Complacency kills. Antibiotic resistance still on the rise in Europe

WHO raises the alert on World Health Day

Copenhagen, 7 April 2011

Every year in the European Union alone it is estimated that over 25 000 people die of antibiotic-resistant bacterial infections, mostly acquired in hospitals. In the wider WHO European Region, which encompasses 53 countries, the full number is not known as data are not available, but the signs suggest that the situation is even worse. Doctors and scientists across the Region fear that with the reckless use of antibiotics, resulting in the emergence and spread of antibiotic-resistant infections, we could return to a pre-antibiotic era where simple infections do not respond to treatment, and routine operations and interventions may become life-threatening.

On the occasion of World Health Day 2011, under the slogan “No action today, no cure tomorrow”, WHO/Europe is highlighting the real and urgent risks of lifesaving antibiotics losing their healing power, and is targeting the need to reduce complacency, ignorance and irresponsibility. It calls on all key stakeholders, including policy-makers and planners, the public and patients, practitioners and prescribers, veterinarians, farmers, pharmacists and the pharmaceutical industry, to use antibiotics properly and responsibly, in the best way for combating antibiotic resistance.

“We need to raise the alert that we are at a critical point in time where antibiotic resistance is reaching unprecedented levels, and new antibiotics are not going to arrive quickly enough,” said Zsuzsanna Jakab, WHO Regional Director for Europe. “Antibiotics are a precious discovery, but we take them for granted, overuse and misuse them: there are now superbugs that do not respond to any drug. Given the growth of travel and trade in Europe and across the world, people should be aware that until all countries tackle this, no country alone can be safe.”

WHO/Europe’s response

The emergence of antimicrobial resistance is a complex problem driven by many interconnected factors, and a multisectoral response is urgently needed. Antibiotics are one of the most important antimicrobial agents and WHO/Europe works with its Member States on surveillance of antibiotic resistance, rational use of antibiotics, infection prevention and control, and research and innovation. It plans to scale up its work and has developed a strategic action plan to present to all ministers of health in the Region, at the annual meeting of its governing body in September 2011. WHO/Europe works very closely with European Union institutions such as the European Commission, the European Centre for Disease Prevention and Control and the European Food Safety Authority, as well as with public health institutes such as the National Institute for Public Health and the Environment (RIVM) in the Netherlands, and nongovernmental organizations such as ReAct in Sweden.

Several European countries have shown what can be done to combat antibiotic resistance but, in many countries, there are no national regulations on antibiotic usage, healthy animals are given antibiotics as growth promoters or to prevent disease, and commercial companies engage in irresponsible promotion. In too many countries, antibiotics can be bought over the counter by the general public, including farmers, without a prescription and used at will. Further, doctors often prescribe them too easily or inappropriately and people take them to treat viral infections such as influenza and the common cold, which many (mistakenly) believe to be treatable with antibiotics.

An informal survey of 21 countries in the eastern parts of the European Region indicated that, in 14 of them, buying antibiotics over the counter is common practice. Only 7 out of the 21 have a national plan of action on antibiotic resistance, and 7 out of 21 have a national coordinating committee in place. Less than half the countries surveyed have national guidelines on hand hygiene in health care settings, and only a third have a national surveillance system and database on antibiotic resistance.

Awareness campaigns have successfully addressed the overuse of antibiotics, and several countries can demonstrate a steady decrease in antibiotic usage resulting in a decrease in resistance. Stringent infection prevention and control programmes in health care settings, starting with simple hand hygiene, significantly reduce the occurrence of, for example, methicillin-resistant Staphylococcus aureus (MRSA), the much-feared hospital bacterium.

Resistance spreading from the food-chain and the environment

Antibiotic-resistant bacteria and resistance genes can pass on to people via handling food or taking care of food animals. This results from the overuse and misuse of antibiotics for disease prevention or growth promotion in food animals. In some countries, animal use seems to outweigh the use in human medicine. Some antibiotics such as ciprofloxacin are vital for treating humans, yet they are widely used by veterinarians on animals in food production, thus giving rise to drug resistance that may spread to humans. Although antibiotic use for growth promotion has been banned since 2006 in the European Union, this is not the case in all countries in the WHO European Region. The occurrence of resistant infections caused by Salmonella and Campylobacter species, common foodborne bacteria, can be directly linked to antibiotic use in food animals.

New antibiotics

The need for new antibiotics is growing as resistance spreads in European countries, making infections such as those in the bloodstream very difficult to treat, even with last-resort antibiotics such as carbapenems. For instance, the increasingly prevalent New Delhi metallo-ß-lactamase-1(NDM-1) gene contains an enzyme that can make carbapenems ineffective. Less than a handful of antibiotics are currently in the pipeline to combat antibiotic-resistant bacteria, and the worldwide spread of severe resistance genes is considered a nightmare scenario. Furthermore, multidrug-resistant tuberculosis, a heavy burden in the eastern part of the Region, continues to spread, threatening the lives of many.

Events

On 7 April 2011, WHO/Europe will launch a new regional strategy on the containment of antibiotic resistance and World Health Day events will be held throughout the European Region, including press briefings or technical meetings: in Moscow aimed at the Russian-speaking countries, in London to highlight the emergence of new mechanisms of antibiotic resistance, in Strasbourg to promote the need to address the lack of antibiotic drugs, in Kyiv to stress the urgent need to address multidrug-resistant tuberculosis, in Copenhagen to promote the prudent use of antibiotics and infection prevention, and in Rome where a new publication Tackling antibiotic resistance from a food safety perspective in Europe will be launched.

Fact sheets

Fact sheets and other information can be found on the WHO/Europe web site.

For further information, contact:

Bernardus Ganter
Senior Adviser, Communicable Diseases
WHO Regional Office for Europe
Mobile: + 45 20 45 92 73
E-mail: bga@euro.who.int 

Hilde Kruse
Programme Manager, Food Safety
WHO European Centre for Environment and Health, Rome
WHO Regional Office for Europe
Tel.: +39 064877525
E-mail: hik@ecr.euro.who.int

Kees de Joncheere
Pharmaceuticals and Health Technology
WHO Regional Office for Europe
Tel.: +45 39 17 14 32
E-mail: cjo@euro.who.int

Viv Taylor Gee
Communications Adviser
WHO Regional Office for Europe
Tel.: + 45 39 17 12 31
Mobile: +45 2272 3691
E-mail: vge@euro.who.int

Albena Arnaudova
Communications Officer
WHO Office at the European Union, Brussels
Tel.: +32 25064658
E-mail: arnaudovaa@who-eu.be