On Thursday 27 October 2022, Health First Europe’s European Patient Group on Antimicrobial Resistance organised a Parliament Roundtable Debate under the title “Engaging with patients and closing knowledge gaps to fight antimicrobial resistance: the role in infection prevention and antimicrobial stewardship”. The event took place in the European Parliament, hosted by MEP Ondřej Knotek (Renew Europe, Czech Republic) and held under the patronage of the Czech Presidency of the Council.
Dr Roberto Bertollini, President of Health First Europe, kicked off the event by describing antimicrobial resistance as one of the major issues that the public health community will face in the next few years. He warned that without proper solutions, common illnesses might become untreatable or only treatable with a significant risk to the patient. On top of the human suffering AMR causes, Dr Bertollini also highlighted the significant economic costs it causes. By 2030, the World Bank estimates a $3.4 trillion global GDP fall due to AMR and its consequences among the population. He then welcomed the speakers and asked them to reflect on past experiences dealing with AMR to help identify lessons for the future.
This introduction was followed by a message from MEP Knotek, who further underlined that the inappropriate use of antibiotics leads to the development of a “silent pandemic”. He called for AMR to be addressed at every level, asking EU and global institutions to continue monitoring it and to issue recommendations on how to tackle it. He also commended the work of the members of the AMR Patient Group. He asked authorities to work with them to bridge the knowledge gap on the use of antibiotics among citizens at the local level.
After these introductory interventions, Dr Andrea Ammon, Director of the European Centre for Disease Prevention and Control (ECDC) set the scene for the exchange by sharing some key facts about AMR in Europe at present. Dr Ammon mentioned that while antibiotic consumption and AMR decreased in 2020 as a result of the exceptional measures taken to control Covid-19, there are still high levels of resistance for several important bacterial species-antimicrobial group combinations. She pointed out that the burden of AMR remains very high, as it is similar to the burden of influenza, tuberculosis and HIV/AIDS combined. According to ECDC estimates, 70% of this burden is related to health care-associated infections. Dr Ammon added that the ECDC is working with other global and EU-institutions and Member States towards finding solutions. For instance, the ECDC supports national AMR reference laboratories in building capacity on whole genome sequencing to integrate it as part of AMR surveillance, which has greatly helped the ECDC’s risk assessments. Furthermore, in cooperation with the European Commission’s Directorate General for Health and Food Safety (DG SANTE), they undertake joint One Health country visits to interested Member States. This helps them identify areas of improvement in their human and animal health sectors, which they use for national actions plans.
Dr Ammon finished her intervention by asking participants to mark the 15th European Antibiotic Awareness Day on 18November under the theme “Preventing Antibiotic Resistance Together”, which highlights everyone’s important role in this fight.
In line with this Call for Action, Céline Ledoux and Julia Langer, from DG SANTE, then presented the latest actions the EU has taken in the fight against AMR. They both underlined the Commission’s One Health approach to AMR, which acknowledges that efforts are needed across sectors (i.e., human, animal, and environmental health) to address the AMR crisis adequately. Ms Ledoux emphasised that the upcoming Proposal for a Council Recommendation on AMR, planned for the beginning of 2023, will use the lessons learnt from the 2017 EU One Action Plan against AMR, extending and complementing it. Ms Langer remarked that the European Health Union initiative reinforces the EU’s role in addressing AMR. This initiative includes the revised legislation on cross-border health threats, recently adopted by the Council; the extension of the mandate of the ECDC; and the creation of the Health Emergency Preparedness and Response Authority (HERA). Moreover, she added that the revised Pharmaceutical Strategy for Europe includes measures for the prudent use of antimicrobials and explores options for developing new antimicrobials addressing AMR.
The presentations from EU representatives were followed by an address from Dr Malin Grape, Sweden’s Ambassador on Antimicrobial Resistance. Dr Grape presented the Swedish experience with AMR and the country’s plans for its forthcoming Presidency of the Council of the EU in the first half of 2023. She explained that her country’s Public Health Agency and the Board of Agriculture have been spearheading intersectoral cooperation since 2012 to address the development of resistance. Cooperation between the local, national, and international governance levels plays a key role in Sweden’s actions on AMR. She highlighted the importance of integrating surveillance, stewardship, and infection control. She then presented Sweden’s national stewardship programme, known as Strama, which among other measures, includes monitoring prescriptions of antibiotics, sets national targets, and ensures both a bottom-up and a peer-to-peer approach. When Sweden takes the helm of the Council, they will continue the work on the AMR policy package, and on the Strategy for Global Health, which will strengthen EU leadership worldwide.
