image: Antimicrobial resistance (AMR) has an impact on people lives. The situation with antimicrobial resistance is getting worse, and new bacterial strains are emerging that are resistant to several antibiotics at the same time (known as multidrug-resistant bacteria). A major antimicrobial resistance problem, especially in hospitals, is the emergence of bacteria that are resistant to last-line antimicrobials, which severely limits treatment options for infected patients. Such bacteria may eventually become resistant to all existing antimicrobials. AMR is invisible, but the patients are not.
Credit: ECDC
Between 2019 and 2023, antibiotic consumption in the EU increased by 1%, moving further away from the 2030 target of a 20% reduction recommended by the Council of the European Union.
Although there have been significant reductions in methicillin-resistant Staphylococcus aureus bloodstream infections during the same period, the situation in other critical areas, such as carbapenem-resistant Klebsiella pneumoniae bloodstream infections, has worsened, with an increase in incidence by almost 60% between 2019 and 2023. This represents a growing threat to patients in hospitals across the EU, particularly since very few therapeutic options remain available to treat patients infected with carbapenem-resistant K. pneumoniae.
Reaching the EU targets by 2030 requires a united, urgent response across the EU to prevent AMR from undermining healthcare. This response is key to protecting patients and sustaining the effectiveness of antibiotics for future generations.’ says Dr Pamela Rendi-Wagner, ECDC Director.
To highlight the serious threat presented by antimicrobial resistance (AMR), ECDC has launched a series of patient stories to give a voice to people who have experienced prolonged hospital stays, uncertain recovery and complex treatments due to AMR. The stories also talk about the impact that these infections have had on the patients’ lives and families.
While some Member States have made great progress towards their recommended AMR targets, or even in some instances have already reached the recommended targets, the overall picture shows that more specific, intensified interventions are urgently needed across the EU.
To turn the tide in the fight against AMR, ECDC is calling for accelerated efforts in three main areas: infection prevention and control, prudent use of antimicrobials, and the development of and access to novel antimicrobials.
Healthcare-associated infections account for 70% of the AMR-related health burden in the EU. This is why hospitals must prioritise basic, yet critical measures for infection prevention and control, such as:
• improving hand hygiene and giving easy access to alcohol-based solutions for hand disinfection,
• increasing screening for the carriage of resistant bacteria to curb the growing trend in carbapenem-resistant Klebsiella pneumoniae,
• increasing the capacity to isolate positive patients by making sure that there are enough single rooms,
• increasing the number of dedicated infection prevention and control staff and relevant training.
The community sector accounts for 90% of total antibiotic use in humans. Reducing the use of antibiotics requires more information and public awareness campaigns, complemented by social and behavioural interventions to prevent their unnecessary use.
ECDC continues to promote the development of and access to novel antimicrobials, and alternatives to antimicrobials, that are both effective and safe for humans. Antimicrobials of this type are essential for treating patients with infections that are resistant to last-line antibiotics such as carbapenems.
In the absence of stronger and swifter public health action, it is unlikely that the EU will reach all its targets by 2030. The consequence will be an increased number of infections with antimicrobial-resistant bacteria that will be more difficult to treat, leading to increasing challenges for patients and larger numbers of AMR-related deaths.
ECDC is committed to supporting Member States in achieving their 2030 AMR targets and has a range of measures to help them address specific gaps and strengthen national capabilities. These include individual AMR country visits and regular Public Health Emergency Preparedness Assessments for all EU/EEA countries, with antimicrobial resistance and healthcare-associated infections as key focus areas.
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Notes to editors:
In 2023, the estimated total EU incidence of meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infections was 4.64 per 100 000 population (country range 0−15.5). This was 17.6% lower than in 2019 (baseline year) and 0.15 per 100 000 population lower than the 2030 target of 4.79 per 100 000 population. For the EU overall, a statistically significant decreasing trend was detected between 2019 (baseline year) and 2023.
