New ECDC Study: last-line antibiotics increasingly ineffective

It is a figure that is significantly higher than previously thought: Around 33,000 Europeans die every year as a result of bacterial infections. The main reason is that antibiotics are no longer effective against many of these infections. Even last-line antibiotics are no longer able to cure almost 40 percent of all infections investigated in a recent study.

“Infections by antibiotic-resistant bacteria are threatening modern healthcare.” This is what the research team around Dr. Alessandro Cassini from the European Centre for Disease Prevention and Control (ECDC, an EU organisation) in Solna, Sweden, write in „The Lancet Infectious Diseases“ journal1. The research team carried out the study on infections and deaths caused by antibiotic-resistant bacteria. “Estimating frequency, complications and associated mortality is a challenge, however,” they add.

A burden as high as flu, tuberculosis and HIV combined

The previous assumptions were based on data from 2007, when about 25,000 people in Europe died from the consequences of an infection with multi-resistant pathogens. For the current analysis, the scientists evaluated more recent data from a European Antimicrobial Resistance Surveillance Network (EARS-Net) dating from 2015.

The scientists analysed the data of eight different bacterial species that are resistant to different antibiotics and antibiotic combination preparations: Acinetobacter spp, Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus (MRSA) und Streptococcus pneumoniae. The pathogens cause urinary and respiratory infections, and infections of the bloodstream and surgical wounds, among others. The scientists now assume that these pathogens will lead to about 8,000 more deaths per year in the EU.

In addition, the research team has calculated the so-called burden of disease. This is based not only on deaths, but also on the severity of the disease. The researchers have discovered that a large proportion of infections, 39 percent, are caused by bacteria that are resistant to so-called last-line antibiotics. The ECDC 2 calls this number “worrying” because these antibiotics are actually the last available treatment options. If even they are no longer effective, it is extremely difficult or even impossible to treat the infections. According to the study, children under twelve months of age and people aged 65 and over are particularly at risk of dying from multi-resistant germs.

Overall, the scientists write, “the estimated burden of infections with antibiotic-resistant bacteria in the EU is as high as that of influenza, tuberculosis and HIV/AIDS combined.”

Great differences between countries

A closer look at the EU countries studied reveals that the disease burden varies from country to country: Italy was hit hardest (more than 200,000 infections with antibiotic-resistant germs, and more than 10,000 deaths), followed by Greece. According to the study, almost 55,000 people in Germany suffered an infection in 2015 and almost 2400 died from it.

In comparison, northern European nations such as Denmark, Sweden, Finland, Norway, the Netherlands, Estonia and Iceland, had significantly fewer antibiotic resistant infections, such as almost 5,000 in the Netherlands to just 27 in Iceland, and correspondingly few deaths (around 200 to only 1), occupied the lowest places in the European economic area.

63 percent of infections occurring in health facilities

The authors explain that about two-thirds of those affected are infected in hospitals or other health care facilities (healthcare-associated infections, HAIs). More than half of these cases are likely to be preventable. Improved measures for infection prevention and control and a cautious use of antibiotics could significantly alleviate the problem.

Most antibiotic resistance could be prevented for two US dollars per person per year

A recent study by the Organisation for Economic Co-operation and Development (OECD)3 has now revealed that infections with antibiotic-resistant bacteria could kill around 2.4 million people in Europe, North America and Australia in the next 30 years.

75% of the predicted deaths could be avoided by simple hygiene measures (hand washing, more sensible use of antimicrobial agents, etc.). According to OECD calculations, it would be sufficient to invest an additional two dollars in hygiene measures per year and per capita of the population in OECD countries.

Weiterführende Informationen:

  1. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis, Cassini, A, The Lancet Infectious Disease
  2. 33000 people die every year due to infections with antibiotic-resistant bacteria, ECDC
  3. Stopping antimicrobial resistance would cost just USD 2 per person a year, OECD

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