Antibiotic resistance cause of 33,000 deaths annually, finds ECDC

Antibiotic resistance may be a cause of 33,000 deaths annually, according to a European Centre for Disease Prevention and Control (ECDC) study.

Such a huge number of people die each year as a direct consequence of an infection due to Antibiotic resistance and bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined.

"To our knowledge, this study is the first to estimate the burden of all types of infections with antibiotic-resistant bacteria expressed in disability-adjusted life-years (DALYs)," report the authors.

The authors said "the estimated burden of infections with antibiotic-resistant bacteria in the EU/EEA is substantial compared to that of other infectious diseases, and increased since 2007. Strategies to prevent and control antibiotic-resistant bacteria require coordination at EU and European Economic Area (EU/EEA) and global level. However, our study showed that the contribution of various antibiotic-resistant bacteria to the overall burden varies greatly between countries, thus highlighting the need for prevention and control strategies tailored to the need of each EU/EEA country."

"Our burden estimates provide useful information for public health decision-makers prioritizing interventions for infectious diseases," write the authors.

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Antibiotic-resistance is on the rise and infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging.

The study, published in The Lancet Infectious Diseases, estimates the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in the number of cases, attributable deaths, and DALYs. The estimates are based on data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) data from 2015.

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Key Findings:

• 671 689 (95% UI 583 148–763 966) cases of infections with selected antibiotic-resistant bacteria occurred in 2015 in the EU and EEA.


• These infections accounted for 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs.


• These estimates corresponded to an incidence of 131 (113–149) infections per 100 000 population and an attributable mortality of 6·44 (5·54–7·48) deaths per 100 000 population, causing 170 (150–192) DALYs per 100 000 population.


• YLLs (years of life lost) accounted for 85·3% (145 of 170) and BSIs for 71·7% (122 of 170) of total DALYs, suggesting that the attributable mortality estimates affect the final results the most, in particular for BSIs (bloodstream infections).


• 67·9% (115 of 170) of the total DALYs per 100 000 were caused by infections with four antibiotic-resistant bacteria with the largest effect on health: third-generation cephalosporin-resistant E coli, MRSA, carbapenem-resistant P aeruginosa, and third-generation cephalosporin-resistant K pneumoniae.


• 39% of the burden is caused by infections with bacteria resistant to last-line antibiotics such as carbapenems and colistin. This is an increase from 2007 and is worrying because these antibiotics are the last treatment options available. When these are no longer effective, it is extremely difficult or, in many cases, impossible to treat infections.

"Our findings show that all age groups are affected by infections with antibiotic-resistant bacteria, although their burden is significantly higher among infants than in any other age group. Among adults, the burden increases with age, suggesting that the ageing EU and EEA population could result in an increasing burden," write the authors.

"In adults and young adults, a higher proportion of the burden was caused by infections with carbapenem-resistant and colistin-resistant bacteria. This finding might be due to a lower risk of complications after an infection in this age group in general, except for patients who are often admitted to hospital and have difficult-to-treat infections because of carbapenem or colistin resistance."

"In the long term, research should be done to better understand the factors underlying the estimations of EARS-Net country coverage, such as catchment population, patient case-mix, laboratory capacity, and the appropriateness and frequency of collection of blood cultures," they concluded.