –  2018

Increasing burden of antibiotic resistant infections – new data that require action

2018-11-08

A new study in The Lancet Infectious Diseases reports an increase in the burden of antibiotic resistant infections in the EU/EEA. Now 33000 people die annually from antibiotic resistant bacterial infections, an increase from 10 years ago. In Europe, the burden is actually comparable to that from HIV, TB and influenza combined.

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In The Lancet Infectious Diseases, the European Centre for Disease Prevention and Control (ECDC) presents the latest data on the burden of antibiotic resistance in countries of the EU and European Economic Area. Besides estimating the number of deaths caused by resistant bacteria, the study is the first to also estimate the burden of resistance by means of Disability-Adjusted Life Years (DALYs). This gives an estimate of morbidity or non-lethal consequences of antibiotic resistance to patients’ health. The study is based on data from the European surveillance system EARS-Net, collected during 2015.

Mortality from resistant infections increasing

Mortality attributable to infections with antibiotic resistant bacteria is estimated to 33110 annually. This is an increase of approximately 30% from the previous report from 10 years ago, which estimated the number of attributable deaths in 2007 to be around 25000. However, it should be kept in mind that the numbers in the different studies are not directly comparable due to differences in for example methodology and a higher number of included bacterial species in the recent report. However, when correcting some of these differences, an increase in number of deaths annually in Europe from 2015 is still clear.

Burden comparable to HIV, tuberculosis and influenza

Measuring the burden of antibiotic resistance in terms of DALYs is useful, as antibiotic resistance not only increases mortality, but makes treatment of infections more difficult resulting in more suffering for the patient. The burden of antibiotic resistance is estimated to be 170 DALYs/100 000 population. By comparison, the combined burden of HIV, tuberculosis and influenza is 183 DALYs/100 000 population.

Data demanding action

Although the study and modelling has limitations, it present robust data on the situation in the EU/EEA and demonstrates that antibiotic resistance is a major contributor of ill health in Europe. A worrying trend is a substantial increase in burden from carbapenem resistant infections, for which extremely few therapeutic options are available and which are associated with high costs. Moreover, of all infections with resistant bacteria, more than 60% were associated with healthcare.

Key take-aways include:

  • The increasing carbapenem resistance emphasizes the need for new, innovative antibiotics that do not have cross-resistance to the existing antibiotic classes.
  • The large proportion of healthcare associated infections calls for much bigger focus in the European region on drastically improving infection prevention and control practices in hospitals.
  • Antibiotic stewardship is instrumental for optimizing the use of antibiotics and managing resistance, including in primary healthcare.

Naturally, this data cannot be extrapolated directly to the world population, as the burden of antibiotic resistance, as well as HIV and tuberculosis, is likely higher in many other regions. Similar burden data from other regions or countries is needed to allow for a better picture of the overall global burden in order to increase action from funders, governments and health care providers to address this growing problem.

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