On this World Patient Safety Day 2022, we are reminded of how unsafe medical practices can exacerbate existing medical conditions or even create additional health issues. This is particularly the case in the use of medication, where errors can significantly harm patients. This year, the WHO has chosen the slogan “Medication without harm” to raise awareness about this major problem, and the circumstances and conditions that give rise to it. These include poor training of both of healthcare professionals and patients, staff shortages, and a lack of infection prevention and control measures, among other factors.[1]

One of the most far-reaching and impactful consequences of these errors, to a large extent, is Antimicrobial Resistance (AMR), where the inappropriate use of antibiotics leads to bacteria becoming resistant to them. This makes regular medical interventions increasingly dangerous, in particular intensive care, cancer treatment, and organ transplantation.[2] The development of so-called “superbugs”, bacteria resistant to the most used antibiotics, represents a threat to modern medicine and could go so far as to push back decades of medical advances.  AMR does not discriminate in its potential to harm patients: complications from drug-resistant bacteria can affect anyone, no matter their health status, of any age, and in any country, leading to increased medical costs, prolonged hospital stays, greater demands on healthcare infrastructure and capacity, and increased mortality.[3] This is to say nothing of the implications of AMR beyond human health: resistance can build as medication cycles across humans, animals, and the environment, with antibiotics in livestock and in agricultural uses contributing to AMR in humans and vice versa.

Several factors lead to this misuse or overuse of antibiotics. To begin with, there is a general lack of awareness among the public. A 2015 WHO survey conducted in 12 countries revealed that while 64% of people knew about antimicrobial resistance, around the same number incorrectly believed antibiotics can be used to treat colds and flu.[4] As viral infections, antibiotics have no effect as the health of the patient is concerned – although attempting to treat viruses with antibiotics does exacerbate AMR. Additionally, while most healthcare professionals are aware of the risk of excessive antimicrobial use, there are still some gaps. A 2019 ECDC survey showed that only 75% of healthcare professionals were aware of the link between treatment with antibiotics and an increased risk of antibiotic-resistant infection. Many also recognised that they have prescribed antibiotics to patients when they would have preferred not to, for “fear of patient deterioration” or “fear of complications”.[5]

Several measures need to be implemented urgently to address this truly global public health threat. First, better infection prevention measures are needed. During the Covid-19 pandemic, citizens around the world came to realise the importance of their own actions in preventing infections, and how individual efforts can make a widely felt difference. Similar measures to the ones taken during that health emergency, building on this awareness and sense of shared mobilisation, can also be applied to AMR. First, better hand hygiene, particularly in healthcare settings, is essential. Local advocacy groups, working together with healthcare professionals, should help create and disseminate checklists with key hygiene measures that can easily be followed by everyone. Second, to avoid unnecessary consumption of antibiotics, healthcare professionals should make sure that a specific antibiotic is needed before prescribing it when a patient shows symptoms of infection. A better use of point-of-care rapid testing could reassure them about whether and which antibiotics are needed. Existing medical technologies are already effective in determining the relevant pathogen, but further investment is necessary to make them even more accurate and to reduce the instances of healthcare professionals who felt compelled to unnecessarily prescribe out of fear or uncertainty. Finally, awareness raising among the public is also indispensable. If patients are better informed, they will be aware that they should only be taking antibiotics if prescribed to them and in the manner prescribed to them (i.e., they should follow the antibiotic treatment as prescribed, not stop it prematurely once the symptoms disappear).

AMR is a serious health concern, but it is one where greater leadership from policy makers, healthcare professionals, and patient advocates can help reduce harm, improve outcomes, and make global progress.  World Patient Safety Day remains a positive occasion to reflect on where that leadership is most needed and what we can do to find solutions that would help everyone address the major public health threat that Antimicrobial Resistance represents. In Europe, both the EU and Member States, together with all relevant stakeholders, should work together to find a common approach to urgently address this problem, doing the necessary work to raise awareness and promote best practices, gathering and sharing key health data, and endorsing a comprehensive “One Health” approach that brings all sectors together.