Following the institutional panel, attendees heard the emotional testimony of patient advocates. Ms Vanessa Carter, a South African Patient Advocate for Antimicrobial Resistance who suffered a resistant infection after being a victim of a car accident, shared her personal story of dealing with AMR. She is actively engaged with the WHO, the Africa Centres for Disease Control and Prevention, and other institutions in educating patients about AMR. Mr Jonathan Pearce, CEO of the Antibiotic Resistance UK charity, also provided examples of patient stories and highlighted the work he does in the UK as the only UK patient support service for patients with AMR and their families. Both speakers called for greater support for victims of resistant infections and asked the institutions to improve communication on the topic, as well as research, infection prevention, and antibiotic stewardship actions at every level.
The patients’ perspective part of the event was complemented with the healthcare professionals’ point of view. Dr Christiaan Keijzer, President of the Standing Committee of European Doctors (CPME), spoke on their behalf. He stated that while doctors have a basic knowledge about the prudent use of antibiotics and the risk of resistance, they often lack resources or time to provide appropriate advice to their patients. He emphasised the need to increase the uptake of antibiotic stewardship teams so that information about antibiotics is passed on to healthcare professionals and patients in a more systematic way. He argued that national guidelines on antibiotics must enshrine that doctors diagnose the patient in person before prescribing antibiotics, performing a clinical and diagnostic examination before initiating therapy. Doctors should ascertain that the patient most probably has a bacterial infection, and a real effect can be expected by treatment with antibiotics. Finally, they must choose as specific a narrow-spectrum antibiotics as possible as first choice.
Subsequently and in line with Dr Keijzer’s arguments, Miriam D’Ambrosio, External Affairs – Manager Communications at MedTech Europe, stressed that the effective use of diagnostic tests and medical devices can help address these health challenges throughout the entire patient pathway: before admission to the hospital or in the community, at the arrival at the ward, in the operating room, during the hospital stay and recovery, and when the patient is discharged and sent back home.
Furthermore, she emphasised that behavioural change and strict adherence to clear guidelines are needed to reduce antibiotic demand. Medical technologies give specific guidance on how to prevent and control infections. If effectively implemented, the medical technology solutions address the spreading of infections by detecting and identifying bacterial infection and the susceptibility to medication, monitoring and tracking resistance, management, and containment outbreaks. Finally, Ms D’Ambrosio called for more coordination between stakeholders to address this global health threat.
Throughout the event, attendees had the chance to participate in an online poll about AMR. The majority identified a lack of information as the main reason citizens are unaware about AMR. Most of them held that the use of antibiotics by GPs and patient self-medication are the main areas to target to successfully slow the development of resistance. In addition, participants said that further training of healthcare professionals is key to combat AMR in their local communities.
In conclusion, the event revealed that AMR is a topic that raises interest from a wide array of stakeholders, who are making their contributions within their capacities to better address this silent pandemic. Better coordination is needed between global, EU, national, and local authorities as well as with patient representatives who have a direct impact in their communities. Infection prevention was mentioned by keynote speakers and attendees as a key aspect of the fight against AMR. Better prevention measures can be adopted by patients and healthcare professionals alike, improving outcomes for individuals and for society as a whole. The debate was an excellent opportunity to learn from each other and to create bridges between all actors, setting the foundations for future cooperation across Europe.
Presentation - AMR event 27 October 2022
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.
In February 2022, the European Commission launched a Call for Evidence for their upcoming Recommendation to Member States for greater action on Antimicrobial Resistance. Here is our contribution.
Health First Europe and the European Patient Group on Antimicrobial Resistance welcome the opportunity to contribute to the Commission’s Call for Evidence.
The AMR Patient Group includes 16 national patient associations from across Europe. The Group is united to empower European citizens & patients to speak with one voice when sharing personal and group insights and experiences regarding the real-world impact of antimicrobial resistance (AMR) and healthcare-associated infections (HAIs). It is now more urgent than ever to step up actions to prevent HAIs and AMR-related development throughout the patient journey.
