Latest data on antimicrobial resistance and consumption in Europe. Marc Sprenger (ECDC)
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Latest EU-wide data: Resistance to last-line antibiotics continues to cause concern in Europe European Centre for Disease Prevention and Control Marc Sprenger, Director, ECDC 3 rd Joint Meeting of the ARHAI Networks, 11 February 2015 Marriott Courtyard Hotel, Stockholm
Latest data on antimicrobial resistance and consumption in Europe. Marc Sprenger (ECDC)
Latest EU-wide data: Resistance to last-line antibiotics continues to cause concern in Europe
European Centre for Disease Prevention and Control
Marc Sprenger, Director, ECDC 3rd Joint Meeting of the ARHAI Networks, 11 February 2015 Marriott Courtyard Hotel, Stockholm
Presenter
Presentation Notes
Dear colleagues from the Member States of the European Union, candidate countries, potential candidate countries, European Neighbourhood policy countries, as well as colleagues from the European Commission, WHO and the US CDC. I would like to welcome you today to Stockholm and to the 3rd Joint meeting of the so-called ARHAI networks. I am particularly pleased that this year’s meeting takes place in Sweden, because resistance to antimicrobials and healthcare associated infections are high on the agenda in this country. The Swedish Ministry of Health and Social Affairs, and the Public Health Agency of Sweden have greatly contributed to the organisation of this meeting. Most of you present here today represent either the EARS-Net, ESAC-Net or HAI-Net networks in your home countries. And in addition we have experts from several other countries outside of the European Union. So we have, in other words, an incredible amount of expertise gathered here today. --- I am often asked by journalists what I consider to be the major threat to public health. And my answer is always, resistance to antimicrobials, both in humans and animals, and healthcare-associated infections. Because, the increasing resistance to antimicrobials that we are seeing is not only a major threat to public health in Europe, but a threat of global concern. And your role is crucial in order to turn the tide of AMR and of HAI. I will come back to this soon in my presentation, but allow me first to give you a brief overview of the alarming situation in Europe. (Click)
Staphylococcus aureus: percentage of invasive isolates resistant to meticillin (MRSA); EU/EEA, 2013
Source: EARS-Net, 2014 The symbols and indicate a significant increasing or decreasing trend for the period 2010-2013, respectively. These trends were calculated on laboratories that consistently reported during this period.
Presenter
Presentation Notes
This slide presents the latest EU data available for MRSA, meticillin-resistant Staphylococcus aureus. As you know, MRSA is one of the most frequent causes of antibiotic-resistant healthcare-associated infections worldwide. And as in previous years, we see large variations among the countries, from less than 1% (DARK GREEN) to more than 50% (DARK RED). The good news is that, in several European countries, we continue to see a declining trend of MRSA. This is most likely due to the national programmes and actions implemented in these countries. Thanks to your action plans, And these should serve as examples for other countries. And overall for the EU/EEA, this meant that the average percentage decreased from 22% in 2010 to 18% in 2013. Nevertheless, seven out of 30 reporting countries had MRSA percentages above 25%, mainly in southern and eastern Europe. So although the continuous decreasing trend at the EU level gives reason for optimism, MRSA remains a public health problem in Europe. (Click)
Source: EARS-Net, 2014
K lebsiella pneumoniae: % of invasive isolates with resistance to all antibiotic groups under surveillance*, EU/EEA, 2013
*Third-generation cephalosporins, fluoroquinolones, aminoglycosides, carbapenems and colistin). Only among isolates that were tested for susceptibility to all these antibiotic groups were included.
