European Antibiotic Awareness Day - 18th November 2023
European Antibiotic Awareness Day, celebrated on November 18th, underscores the importance of responsible antibiotic use to combat the increasing threat of antimicrobial resistance (AMR).
This year’s European Antibiotic Awareness Day focuses on the reduction targets for antimicrobial consumption levels and AMR incidences set by the EU Council for each EU Member State, including Ireland. To achieve these targets, it is essential for healthcare professionals, policymakers, and patients to come together and adopt better practices, to preserve the vital effectiveness of antibiotics for future generations.
Antimicrobial resistance
Antimicrobial resistance (AMR) occurs when microorganisms such as bacteria, viruses, and fungi evolve their biological and genetic properties, rendering the medications used to combat them ineffective. As a consequence, infections become more challenging, and sometimes impossible, to treat. AMR also poses a significant threat to the achievements of modern medicine, increasing mortality and morbidity rates in major surgeries, cancer chemotherapy, and dental care. Furthermore, AMR escalates healthcare expenditure as it necessitates more intensive care and prolongs patients' hospital stays.
While AMR can occur naturally in certain microorganisms, the primary driver is the inappropriate and excessive use of antimicrobial agents, including antibiotics, in both human and animal health. This is why the European Centre for Disease Prevention and Control (ECDC) initiated a health campaign in 2008 and designated the 18th of November as European Antibiotic Awareness Day. This event is aligned with the World Health Organization's (WHO) Antibiotic Awareness Week, which takes place from November 18th to 24th 2023.
The focus of this year's European Antibiotic Awareness Day is the EU Council Recommendations on strengthening EU actions against AMR. In this significant document, each EU Member State is given a target to reduce its antimicrobial medicine use and infection rates for specific antibiotic-resistant organisms.1
Antibiotic consumption in Ireland
In Ireland, the total antibiotic consumption in primary and hospital care sectors in 2019 was 22.8 Defined Daily Doses (DDD) per 1000 inhabitants per day (DID). Ireland ranked seventh highest among EU Member States in terms of overall antibiotic consumption in 2019. The EU Council has set a reduction target of 27% for Ireland by 2030. Although Ireland had lower levels of antibiotic consumption in 2020 and 2021 due to the COVID-19 pandemic, at 18.6 and 17.8 DID respectively, consumption returned to pre-pandemic levels in 2022, reaching 23.1 DID.
The WHO classifies antibiotics into three groups: Access, Watch, and Reserve, to emphasize the importance of their appropriate use. Access group includes antibiotics that are effective against a wide range of pathogens while also showing lower resistance than antibiotics in the other groups. Watch group consists of critically important antibiotics while Reserve group includes last resort antibiotics. The recommended target for total antibiotic consumption of the Access group of antibiotics is 65% for every EU Member State by 2030. Ireland has already achieved this target, with the consumption of Access group antibiotics reaching almost 75% in 2022. These results indicate that despite higher consumption levels in Ireland, most of this consumption consists of Access group antibiotics.
The document1 also outlines target incidence rates for three antibiotic-resistant bloodstream infections: meticillin-resistant Staphylococcus aureus (MRSA), third-generation cephalosporin-resistant Escherichia coli, and carbapenem-resistant Klebsiella pneumoniae infections. In 2019, Ireland's MRSA incidence rate was 3.1 per 100,000 population, ranking 13th among 27 EU Member States, with a 6% reduction target set for the country by 2030. The proportion of MRSA isolates among all S. aureus isolates was 12.1% in 2019. In 2022, the proportion had decreased to 10.6%. Concerning cephalosporin-resistant Escherichia coli bloodstream infections, Ireland ranked 9th highest among 27 countries, with an incidence rate of 8.3 per 100,000 population. The proportion of cephalosporin-resistant E. coli was 12.4% in 2019 and it decreased to 9.7% in 2022. A 10% reduction target has been established for the country. However, for carbapenem-resistant Klebsiella pneumoniae infections, Ireland performed better than most EU Member States, ranking 10th lowest in terms of incidence. The incidence rate for carbapenem-resistant K. pneumoniae was 0.11 per 100,000 population, with a 2% reduction target set for the country. The proportion of carbapenem-resistant K. pneumoniae was 1.1% in 2019 but it increased slightly to 1.2% in 2022.
Antimicrobial stewardship & rational antibiotic use
To achieve these targets and mitigate the impact of AMR, it is essential for healthcare professionals, policymakers, and patients to adhere to multidisciplinary antimicrobial stewardship and rational antibiotic use principles.
- Healthcare settings should improve their infection prevention and control measures to limit the spread of antimicrobial resistant organisms.
- Prescribers should follow national guidelines and prescribe the right antibiotic when truly needed, at the appropriate dose and duration.
- Patients should follow the instructions of their physicians and pharmacists when using antibiotics, complete their courses, and avoid pressuring prescribers for antibiotics.
- Epidemiological and surveillance staff should monitor consumption and drug-resistant infection trends and alert policymakers when an action needs to be taken.
- Policymakers should enact binding guidelines and legislation that aligns with the WHO's Global Action Plan on Antimicrobial Resistance2 and the EU One Health Action Plan3, making decisions based on the evidence presented to them.
Keeping antibiotics effective is everyone's responsibility. These principles can help prevent resistant bacteria from developing and ensure the continued effectiveness of antibiotics for future generations.
Further information
Advice on best practice in antimicrobial prescribing is available at: https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/
More info on European Antibiotic Awareness Day is available from the European Centre for Disease Prevention and Control.
European Antimicrobial Awareness Day events
The next episode in the 2023/24 RCSI MyHealth Series will focus on the topic of antibiotic-resistance – one of the biggest threats to global health and development today. More information available at RCSI.com
Umut Gurpinar, Epidemiologist at HPSC
References
- Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach, The Council of The European Union, 2023. Available at: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32023H0622%2801%29
- Global Action Plan on Antimicrobial Resistance, World Health Organization, 2015. Available at: https://iris.who.int/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1
- A European One Health Action Plan Against Antimicrobial Resistance, the European Commission, 2016. Available at: https://health.ec.europa.eu/system/files/2020-01/amr_2017_action-plan_0.pdf