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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
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General background 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 Antimicrobial resistance (AMR) is still a growing European and global health problem. (Council Conclusions on Antimicrobial Resistance (AMR), Luxembourg, 10 June 2008)
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Background for ECDC-EMEA Joint Report 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 ECDC-EMEA Joint Working Group (established February 2008)
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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 Methods (1): Selected resistant bacteria of public health importance Source: EARSS & Biedenbach DJ et al., 2004.
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Methods (2): Trends and burden of human infections due to resistant bacteria Trends –Data on resistant bacteria from bloodstream infections (European Antimicrobial Resistance Surveillance System - EARSS) –2002-2007 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
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Percentage of resistant isolates in bacteria from bloodstream infections, EU countries, Iceland and Norway, 2007 Country with a significant increase (2005-2007) Country with a significant decrease (2005-2007) Methicillin-resistant S. aureus - MRSA (%) 3rd-gen. ceph.-resistant Klebsiella pneumoniae (%) 3rd-gen. ceph.-resistant Escherichia coli (%) Source: EARSS & ECDC, 2009 No. of countries
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Gram-positive bacteria Gram-negative bacteria Population-weighted, average %resistant isolates among bacteria from bloodstream infections, EU, Iceland and Norway, 2002-2007 *Excluding Greece, which did not report data. **Excluding Belgium and Slovakia, which did not report data. Source: EARSS & ECDC, 2009
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Human burden Economic burden Limitation: these are underestimates. Burden of multidrug-resistant (MDR) bacteria in the EU, Iceland and Norway Source: ECDC, 2009 Infections (6 most frequent MDR bacteria, 4 main types of infection) approx. 400,000 / year Attributable deaths approx. 25,000 / year Extra hospital days approx. 2.5 million / year Extra in-hospital costs approx. € 1 billion / year Productivity losses approx. € 600 million / year
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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.
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