In line with our 2021 Declaration, we call upon European policymakers and national governments to urgently commit to a full range of interventions and to consider including the following action points in their upcoming Recommendation to have a common approach across Member States:
The COVID-19 pandemic has underlined the need to understand the complex connections between bacterial and viral infections. AMR will likely increase through the heavy use of antibiotics in COVID-19 patient treatment. Hence, it is essential to diagnose, encourage more responsible behaviour, and promote the optimal prescription and sustainable use of antibiotics. As a result, there will be stronger preparedness for our healthcare systems and timely responses to this public health challenge.
For more information on the Health First Europe AMR Patient Group, please contact Ms. Laura Cigolot at secretariat@healthfirsteurope.org
Health First Europe (HFE) together with the members of the European Patient Group on Antimicrobial Resistance (AMR Patient Group) are delighted to announce the creation of a new group of Members of the European Parliament (MEP) who have agreed to become the new MEP Ambassadors of the AMR Patient Group.
Health First Europe and the AMR Patient Group representatives are committed to raising awareness about the real-world impact of antimicrobial resistance and healthcare-associated infections (HAIs) that have become a bane for public health and lives. This will ultimately empower patients across Europe with the necessary knowledge about AMR so that everyone understands when it is appropriate to take antibiotics and how to take them responsibly, by addressing the gap in awareness at the patient-level about the danger of antibiotic misuse and the lack of effective infection prevention measures.
We welcome MEPs Manuela RIPA (Greens/EFA, Germany); Brando BENIFEI (S&D, Italy); Tilly METZ (Greens/EFA, Luxembourg); Cyrus ENGERER (S&D, Malta); Piernicola PEDICINI (Greens/EFA, Italy); Sirpa PIETIKÄINEN (EPP, Finland); Tomislav SOKOL (EPP, Croatia); Sara CERDAS (S&D, Portugal); Nicolás GONZÁLEZ CASARES (S&D, Spain); Jessica POLFJÄRD (EPP, Sweden); István UJHELYI (S&D, Hungary); Frances FITZGERALD (EPP, Ireland); Pernille WEISS (EPP, Denmark); Susana SOLÍS PÉREZ (Renew Europe, Spain); Ondřej KNOTEK (Renew Europe, Czechia); Dominique RIQUET (Renew Europe, France); Michèle RIVASI (Greens/EFA, France); and Emma WIESNER (Renew Europe, Sweden).
These MEPs were selected based on their advocacy and active participation in the legislative chamber on matters of health. In furtherance of our objectives, the MEP Ambassadors of the AMR Patient Group will help champion our initiatives in the fight against antimicrobial resistance, sustain political interest and mobilise change by calling for more investment in key areas, such as in the field of education, prevention, and investment, among others.
There is a salient need for action on antimicrobial resistance (AMR) because it is, currently, one of the most serious threats to public health globally. It is responsible for an estimated 33,000 deaths per year in the EU and is estimated to cost the EU €1.5 billion annually in healthcare costs and productivity losses.
The members of the AMR Patient group are delighted to officially welcome the new Members of the European Parliament as MEP Ambassadors of the AMR Patient Group and look forward to future collaboration with a view to prevent healthcare-associated infections and the related development of AMR throughout the patient journey.
For more information on the Health First Europe AMR Patient Group, please contact Ms. Laura Cigolot at secretariat@healthfirsteurope.org
The members of the European Patient Group on Antimicrobial Resistance (AMR Patient Group), are truly committed to raising awareness about the real-world impact of antimicrobial resistance (AMR) and healthcare-associated infections (HAIs). Consequently, we strive to help reduce the inappropriate use of existing antibiotics, promote antimicrobial stewardship and infection prevention and control measures across Europe, and develop novel antibiotics where needed.
The European AMR Patient Group has developed a pan-European survey to assess the level of knowledge and awareness of antimicrobial resistance (AMR) and health-associated infections (HAIs) among 5 European countries, namely Italy, France, Germany, Spain and the UK.
The survey has close-ended questions and it will take only 15 minutes to be completed.
The overarching objective of this questionnaire is to arm all European citizens with the necessary knowledge about antimicrobial resistance and healthcare-associated infections to ensure the appropriate use of antibiotics as well as the knowledge of other existing tools that can prevent, monitor, detect and diagnose infections.
The AMR Patient Group kindly invites you to reply to and increase participation in the survey among your network. Although voluntary, the participation of patient representatives based in the afore-mentioned countries will be highly appreciated and will enrich the results in a meaningful way.
Please find the links to fill in the survey as follows
Kindly note that all contributions to this survey will be treated anonymously and in full compliance with the GDPR.