[1] https://www.who.int/news-room/events/detail/2022/09/17/default-calendar/world-patient-safety-day-2022

[2] https://www.efsa.europa.eu/sites/default/files/topic/files/AMR-ECDC-Policy-Brief-2022.pdf

[3] https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance

[4] https://www.who.int/news/item/16-11-2015-who-multi-country-survey-reveals-widespread-public-misunderstanding-about-antibiotic-resistance

[5] https://www.ecdc.europa.eu/en/publications-data/survey-healthcare-workers-knowledge-attitudes-and-behaviours-antibiotics

Press release

Brussels, 28 June 2022

The European Patient Group on Antimicrobial Resistance is happy to announce its new visual identity and its new website: amrpatientgroup.eu. Given the growth of the group in the past few months with new patient organisations joining it from all over Europe, we are excited to present a new rebranding to consolidate their work.

The patient group, through its various advocacy and communication activities, will continue to advocate for effective measures to address the threat of Antimicrobial Resistance. Our recent contribution to the European Commission’s Call for Evidence for a Recommendation for Further Action on Antimicrobial Resistance summarises our main policy proposals, that include raising awareness about AMR and healthcare-associated-infections (HAIs), improving infection prevention and control measures, empowering patients through stewardship programmes, and investing in medical technologies to prevent AMR and HAIs.

To ensure action is taken at every governance level in Europe, we are organising a Parliamentary Roundtable Debate in October with stakeholders from the EU institutions, member states, healthcare professionals and, most importantly, patient representatives. It will be titled “Engaging with patients and closing knowledge gaps to fight antimicrobial resistance: the role in infection prevention and antimicrobial stewardship” and will be a hybrid event to boost participation and availability so any person can follow it. More information on this will be coming soon and we look forward to putting together this exciting event.

About the European Patient Group on Antimicrobial Resistance

The first European AMR Patient Group was officially launched on the 18th November 2020 to coincide with European Antibiotic Awareness Day 2020 and World Antimicrobial Awareness Week (18-24 November). The AMR Patient Group is an initiative by Health First Europe and is comprised of national patient associations from across Europe. The group aims to address the gap in awareness at the patient-level about the danger of antibiotic misuse and the lack of effective infection prevention measures. The AMR Patient Group will empower patients across Europe with the necessary knowledge about antimicrobial resistance so that everyone understands when it is appropriate to take antibiotics and how to take them responsibly.

If you are interested in our activities or want to join the European AMR Patient Group, please contact us at secretariat@healthfirsteurope.org

Author: Ilaria Galetti, Vice President GILS ODV – Gruppo Italiano per la Lotta alla Sclerodermia.

Milan, Spring 1996. I was studying at the University, in an ancient cloister, when I noticed the first sign of the disease that would be my unfriendly and undesired partner of my life: systemic sclerosis, also known as scleroderma. Systemic sclerosis is a rare, autoimmune, and very complex condition, that can affect the skin, lungs, heart, gastrointestinal tract, joints, and overall, the whole body. One medicine has been approved for its treatment, but only for lung fibrosis and nothing else.

Clinical practice guidelines recommend immunosuppressive therapies to lower the immune system, but no selective or personalised therapies are available. This means that the whole immune system is affected, exposing the body to many infections. The disease causes digital ulcers, very painful and often infected, that need to be treated with topic or systemic antibiotics. A swab should always be performed to use the right antibiotics.

Immunosuppressive therapies are still too generic, meaning that they inhibit the whole immune system, paving the way to several infections (mainly lung infections). This can be difficult to treat and can require hospitalisation. A careful evaluation of which antibiotics or specific treatments must be used, should always be performed, targeting the right bacteria, viruses, or fungi.

The last two and a half years have taught us many things regarding prevention that should become routine in our daily life. Prevention plays an extremely important role. Hand hygiene, the use of masks when meeting people with the flu, meeting people who are not perfectly healthy, and when going to the hospital for check-up visits or infusion therapies, should be a must for the so-called fragile patients and their families. The lower the risk of infections, the lower the need to use antibiotics.

Another important issue is the adherence to the prescribed therapy. In too many cases the antibiotic therapy is halted by the patient when symptoms and signs of the illness disappear. Prescribers and pharmacists should stress the importance of adhering to the therapy in order to get a full healing and prevent a relapse. On top of this, patients often spontaneously use the pills that remain in their stock, with a sort of self-prescription to cure “potential” infections diagnosed by themselves.

In my experience at national and European level I would encourage a programme on the correct use of antimicrobics in the wider community of connective tissue diseases. A few tips to prevent the spread of antimicrobial resistance:

These recommendations can help save lives including your life and the lives of those close to you.