A patient arrives in the emergency department, sick and in urgent need of medical attention. The nurses measure her vital signs, the doctors examine her to establish the diagnosis. They all act quickly recognising that sepsis is the problem and that antibiotics can save her. They give the push of first-line antibiotics, hours pass, and they hope to see signs of stabilisation. They do not come… The patient needs intensive care, they escalate antibiotics, and then the microbiologist calls. The patient has an extensively drug-resistant bacteria causing septicaemia and treatment options are limited.

This problem is not new or unique to any global setting, but the burden of antimicrobial resistance (AMR) varies across geographies and is challenging to accurately estimate. A recent study has presented the estimated burden of AMR in the WHO European region, using the methodology used in the GRAM report published earlier this year, allowing for comparisons to be made across regions.

This study assessed 23 bacteria and 88 drug-bug combinations within the WHO European region in 2019. In assessing the excess burden that AMR places when infection occurs, they estimate that 541,000 deaths might have been prevented if antibiotic-resistant infections were replaced with no infection, and 133,000 deaths prevented if antibiotic-resistant infections were replaced with antibiotic-susceptible infections. Further, the study identified the most frequent seven pathogens: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, Streptococcus pneumoniae, and Acinetobacter baumannii, contributing to 457,491 deaths in 53 countries. Interestingly, the same top seven pathogens as seen in the global study, with the exception of M. tuberculosis.

Geography matters when it comes to getting an AMR infection, with the highest mortality rates seen in eastern Europe for both deaths associated with AMR and attributable to AMR, followed by central Europe and then Western Europe. Age too matters, in certain regions. A number of Eastern European countries, namely Azerbaijan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, and Uzbekistan, demonstrate worrying levels of neonatal mortality associated with AMR, far exceeding any other age group. It is also then important to note that access to last-line antibiotics that are needed to treat these infections, is often limited in the regions where the AMR burden is highest.

This study highlights the need for continued improvement in interventions included in National Action Plans (NAP) to reduce AMR, such as infection prevention and control policies in the community and healthcare facilities, vaccination, and antibiotic stewardship programmes. Disappointingly, in the European setting, the majority of countries (42/53) did not yet have financed and implemented NAP, which in the medium term will hamper the progress towards reducing the impact of AMR on human health.

Read the full report here.