(i.e., less than 10 reported isolates were tested for susceptibility to all these antibiotic groups)
Presenter
Presentation Notes
If we now take a look at the situation of Klebsiella pneumoniae in Europe, our data tells us that this bacterium is increasingly becoming resistant to all antibiotic groups under surveillance. Colistin resistance is now developing in infections that are already carbapenem resistant. Overall in the EU in 2013, 6.6% Klebsiella pneumoniae blood isolates were resistant to both the last-line antibiotics carbapenems and colistin. New data on this map indicates that in some EU countries resistance to all the antibiotic groups under EARS-Net surveillance, including the carbapenems and colistin, can be as high as 10-25%. And individual countries have reported, in other published studies, percentages as high as 43% colistin resistance in K. pneumoniae infections already resistant to carbapenems. This is the most worrying development, and mainly due to the increased use of antibiotics, in particular the carbapenems, and varying hospital infection control practices. (Click)
Trends in consumption of antibacterials for systemic use in the hospital sector (expressed in DDD per 1000 inhabitants and per day), EU/EEA, 2009-2013
Let us now look at the consumption of antibacterials for systemic use in the hospital sector, The trend we are seeing here is that consumption is stabilising overall in the EU. That is good news. But what is of concern, is that we see an increasing trend in the consumption of both carbapenems and of polymyxins (mainly colistin). So we need to continue to pay careful attention to prudent use of antibiotic and antimcirobial stewardship. And we certainly need to pay careful attention to infection control measures in hospitals. (Click)
Alcohol hand rub consumption (L / 1000 patient-days)
ECDC PPS in European acute care hospitals, 2011-2012: example of indicator
Presenter
Presentation Notes
In 2013, ECDC published a report on a point prevalence survey in European acute care hospitals. This survey showed large variations between countries in infection control structures and process indicators. As you see from this slide, there were, for example, large variations among the hospitals within a country regarding the use of alcohol hand rub for hand hygiene. Alcohol hand rub is one of the simplest and most efficient measures to prevent transmission of microorganisms. (Click)
Modern medicine: not possible without effective antibiotics
Care of preterm babies
Intensive care
Organ transplant
Hip / knee replacement
Cancer chemotherapy
Presenter
Presentation Notes
Let me also remind you, that with a smaller number of effective antibiotics, we are gradually returning to the “pre-antibiotic era”, The era when bacterial diseases could not be treated and most patients would die from their infection. Failure to contain highly resistant bacteria would mean the end of modern medicine as we know it. It would mean that common medical interventions, such as: Hip/knee replacement Organ transplant Cancer chemotherapy Intensive care Care of preterm babies would not be possible without effective antibiotics. If not controlled highly-resistant bacteria are indeed a threat, not only to the safety of hospital patients, �but to our societies in general. (Click)
Surveillance of AMR, antimicrobial consumption and HAI in the EU
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European Antimicrobial Resistance Surveillance Network (EARS-Net)
European Surveillance of Antimicrobial Consumption Network (ESAC-Net)
Healthcare-Associated Infections surveillance Network (HAI-Net) incl. ECDC point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011-2012
Without comprehensive and good quality data, we would not even have a basis for control of antimicrobial resistance and healthcare-associated infections. This is why your role in the networks is so important: EARS-Net for the surveillance of antimicrobial resistance; ESAC-Net on human antimicrobial consumption; and HAI-Net that published the first European point prevalence survey on healthcare-associated infections�and antimicrobial use in 2013 And I dare say that these three networks have become models for the establishment of surveillance networks also at the global level. Tackling antimicrobial resistance and healthcare-associated infections is close to my heart. And I am impressed with the work you are doing in your home countries. From the monthly visits I pay to your countries’ Ministries of Health, National Public Health Institutes and often also to your hospitals, I know that as the ‘guardians of infection control’ you are often facing an ‘uphill battle’. I can only say how much your work is appreciated and valued! (Click)
Microbiology laboratory, Nicosia General Hospital, Cyprus
Photo: Kathryn Edwards
Presenter
Presentation Notes
Last week I returned from a country visit to Cyprus. During this visit I met with Dr Despo Pieridou, the Director of the Microbiology Department at Nicosia General Hospital. You see her here on the right hand side. Dr Pieridou also introduced me to her colleague, that you see here on the left hand side, who will be introducing the EUCAST breakpoint system in Cyprus. This is much welcomed news. (Click)
Country visit to Hungary, September 2013 Hungarian Institute of Cardiology, Paediatric ICU
Photos: Ministry of Health, Hungary
Presenter
Presentation Notes
I also visited the Hungarian Institute of Cardiology and its paediatric intensive care unit some time ago. And I recall that infection control measures in place in this hospital were extensive and comprehensive. I also remember learning that the Institute had developed an infection control programme with a manual on hand hygiene policy and on antibiotic policy. So a good example of the excellent work you are doing in your countries. (Click)
European Health Forum Gastein 2013, ECDC workshop on AMR & HAI
Photo: Kathryn Edwards
Presenter
Presentation Notes
At the European Health Forum in Gastein in Austria a couple of years ago, ECDC organised a workshop on AMR and HAI. In our panel of speakers was Prof. Elisabeth Presterl from the Clinical Institute of Hospital Hygiene, Vienna General Hospital –you see her on the left hand side of this picture. Prof. Presterl spoke about her role as infection control professional in the hospital and her experience of how the hospital personnel approaches the issue of patient safety. So again an example of the tireless work you are conducting in your home countries. I truly hope that the 3rd Annual network meeting of the ARHAI networks will give you all the opportunity to discuss and exchange views and best practices. Your work is making a difference and without you we will not be able to tackle this health threat! (Click)
Antimicrobial resistance: three messages
Prudent use of antibiotics
Infection control New
antibiotics
Presenter
Presentation Notes
Because antimicrobial resistance and healthcare-associated infections are one of the most serious global health challenges that we face. And we need to continue focussing on the solutions, in other words on: prudent use of antibiotics, infection control, and on the development of new antibiotics. I believe that turning the tide is indeed possible, but it will require Leadership, Commitment and Coordination, within healthcare settings and in the community. And only by cooperating together, globally, can we tackle the threat of AMR and find the solutions. I wish you fruitful days here in Stockholm with good discussions!
