1. ECDC-EMEA Joint Technical Report Part I: Trends and burden of antimicrobial resistance in the European Union
Zsuzsanna Jakab, Director European Centre for Disease Prevention and Control
Jönköping, 6 July 2009

2. General background Prevention and control of AMR can be achieved by:
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

3. 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

4. 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.

5. Methods (2): Trends and burden of human infections due to resistant bacteria
Data on resistant bacteria from bloodstream infections (European Antimicrobial Resistance Surveillance System - EARSS)
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

6. Percentage of resistant isolates in bacteria from bloodstream infections, EU countries, Iceland and Norway, 2007
Country with a significant increase ( )
 Country with a significant decrease ( )
Methicillin-resistant S. aureus - MRSA (%)
No. of countries
3rd-gen. ceph.-resistant Escherichia coli (%)
3rd-gen. ceph.-resistant Klebsiella pneumoniae (%)
Source: EARSS & ECDC, 2009

7. Population-weighted, average %resistant isolates among bacteria from bloodstream infections, EU, Iceland and Norway,
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

8. 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 ,000 / year
Attributable deaths approx ,000 / year
Extra hospital days approx million / year
Extra in-hospital costs approx € 1 billion / year
Productivity losses approx. € 600 million / year
Source: ECDC, 2009

9. 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.