The two most common antibiotic-resistant bloodstream infections – methicillin-resistant Staphylococcus aureus (MRSA) and resistant Escherichia coli – caused 8215 excess deaths (5503 and 2712, respectively) in 31 European countries in 2007. They also accounted for more than 260 000 bloodstream infections, and over 370 000 extra days in hospital, at a cost of €62 million, according to a recent study (1). Less is known about these and other such infections in other countries the WHO European Region, where data are not reported to international surveillance systems.

Multidrug-resistant tuberculosis (MDR-TB) is spreading at an alarming rate in the Region. The Region includes not only the 9 countries leading the world in rates of drug resistance among newly diagnosed patients (up to 40%) but also the 6 countries with the world’s highest rates of MDR/TB among previously treated TB patients (up to 70%). WHO estimates that about 81 000 MDR-TB cases occur in the Region each year; only about 28 000 (34%) of these are reported, owing to limited laboratory capacity, and only about 17 000 of the reported cases (62%) are said to receive treatment with high-quality second-line drugs. The funds needed for treatment are expected to rise from US$ 454 million for 2011 to US$ 1.7 billion for 2015. At present, the rate of treatment success for people with MDR-TB is only 57.4%, with many patients ceasing treatment and/or dying.

To combat resistance effectively, information is needed on antibiotic use, as well as the origin and spread of resistant pathogens and their impact on society. Health professionals, risk managers and decision-makers need this information to prioritize their resources and efforts to contain antibiotic resistance. Surveillance forms the basis for evidence-based action.

WHO/Europe will strengthen the surveillance of antibiotic resistance by assisting 21 countries to gather and report data so that they are compatible with existing surveillance systems, following Member States’ endorsement of the European strategic action plan on antibiotic resistance in September 2011.

“Coordinating surveillance efforts on antibiotic resistance across the European Region will shed much-needed light on this increasing public health threat. I applaud countries for committing to the European action plan, which will enable policy-makers and health professionals to make informed decisions to prevent, contain and mitigate antibiotic resistance,” says Zsuzsanna Jakab, WHO Regional Director for Europe.

Collaboration with major players in the Region – such as the European Commission, the European Centre for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA) and the European Food Safety Authority (EFSA) – and with strong technical partners – such as the National Institute for Public Health and the Environment (RIVM) in the Netherlands, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and ReAct – Action on Antibiotic Resistance – is an integral part of the action plan.

Current surveillance in Europe

Countries in the European Union (EU) collect data on antibiotic resistance through the European Antimicrobial Resistance Surveillance Network (EARS-Net), managed by ECDC.  European Surveillance of Antimicrobial Consumption (ESAC) gathers data on antimicrobial usage in 34 European countries, including all 27 EU Member States. In addition, WHO/Europe and ECDC jointly conduct surveillance of resistance to anti-TB drugs in a framework that covers all 53 WHO Member States in the Region.

Finding the gaps in knowledge

WHO/Europe made an informal survey of 21 countries in the eastern part of the European Region to obtain baseline information on their capacity (level of awareness, infrastructure and preparedness) to face the rapidly growing threat of antibiotic resistance to human and animal health.

The results showed that 6 countries (29%) have national coordinating committees and are current or former members of EARS-Net, and 7 have national surveillance systems for antibiotic resistance. A third of the responding countries have national programmes on hospital-acquired infections, and almost half collect data on them.

Information on antibiotic use in the medical sector is available in 8 countries (38%), and 5 (24%) have information on antibiotic use in the veterinary and food-animal production sectors. This points to an urgent need to address antibiotic resistance in relation to food safety in some parts of the Region. WHO/Europe’s new book, “Tackling antibiotic resistance from a food safety perspective in Europe”, explores options for countries to prevent and contain antibiotic resistance in the food chain. It discusses the regulation and reduction of antibiotic use in food animals, training and capacity building, surveillance of resistance trends and antibiotic usage, promotion of knowledge and research, and awareness raising through advocacy and communication.

European action plans

Two new action plans approved by the WHO Regional Committee for Europe in September 2011 – the European action plan on antibiotic resistance and the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis (M/XDR-TB) in the WHO European Region 2011–2015 – include a number of key strategic actions for mitigation, prevention and control. These include:

- promoting national coordination to implement strategic plans of action and develop regulatory functions and guidance;

- promoting the prudent use of antibiotics across all relevant sectors;

- strengthening surveillance systems to monitor antibiotic use and resistant bacteria in human and animal health, including the food chain; and

- creating awareness of the prudent use of antibiotics and the paucity of new antibiotic drugs coming into the market.

Public awareness

The WHO/Europe survey indicated that patients usually expect their doctors to prescribe antibiotics in 19 countries (90%). The campaign for World Health Day 2011 sought to raise awareness of the real and urgent risks of life-saving antibiotics’ losing their healing power as a result of widespread use and misuse in both human beings and animals. European Antibiotic Awareness Day, observed on 18 November every year, reminds the people and groups that regulate, produce, prescribe and administer antibiotics of the necessity to remain vigilant about their use and to combat resistance.

Signs of the success of such campaigns include not only a demonstrable effect on antibiotic use in a number of countries but also similar annual events’ being held on or around 18 November by countries outside Europe, such as Canada, Japan and the United States of America. WHO/Europe works to encourage all countries in the European Region to participate in this initiative.

Additional information

European strategic action plan on antibiotic resistance

Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis (M/XDR-TB) in the WHO European Region 2011–2015

World Health Day 2011 – Antibiotic resistance: no action today, no cure tomorrow

World Health Day 2011 – Fact sheets

Tackling antibiotic resistance from a food safety perspective in Europe 

European Antimicrobial Resistance Surveillance Network (EARS-Net)

European Surveillance of Antimicrobial Consumption (ESAC)

European Antibiotic Awareness Day

For further information, contact:

Danilo Lo Fo Wong

Senior Adviser on Antimicrobial Resistance

WHO/Europe

Tel.: +45 39 17 14 23, +45 51 53 96 16 (mobile)

E-mail: DLO@euro.who.int

Gregory Härtl

Acting Communications Manager

WHO/Europe

Tel.: +45 39 17 12 31, +41 79 203 6715 (mobile)

Email: hartlg@who.int

1. De Kraker MEA, Davey PG, Grundmann H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. “PLoS Medicine”, 2011, 8(10) e1001104 8