1. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Antibiotic resistance a new pandemia

2. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Economic and social impact of antibiotic resistance ca. 25 000 patients per year die from antibiotic resistant infections ca. 2.5 Mio. extra hospital days to a cost of EUR 900 Mio. Out-patient care costs increase ca. EUR 10 Mio. Loss of work costs EUR 150 Mio. Productivity losses are estimated to around EUR 150 Mio.  Overall social costs of antibiotic-resistant infections are estimated to EUR 1.5 billion each year.

3. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Recent initiatives European Antibiotic Awareness Day EU/US transatlantic task force on antibiotic resistance A conference on incentives for effective antibiotics hosted by the Swedish EU presidency

4. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se MRSA in Europe 2006. S.aureus: Proportion of invasive isolates resistant to oxacillin (MRSA) in 2006. * These countries did not report any data or reported less than 10 isolates, Source: http://www.earss.rivm.nl, March 2008 Methicillin-resistant S. aureus (MRSA) - most common multidrug resistant bacterium in EU

5. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se An increasing problem is resistance among Gram-negative bacteria The biggest challenge is treatment of infections caused by penicillin resistant bacteria so called ESBL (extended spectrum beta-lactamase) In Sweden, this year, 3 children died during a few weeks in neonatal care in a Swedish hospital due to a ESBL infection

6. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se The industry has failed to launch new antibiotics Between 1996 and 2004: more than 125 antibacterial screens on 60 different antibacterial targets were run by 34 companies None of these efforts resulted in novel mechanism compounds. Pharmaceutical companies left the antibacterial sector  The industrial failure to meet the need of new antibacterial drugs indicates that novel approaches are needed to combat antibiotic resistant infections

7. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se What can be done immediately? Legislation Restricted use of antibiotics, e. g. clear rules how antibiotics should be used in whole EU to minimize the spread of antibiotic resistance Surveillance/Epidemiology Develop a monitoring systems including a large database to monitor the epidemiology of antibiotic resistance and make this information rapidly available which also should include details about the infecting organism as such,meta-genomics Create a task force on EU level and national level against antibiotic resistance to take immediate actions

8. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Improve hygiene Combination therapy of known antibiotics to improve effect of treatment and possible resistance development New and improved methods for rapid diagnosis of the infectious agents and resistance patterns based on large scale genome sequencing  reduce the need of antibiotics through disease prevention What can be done immediately?

9. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Characteristics of the ideal novel antibiotic Narrow spectrum Coupled to rapid diagnosis Not leading to resistance What can be done in a sustainable perspective?  find new anti-bacterial agents or therapies with novel mechanisms of action that will limit resistance development

10. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Anti virulence strategies to disarm infectious bacteria Functional genomics - targeted drug design Continue high throughput screening of natural products Novel vaccines based on meta-genomics Therapeutic antibodies Antibacterial peptides Areas of research that will have the highest probability to solve the antibiotic resistance problem: EU: international leading research on molecular mechanisms of microbial pathogenesis

11. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se When do we expect results? MeasuresImmediate results Results within 1-5 years Results within 5-15 years - Improve hygiene - New and improved diagnostic -Restricted use -Clear rules for usage Surveillance/epidemiology/monitoring of resistance Research on new antimicrobial strategies combined with modern genomics, metagenomics and proteomics High throughput screening of natural products Novel vaccines, therapeutic antibodies, antibacterial peptides Funding of small and medium sized biotech companies for translational research on new antimicrobials

12. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Maximise the effectiveness of research efforts through coordination of funding and resources Boost research advances and innovations Increase competitiveness of the EU on a global scale Joint Programming- the way forward

13. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se European Centre for Disease Control (ECDC) European Medicines Agency (EMEA) report: > 25 000 patients in the EU die each year from infections caused by multidrug-resistant bacteria antibacterial drug resistance - one of the major health threats in Europe

14. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Support for small and medium sized biotech companies needed Coordinated funding in EU networks of excellence Development of new antimicrobials in biotech companies: EU: translational research

15. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Epidemiology and surveillance Informatics based on genomics Rapid diagnosis Prevention and treatment of infection Rapid diagnosis Improved hygien Novel anti-microbial drugs

16. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Swedish MRSA cases 2000-2009

17. Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, Umeå University, Sweden, www.ucmr.se, www.molbiol.umu.se Swedish ESBL cases 2005-2009