Running Out of Antibiotics: Europe Gets It

In the United States, it’s been “Get Smart About Antibiotics” Week this past week, an annual observance in which the Centers for Disease Control and Prevention and its medical and public health partners try to raise awareness of antibiotic resistance. The real action this week though was in Europe, where individual researchers and the EU’s version of a CDC — the European Centre for Disease Prevention and Control — are speaking out about the problem with unusual candor.

Here’s the short version: In Europe, according to the ECDC, 25,000 people each year die as a result of multi-drug resistant infections, causing an additional cost to society of 1.5 billion Euros ($2.02 billion): 938 million Euros ($1.27 billion) in hospital and outpatient medical costs, and an additional  596.3 million Euros ($806 million) in lost productivity.

Dr. Marc Sprenger, director of the ECDC, said Friday:

This certainly is an underestimate of the true economic impact of antimicrobial resistance. In particular, the figures were based on data for just five multidrug-resistant bacteria.The estimate was also based on a conservative figure for the cost of a day in hospital… We think the real cost of treating a patient with a multidrug-resistant infection would be higher than this. My take home message is that antimicrobial resistance is one of the most serious public health challenges that we face.

Sprenger was talking at the release of a major Europe-wide report (press release here too) that found organisms that cause serious hospital infections are becoming substantially resistant to last-resort drugs. In some countries, 50 percent of Klebsiella isolates are resistant to carbapenems — that’s the almost-untreatable hospital superbug CRKP that has appeared in 37 US states so far — and so are 25-50 percent of Pseudomonas isolates, another deadly hospital-acquired organism.

Meanwhile, 13 countries just in the EU have found more than 100 cases of infection with bacteria carrying NDM-1, the gene and enzyme that renders organisms effectively untreatable by any antibiotic except for 1-2 old, imperfect drugs. And the ECDC warns that the various countries within the EU simply don’t have the surveillance or personnel to track that bug as it walks undetected across borders in the guts of unknowingly infected people and into hospitals.

Simultaneously, in The Lancet Infectious Diseases, a British researcher expressed her frustration that no one takes this seriously. In an online essay, Laura Piddock, who is president of the British Society for Antimicrobial Chemotherapy, says:

When… patients are denied treatment with a new cancer drug because of its expense, there is public outrage despite the possibility of extending life by only a few weeks. Antibiotics are not perceived as essential to health or the practice of medicine, despite such agents saving lives so that individuals can live for many years after infection… Cancer drugs… sometimes only extend life for weeks or months, whereas antibiotics can extend life for years.

Possibly the most encouraging thing about the EU’s candor is how directly it confronts the tie between antibiotic resistance in human medicine and antibiotic use in agriculture. On Thursday, the European Commission announced a 5-year, 12-point plan to reduce resistance, and half of their proposed “concrete actions” address curbing antibiotic use in agriculture:

  • Improve awareness raising on the appropriate use of antimicrobials
  • Strengthen EU law on veterinary medicines and on medicated feed
  • Introduce recommendations for prudent use of antimicrobials in veterinary medicine
  • Strengthen infection prevention and control in hospitals, clinics, etc.
  • Introduce legal tools to tighten prevention and control of infections in animals in the new EU Animal Health Law
  • Promote unprecedented collaboration to bring new antimicrobials to patients
  • Promote efforts to analyse the need for new antibiotics in veterinary medicine
  • Develop and/or strengthen multilateral and bilateral commitments for the prevention and control of AMR
  • Strengthen surveillance systems on AMR and antimicrobial consumption in human medicines
  • Strengthen surveillance systems on AMR and antimicrobial consumption in  animal medicines
  • Reinforce and co-ordinate research
  • Improve communication on AMR to the public.

And just in case those seem like theoretical, low-priority concerns, a new coalition rose up in Europe last week to emphasize how important ag antibiotic control really is to human health. Three groups — the Soil Association, Compassion in World Farming and Sustain: The Alliance for Better Food and Farming — published a report that painstakingly documents the connections between specific antibiotics used in farming and specific drug-resistant organisms showing up in humans in European countries.

The groups call for cutting antibiotic use on EU farms in half by 2015. Noting that agriculture has simply ignored calls for reduced use on the basis of human health and animal welfare, they smartly propose recasting it as a competitive issue: Lesser antibiotics as a sign of better quality.

The EU has done more than most other regions of the world to monitor farm animal welfare and outlaw some of the worst intensive farming practices (battery cages, sow stalls, veal crates). EU reforms have had an important impact in encouraging similar changes in practices worldwide, through either voluntary action by industry or through law.
The EU should now take the lead again with effective action to end the misuse of antibiotics in farming, and ensure the conditions are provided for the animals to maintain good health based on their own immune systems rather than through routine reliance on antibiotics.
This would be in the interests of Europe’s farmers, establishing their reputation globally for high-quality standards while meeting the demand of their customers, who seek higher standards of animal welfare, more transparency and better quality in their food production.

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