The estimated total EU incidence of third-generation cephalosporin-resistant Escherichia coli bloodstream infections was 10.35 per 100 000 population (country range 0−19.56) in 2023. This was 3.6% lower than in 2019 (baseline year) and 0.68 per 100 000 population higher than the 2030 target of 9.67 per 100 000 population. For the EU overall, there was no statistically significant trend detected between 2019 (baseline year) and 2023.
The estimated total EU incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections was 3.97 per 100 000 population (country range 0.00−21.44) in 2023. This was 57.5% higher than in 2019 (baseline year) and 1.58 per 100 000 population higher than the 2030 target of 2.39 per 100 000 population. For the EU overall, a statistically significant increasing trend was detected between 2019 (baseline year) and 2023.
In summary, while the EU target for the incidence of MRSA bloodstream infections had already been reached by 2023, the EU incidence of third-generation cephalosporin-resistant E. coli bloodstream infections only showed a small decrease compared to 2019 (baseline year) and the EU incidence of carbapenem-resistant K. pneumoniae bloodstream infections showed an increase by over 50% compared to 2019 (baseline year), which counteracts the target of a 5% reduction by 2030.
In 2024, all European Union/European Economic Area (EU/EEA) countries reported data for 2023 to the European Antimicrobial Resistance Surveillance Network (EARS-Net).Antimicrobial resistance can be expressed as the estimated total incidence of bloodstream infections with antimicrobial-resistant bacteria (infections per 100 000 population).
Data from EARS-Net show that, as in previous years, AMR levels remained high in the EU/EEA in 2023.
Increases in the estimated EU incidences of bloodstream infections with resistant bacteria were observed not only for two of the above-mentioned AMR-pathogen combinations with an EU target, but also for many other bacteria and antimicrobial groups under surveillance, such as antimicrobial-resistant K. pneumoniae (other than carbapenem-resistant), vancomycin-resistant Enterococcus faecium and piperacillin-tazobactam-, ceftazidime-, and carbapenem-resistant Pseudomonas aeruginosa.
The AMR situation reported by EU/EEA countries varied widely, depending on the bacterial species, antimicrobial group and geographical region. The highest estimated incidences of antimicrobial-resistant bloodstream infections were generally reported by countries in the south or southeast of Europe.
For each bacterial species, country-specific information on the estimated incidence of antimicrobial-resistant bloodstream infections (including the recommended EU targets on AMR), the percentage of invasive isolates with AMR, data availability and the percentage of intensive care unit patients is available in country summaries. Results by age group and sex are available in the ECDC Surveillance Atlas of Infectious Diseases (https://atlas.ecdc.europa.eu/).
Estimates based on EARS-Net data from 2020 indicate that each year more than 35 000 people die in the EU/EEA as a direct consequence of antimicrobial-resistant infections.
The overall poor progress towards the EU targets on AMR and, more particularly, the continued increase in the incidence of carbapenem-resistant K. pneumoniae bloodstream infections, highlights the urgent need for intensified public health action against AMR.
The Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach (2023/C 220/01) encourages Member States to develop and implement national action plans against AMR, and highlights the need for Member States to allocate appropriate human and financial resources for the effective implementation of these plans.
The plans should include key elements, such as enhanced surveillance and strengthened infection prevention and control programmes in hospitals and other healthcare settings, integrated with antimicrobial stewardship programmes and good diagnostic practices.
In the absence of stronger, swifter public health action, it is unlikely that the EU will reach all its AMR targets by 2030. The consequence will be an increased number of infections with antibiotic-resistant bacteria that will be more difficult to treat, leading to increasing challenges for patients and AMR-related deaths.
Read the full report "Antimicrobial resistance in the EU/EEA (EARS-Net)" for 2023, available from https://www.ecdc.europa.eu/sites/default/files/documents/antimicrobial-resistance-annual-epidemiological-report-EARS-Net-2023.pdf
Read the report "Antimicrobial consumption in the EU/EEA (ESAC-Net)" available from https://www.ecdc.europa.eu/sites/default/files/documents/antimicrobial-consumption-ESAC-Net-annual-epidemiological-report-2023_0.pdf