It is now more urgent than ever to step up actions to prevent HAIs and the related development of AMR throughout the patient journey.
To learn more, please find our 2021 Declaration on AMR and infographics here.
Patient safety is an essential metric when it comes to building resilient public healthcare systems both at the European and global level. It is also indispensable in the provision of health care in all settings including hospitals and long-term care facilities. The lack of proper adherence to patient safety manuals undermines public confidence and trust in health systems, increases mortality and morbidity due to unsafe care, and increases the burden on the public purse in terms of healthcare costs. Unfortunately, patient harm resulting from safety lapses, though avoidable in most cases, is a growing canker that threatens global public health. Safety lapses lead to healthcare-associated infections (HAIs), which result in prolonged hospital stays, long-term disability and high costs for patients, family and healthcare providers.
Health First Europe and the members of the European Patient Group on Antimicrobial Resistance (AMR Patient Group) are committed to raising awareness about the real-world impact of antimicrobial resistance and healthcare-associated infections (HAIs) that have become a bane for individual and public health. The HFE-led initiative’s overarching objectives are to help reduce the inappropriate use of existing antibiotics, promote antimicrobial stewardship and infection prevention and control measures across Europe, and develop novel antibiotics where needed. The AMR Patient Group empowers 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 by addressing the gap in awareness at the patient level about the danger of antibiotic misuse and the lack of effective infection prevention measures.
The European Centre for Disease Control (ECDC) estimates that a total of 8.9 million HAIs occur each year in European hospitals and long-term care facilities combined, with more than half of certain HAIs considered preventable.[1] HAIs represent a common pathway that often leads to sepsis, which in turn contributes to approximately 37,000 deaths directly resulting from HAIs. This is devasting for patients and caregivers alike.
HAI prevention and control is a core element in tackling AMR. HAIs are often caused by resistant bacteria, but the occurrence of an infection in the first place may also increase the risk of developing resistant strains. Even though antibiotics have played a central role in the treatment of human infections, the lack of awareness on the general health risk associated with the excessive and inappropriate use of antibiotics menaces public health and patient safety. Antimicrobial resistance alone is responsible for approximately 33,000 deaths per year in the EU and is estimated to cost the EU €1.5 billion annually in healthcare costs and productivity losses. These figures and the general trend paint a bleak picture of the public health system. The situation is dire.
AMR will likely increase through the heavy use of antibiotics in COVID-19 patient treatment. Hence, the importance of diagnosing and implementing digital technologies, encouraging behavioural compliance in hand hygiene, checklists and safety protocols, and promoting the optimal prescription and sustainable use of antibiotics. As a result, there should be stronger preparedness for our healthcare systems and timely responses to this public health challenge.
Going forward we face an urgent need to arm ourselves with effective tools to improve patient safety in all healthcare settings. “In order to effectively fight healthcare-associated infections and antimicrobial resistance, there is a need to not just raise awareness and promote education, but, rather, a new paradigm shift – one that is patient-centered. The genesis of the European Patient Group on Antimicrobial Resistance is in line with this patient-centered paradigm shift as it includes many active patient groups coming from all over Europe,” says Ms Laura Cigolot, coordinator of the AMR Patient Group.
On 7 April 2021, the group launched a Declaration on AMR, calling on European and national authorities to commit to a full range of interventions in the field of education, prevention and investment. Currently, the AMR Patient Group is undertaking a major pan-European survey to assess awareness and knowledge of antimicrobial resistance and HAIs among the general public in five European countries: France, Germany, Italy, Spain and the UK. The findings of this questionnaire will be collected in five national reports which will be used to identify best practices and address current gaps in the implementation of national action plans on AMR.
It is now more urgent than ever to step up actions to prevent HAIs and the related development of antimicrobial resistance throughout the patient journey.
[1] ECDC, 2018. “Infographic: Healthcare-associated infections – a threat to patient safety in Europe”.
On the World Health Day 2021, Health First Europe along with the members of the European Patient Group on Antimicrobial Resistance (AMR Patient Group), launched their 2021 Declaration on AMR, being truly committed to raising awareness about the real-world impact of antimicrobial resistance (AMR) and healthcare-associated infections (HAIs). Consequently, we strive to help reduce the inappropriate use of existing antibiotics, promote antimicrobial stewardship and infection prevention and control measures across Europe, and develop novel antibiotics where needed.
