Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report 2023

In 2023, the estimated total EU incidence of meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infections was 4.64 per 100 000 population (country range 0−15.5). This was 17.6% lower than in 2019 (baseline year) and 0.15 per 100 000 population lower than the 2030 target of 4.79 per 100 000 population. For the EU overall, a statistically significant decreasing trend was detected between 2019 (baseline year) and 2023.

The estimated total EU incidence of third-generation cephalosporin-resistant Escherichia coli bloodstream infections was 10.35 per 100 000 population (country range 0−19.56) in 2023. This was 3.6% lower than in 2019 (baseline year) and 0.68 per 100 000 population higher than the 2030 target of 9.67 per 100 000 population. For the EU overall, there was no statistically significant trend detected between 2019 (baseline year) and 2023.

The estimated total EU incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections was 3.97 per 100 000 population (country range 0.00−21.44) in 2023. This was 57.5% higher than in 2019 (baseline year) and 1.58 per 100 000 population higher than the 2030 target of 2.39 per 100 000 population. For the EU overall, a statistically significant increasing trend was detected between 2019 (baseline year) and 2023.

In summary, while the EU target for the incidence of MRSA bloodstream infections had already been reached by 2023, the EU incidence of third-generation cephalosporin-resistant E. coli bloodstream infections only showed a small decrease compared to 2019 (baseline year) and the EU incidence of carbapenem-resistant K. pneumoniae bloodstream infections showed an increase by over 50% compared to 2019 (baseline year), which counteracts the target of a 5% reduction by 2030.

Overall antimicrobial resistance situation in the EU/EEA

Data from EARS-Net show that, as in previous years, AMR levels remained high in the EU/EEA in 2023.

Increases in the estimated EU incidences of bloodstream infections with resistant bacteria were observed not only for two of the above-mentioned AMR-pathogen combinations with an EU target, but also for many other bacteria and antimicrobial groups under surveillance, such as antimicrobial-resistant K. pneumoniae (other than carbapenem-resistant), vancomycin-resistant Enterococcus faecium and piperacillin-tazobactam-, ceftazidime-, and carbapenem-resistant Pseudomonas aeruginosa.

The AMR situation reported by EU/EEA countries varied widely, depending on the bacterial species, antimicrobial group and geographical region. The highest estimated incidences of antimicrobial-resistant bloodstream infections were generally reported by countries in the south or southeast of Europe.

For each bacterial species, country-specific information on the estimated incidence of antimicrobial-resistant bloodstream infections (including the recommended EU targets on AMR), the percentage of invasive isolates with AMR, data availability and the percentage of intensive care unit patients is available in country summaries. Results by age group and sex are available in the ECDC Surveillance Atlas of Infectious Diseases (https://atlas.ecdc.europa.eu/).

Public health conclusions

Estimates based on EARS-Net data from 2020 indicate that each year more than 35 000 people die in the EU/EEA as a direct consequence of antimicrobial-resistant infections.

The overall poor progress towards the EU targets on AMR and, more particularly, the continued increase in the incidence of carbapenem-resistant K. pneumoniae bloodstream infections, highlights the urgent need for intensified public health action against AMR.

The Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach (2023/C 220/01) encourages Member States to develop and implement national action plans against AMR, and highlights the need for Member States to allocate appropriate human and financial resources for the effective implementation of these plans.

The plans should include key elements, such as enhanced surveillance and strengthened infection prevention and control programmes in hospitals and other healthcare settings, integrated with antimicrobial stewardship programmes and good diagnostic practices.

In the absence of stronger, swifter public health action, it is unlikely that the EU will reach all its AMR targets by 2030. The consequence will be an increased number of infections with antibiotic-resistant bacteria that will be more difficult to treat, leading to increasing challenges for patients and AMR-related deaths.