Study details how antimicrobial resistance is hitting Europe


A new analysis of the burden of antimicrobial resistance (AMR) in Europe estimates that drug-resistant bacteria were linked to more than half a million deaths in the region in 2019.

The study, published yesterday in the lancet Public Health, found that, in the 53 countries of the European Region of the World Health Organization (WHO), 541,000 deaths were associated with bacterial AMR, and 133,000 deaths were directly attributable to drug-resistant pathogens. The highest mortality rates attributable to and associated with AMR were reported in Eastern Europe, followed by Central Europe.

The vast majority of AMR deaths were caused by seven bacterial pathogens, with resistance to methicillin. staphylococcus aureus (MRSA) and resistant to aminopenicillin Escherichia coli among the main culprits.

The study authors say the analysis provides the most detailed and comprehensive assessment to date of the burden of AMR in Europe.

“The high levels of resistance to several important bacterial pathogens and pathogen-drug combinations, together with the high mortality rates associated with these pathogens, show that AMR is a serious public health threat in the WHO European Region” , they wrote.

Attributable and associated deaths

The study, conducted by an international team of scientists and led by researchers at the Institute for Health Metrics and Evaluation at the University of Washington, used data from a variety of sources to estimate, through statistical modeling, deaths and years of life disability-adjusted (DALY). ) attributable to and associated with 23 bacterial pathogens and 88 pathogenic drugs in the WHO European Region in 2019.

Overall, 471 million individual records or bacterial isolates were obtained from sources such as the European Antimicrobial Resistance Surveillance Network, the Central Asian and European Antimicrobial Resistance Surveillance Network, and the Global Antimicrobial Resistance Surveillance System. WHO Antimicrobial Resistance (GLASS).

The study’s methodology was similar to the approach used in the Global Research on Antimicrobial Resistance (GRAM) report released earlier this year, which estimated that 1.27 million deaths worldwide were directly attributed to AMR in 2019 (from 4.95 million associated with drug-resistant pathogens). The authors say this study extends those results while providing more granular and country-specific estimates within Europe.

As in the GRAM report, the researchers calculated the ADR burden (deaths and DALYs) using a two-counterfactual approach. To estimate deaths directly attributable to resistant bacteria, they considered a scenario in which those infections were replaced by antibiotic-susceptible infections. To estimate associated deaths, they considered a scenario in which resistant infections were replaced by no infections.

Of the estimated 133,000 attributable deaths (95% uncertainty interval [UI], 90,100 to 188,000) and 541,000 associated deaths (95% of UTIs, 370,000 to 763,000), the largest fatal burden of AMR was from bloodstream infections, with 47,200 attributable deaths and 195,000 associated deaths linked to any resistant drug-pathogen combination. Other leading causes of death from any resistant drug-pathogen combination were intra-abdominal infections (31,200 attributable and 127,000 associated deaths) and respiratory infections (28,500 attributable and 120,000 associated deaths).

Seven main bacterial pathogens were responsible for 112,784 attributable deaths and 457,591 associated deaths: E. coli, S. aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, Streptococcus pneumoniae, Y Acinetobacter baumannii.

MRSA was the main drug-pathogen combination in deaths attributable to AMR in 27 countries (51% of the region), while those resistant to aminopenicillin E. coli it was the main drug-pathogen combination of associated deaths in 47 countries (89% of the region). A similar distribution was observed with DALYs for combinations of pathogens and drugs.

The estimated mortality rates per 100,000 population observed in Eastern Europe (19.9/100,000 attributable and 74.0/100,000 associated) and Central Europe (16.6/100,000 attributable and 68.0/100,000 associated) were considerably higher than those of Western Europe (11.7/100,000 attributable and associated). 52.5/100,000 associates). Taking into account age-standardized mortality rates per 100,000, the countries most affected by AMR were concentrated in Central Asia (which WHO considers part of the European Region).

The analysis also found that countries in the region with national AMR action plans developed, approved, funded, and implemented were in the lowest 50th percentile of age-standardized mortality rates for both attributable and associated deaths. Nations with lower sociodemographic index (SDI) scores, a measure of overall development, had a higher mortality burden from AMR.

Furthermore, a positive correlation was observed between crude AMR mortality rates and antimicrobial use, with the strongest relationship observed in Western and Central Europe.

RAM Mitigation Strategies Needed

Compared to the GRAM report estimates, the WHO European region, which represents approximately 12% of the world’s population, accounts for 10.5% of the estimated 1.27 million global deaths attributable to AMR and 10 .9% of the 4.95 million associates. deceased.

In an accompanying commentary, infectious disease experts from University Hospitals and Geneva Medical School say the findings illustrate the substantial adverse health impact AMR-related infections have across Europe. They add that future AMR mitigation strategies in the region will require the development and maintenance of high-quality AMR surveillance networks to advance understanding of the true burden of AMR, funding research to assess the burden of specific combinations. of resistant pathogens and develop pathogen-specific interventions, and quantify the economic impact and indirect costs attributable to AMR.

“All of these elements can close knowledge gaps and pave the way for an exit strategy from this silent pandemic,” Nasreen Hassoun-Kheir, MD, and Stephan Harbarth, MD, wrote.

They also say the findings should encourage clinicians and policymakers across Europe to endorse and implement country-specific AMR control plans, with a parallel focus on implementing the best infection control and antibiotic stewardship programs in settings. of medical care.


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