ECDC-EMEA Joint Technical Report Part I: Trends and burden of antimicrobial resistance in the European Union

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ECDC-EMEA Joint Technical ReportPart I Trends
and burden of antimicrobial resistance in the
European Union
Zsuzsanna Jakab, DirectorEuropean Centre for
Disease Prevention and Control Jönköping, 6 July
2009
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General background
Antimicrobial resistance (AMR) is still a growing
European and global health problem. (Council
Conclusions on Antimicrobial Resistance (AMR),
Luxembourg, 10 June 2008)

• 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

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Background for ECDC-EMEA Joint Report
ECDC-EMEA Joint Working Group (established
February 2008)

• 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

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Methods (1) Selected resistant bacteria of
public health importance

• 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 pneumoniae
• Carbapenem-resistant Pseudomonas aeruginosa

Source EARSS Biedenbach DJ et al., 2004.
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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

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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 ()
No. of countries
3rd-gen. ceph.-resistant Escherichia coli ()
3rd-gen. ceph.-resistant Klebsiella pneumoniae ()
Source EARSS ECDC, 2009
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Population-weighted, average resistant isolates
among bacteria from bloodstream infections, EU,
Iceland and Norway, 2002-2007
Gram-positive bacteria
Gram-negative bacteria
Excluding Greece, which did not
report data.
Excluding Belgium and Slovakia, which did not
report data.
Source EARSS ECDC, 2009
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Burden of multidrug-resistant (MDR) bacteria in
the EU, Iceland and Norway

• Human burden
• Economic burden
• Limitation these are underestimates.

• 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

Source ECDC, 2009
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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.