On Monday I Tweeted a 14 second video clip along with the hashtag #KeepAntibioticsWorking. In the video I explain what I have done to help keep antibiotics working for future generations (you will need to watch it to find out!). The video was my contribution to a social media campaign led by the European Centre for Disease Prevention and Control. Welcome to World Antibiotic Awareness Week (13-19 Nov) and the run up to the 10th edition of European Antibiotic Awareness Day.

Ben Duncan
Senior Adviser

This is the time of year when public health experts in Europe and around the world highlight the problem of antimicrobial resistance. In simple terms, disease causing bugs are continuing to evolve defences against the drugs doctors use to kill them. Though there are signs that the rise of drug resistance may be slowing in the EU, ECDC’s latest data (published 15 November) still make for grim reading.

ECDC highlights the continued emergence of multi-drug resistant strains of the bacteria Klebsiella pneumoniae,Escherichia coli and Acinetobacter. All three are liable to spread in hospitals, clinics and nursing homes. They cause, variously, urinary tract infections (Klebsiella and E. coli), pneumonia (Klebsiella and Acinetobacter) and bloodstream infections (all three). Between 2013 and 2016, the latest year for which EU-wide data is available, Europe saw the rate of drug resistance of these bacteria climb. More than one third of Klebsiella bacteria tested in the EU in 2016 were resistant to at least one of the major antibiotics used in Europe. Some of the Klebsiella was resistant even to carbapenems and colistin, which are considered medicine’s last lines of defence. The significance of this may not be immediately obvious to readers who don’t have a degree in pharmacology. Put simply, though, if a bug is resistant to all the major antibiotics plus carbapenems and colistin, then it is pretty much untreatable. For the patients unlucky enough to be infected with this type of pan-resistant (i.e. resistant to pretty much everything) Klebsiellathe post-antibiotic apocalypse has already arrived.

Commenting on this situation on the day the report was published, Vytenis Andriukaitis, European Commissioner for Health and Food Safety, said: “with increasing resistance even to last-line antibiotics we face a frightening future where routine surgery, childbirth, pneumonia and even skin infections could once again become life threatening.”

But this EU-level summary of the “bad news” from the 2016 data hides a more complex picture. It’s not quite a story of Klebsiella Heaven and Hell, but it’s getting on that way. In most of Northern Europe, including France, Germany, the Netherlands and Scandinavia, pan-resistant Klebsiella has remained rare. In 2016, as in 2013, fewer than 1% of Klebsiella infections tested were resistant to carbapenems. In contrast, more than 25% of Klebsiella infections tested in Italy were resistant to carbapenems. And by 2016 more than 5% of these Klebsiellainfections were resistant to colistin as well as carbapenems. The situation in Greece was even worse. In 2016 upwards of 50% of Klebsiella infections tested there were resistant to carbapenems. More than 10% were resistant to both colistin and carbapenems. The situation in Romania in 2016 was just as worrying: more than 25% of the infections tested were resistant to carbapenems and more than 10% were resistant to both colistin and carbapenems.

The growing incidence of pan-resistant bacteria such as Klebsiella (and also in Escherichia coli and Acinetobacter) southern and eastern EU countries is a worry for all Member States. Nonetheless, the success so far of efforts to prevent them spreading to the north and west gives some cause for hope. So too does the data showing that the percentage of meticillin-resistant Staphylococcus aureus (MRSA) further decreased between 2013 and 2016. Last decade MRSA was the “super-bug” hospitals in Europe feared most. Now it is beginning to look like a manageable problem.

Speaking at the launch of the new data, ECDC Director Andrea Ammon gave the Centre’s analysis of how to halt the rise of antimicrobial resistance: “prudent antibiotic use and comprehensive infection prevention and control strategies targeting all healthcare sectors are fundamental.” Addressing this last point, Dr Ammon also launched new infection control guidance on carbapenem-resistant bacteria such as Klebsiella. Meanwhile back in Brussels Dr Andriukaitis highlighted the EU One Health Action Plan published by the Commission in June. He was also candid about the differences between Member States. “To preserve our ability to effectively treat infections in humans and animals, we need to bridge differences between EU Member States and raise the level of all of them to that of the highest performer.

These seem to be good prescriptions for the EU. As always, though, the challenge will be making sure the patient follows the doctors’ orders.