Reducing antibiotic resistance: is the EU progressing towards 2030 targets?

AMR editorial by ECDC Director Andrea Ammon

Antibiotic resistance is a critical public health challenge affecting not only the European Union (EU) but having an impact globally. With over 35,000 lives lost annually in the EU, Iceland and Norway due to infections resistant to antibiotics, the urgency of this issue cannot be ignored. For the EU, the impact of these infections on public health is comparable to that of influenza, tuberculosis and HIV/Aids combined.

Antibiotic resistance is the ability of bacteria to withstand the effects of the antibiotics that were designed to kill them. The main cause of this health issue lies in the inappropriate and excessive use of antibiotics across human, animal and agricultural sectors, together with insufficient hygiene measures to prevent and control infections in healthcare settings and the community. As these medicines become less effective, treating common infections becomes increasingly challenging, leading to prolonged illness and, in severe cases, death.

According to recent data by the Organisation for Economic Cooperation and Development, the annual cost of antibiotic resistance in the EU and the European Economic Area reaches nearly €11.7 billion. This figure includes both extra health expenditure (€6.6. billion), and economic losses due to reduced workforce participation because of premature death or long sick leaves (€5.1 billion).

In a concerted effort to address this growing public health issue, a Council Recommendation to combat antimicrobial resistance was adopted in June 2023, including five targets to be achieved by 2030, building on a 2019 baseline. These targets are an effective way of monitoring progress and achieving goals related to the prevention and reduction of antimicrobial resistance. They are concrete, measurable goals for the EU and for each EU Member State according to their individual situations.

While there has been slow progress in some areas since 2019, recent data suggest that antimicrobial resistance remains a significant challenge in the EU/EEA. Increased efforts to reduce unnecessary antibiotic use and to enhance infection prevention and control practices are imperative to meet the 2030 targets.

The situation with carbapenem-resistant Klebsiella pneumoniae infections in the EU continues to deteriorate. The incidence of bloodstream infections with these bacteria increased by almost 50 per cent between 2019 and 2022. This goes against the goal of reducing these infections by five per cent by 2030. This is a concerning trend because there are very few effective treatments available for patients with these infections. Control actions are urgently needed to prevent further spread of this pathogen in the EU and revert the current trend.

Encouragingly, there have been notable improvements in two areas: the incidence of bloodstream infections with meticillin-resistant Staphylococcus aureus (Mrsa) declined by 12.2 per cent between 2019 and 2022, which is close to the 15 per cent reduction target. Similarly, the incidence of bloodstream infections with third-generation cephalosporin-resistant Escherichia coli decreased by 16.8 per cent during the same period, indicating that the EU has already met the 10 per cent reduction target. These developments reflect a positive trend in addressing antimicrobial resistance within the EU.

The total consumption of antibiotics in humans (community and hospital sectors combined) decreased by 2.5 per cent between 2019 and 2022, indicating slow progress towards the 20 per cent reduction target by 2030. However, after unprecedented reductions in 2020 and 2021, consumption rebounded in 2022. This might indicate that the patterns of winter respiratory viruses, social contacts, hygiene habits and antibiotic-prescribing practices may now be similar to what they were before the Covid-19 pandemic.

Only nine EU Member States have met or exceeded the target of 65 per cent antibiotic consumption, from the ‘Access’ group as per WHO’s AWaRe classification of antibiotics, placing the EU overall at 59.8 per cent. Antibiotics in this group should be the first choice for common infections as they contribute to a lesser extent to the emergence of antimicrobial resistance. Continued efforts in this area are needed to align consumption patterns with the recommended target.

Without urgent action, we could face a future where medical procedures such as surgical interventions, organ transplants, and cancer treatments would be jeopardised, as the effectiveness of these procedures and treatments relies on effective antibiotics. Healthcare facilities could experience a surge in patients with infections resistant to antibiotics, straining resources, and enhancing the need for specialised care. This could lead to prolonged hospital stays, escalating healthcare costs, and a decline in productivity due to illness or premature death, exerting a considerable economic toll on individuals, families and societies at large.

The European Centre for Disease Prevention and Control (ECDC) emphasises the need for stronger interventions and actions to address antimicrobial resistance in different areas, such as prudent use of antibiotics, infection prevention and control, research and innovation, surveillance of antibiotic resistance and antibiotic consumption, and the implementation of One Health national action plans. Addressing antibiotic resistance and achieving the 2030 targets is an urgent and collective obligation. We are all responsible.

About the targets

For the EU overall, the recommended targets to reach by 2030 include:

• A 5-per cent reduction in the incidence of bloodstream infections with carbapenem-resistant Klebsiella pneumoniae
• A 15-per cent reduction in the incidence of bloodstream infections with meticillin-resistant Staphylococcus aureus (MRSA)
• A 10-per cent reduction in the incidence of bloodstream infections with third-generation cephalosporin-resistant Escherichia coli
• A 20-per cent reduction in the total consumption of antibiotics in humans
• Ensuring that at least 65 per cent of total antibiotic consumption in humans is from the ‘Access’ group, as per WHO’s AWaRe classification

European Antibiotic Awareness Day

European Antibiotic Awareness Day (Eaad) is a European health initiative coordinated by the European Centre for Disease Prevention and Control, which provides a platform and support for national campaigns on the prudent use of antibiotics. Each year, Eaad is marked by national campaigns on or around November 18. EAAD takes place in partnership with the WHO World AMR Awareness Week.

Visit http://antibiotic.ecdc.europa.eu for more information.