Unfortunately, AMR remains one of the biggest threats to public health today and a challenge for Europe. Data from the European Centre for Disease Control and Prevention (ECDC) on AMR in 2019 demonstrated that percentages of resistance to vancomycin – a last-line antibiotic – in Enterococcus faecium bloodstream infections almost doubled between 2015 and 2019. Resistance to carbapenems – another group of last-line antibiotics – also remains a serious concern. Indeed, even as we continue to develop new and effective antibiotics, appropriate antimicrobial stewardship of existing antibiotics as well as regular diagnostic testing remains highly important.
The COVID-19 pandemic has underlined the need to understand the complex connections between bacterial and viral infections. AMR will likely increase through the heavy use of antibiotics in COVID-19 patient treatment. Hence, the importance of diagnosing, encouraging a more responsible behaviour and promoting the optimal prescription and sustainable use of antibiotics. As a result, there will be stronger preparedness for our healthcare systems and timely responses to this public health challenge.
AMR is driven by interrelated dynamics in the human, animal and environmental health sectors, hence the importance of implementing national “One Health” action plans against AMR.
The purpose of this Declaration is to empower European citizens and patients to speak with one voice when sharing personal and group insights and experiences regarding the real-world impact of AMR and HAIs. The Declaration further calls upon European and national authorities to urgently commit to a full range of interventions in the field of education, prevention and investment. It is now more urgent than ever to step up actions to prevent HAIs and the related development of AMR throughout the patient journey.
You can find the Declaration and a new infographic attached below.
2021 AMR Patient Group Declaration
Antimicrobial Resistance infographic
The first virtual workshop of Europe’s first AMR Patient Group entitled, ‘Addressing antimicrobial resistance and healthcare associated infections through patient empowerment’ took place on Wednesday 16 December 2020 from 10:00 to 12:30 Brussels time. The purpose of the workshop was to provide participants with a comprehensive overview of the issues of antimicrobial resistance (AMR) and healthcare associated infections (HAIs), the state of play in Europe, and discussion around the best approach we can take to tackle these deeply concerning problems at the patient-level. The workshop was moderated by Laura Cigolot from Health First Europe (HFE) and participants were given presentations from high-level speakers as well as opportunities to raise questions and have an open discussion to further the group’s mission and objectives.
Ms Cigolot opened the virtual workshop on behalf of HFE, outlining the purpose and mission statement of the new AMR Patient Group: to educate and raise patient awareness about AMR, to build a consistent patient voice on AMR across Europe, and to broaden the AMR debate to include infection prevention control measures.
The first presentation was given by Dr Dominique L Monnet, Head of Disease Programme, Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at the European Centre for Disease Control (ECDC). Dr Monnet gave a comprehensive overview of AMR to help participants understand all the areas that AMR encompasses. Interestingly, Dr Monnet said he prefers not to use the ‘AMR’ acronym himself as it makes the concept too abstract. Dr Monnet’s presentation also provided case studies and the latest Eurosurveillance statistics on AMR from Europe, which are all available on the ECDC website. He advised on the most effective AMR prevention methods, which included the prudent use of antimicrobial agents and good hand hygiene practices. Dr Monnet noted the ongoing studies into the effects of the Covid-19 pandemic on antimicrobial resistance.
The second speaker was Dr Massimo Sartelli from Macerata Hospital in Italy. Dr Sartelli presented the workshop with an excellent overview of infection prevention and control measures from a clinical perspective. Participants learned the incidence rates of HAIs, how they are contracted in healthcare settings and best practices to help avoid them. Dr Sartelli highlighted that hands are the most common vehicle to transmit health care-associated pathogens, and the necessity of strict hand hygiene practices. His key message was that hand hygiene is a simple and effective solution to protect patients from HAIs and to reduce both the spread of infection and multi-resistant germs.
Ms Annabel Seebohm, Secretary General of the Standing Committee of European Doctors (CPME) was the third speaker to take the floor. Ms Seebohm’s presentation centred around the role of doctors in fighting AMR at the primary care level. She noted that doctors in primary care settings are on the frontline of efforts to improve the responsible use of antibiotics and it is paramount that they promote and implement the prudent use of antibiotics, i.e., only when needed, in correct dose intervals and in correct duration. Ms Seebohm also highlighted the CPME’s policy recommendations to Member States and doctors across Europe to help streamline a European approach to prescribing antibiotics responsibly, as well as CPME’s active engagement in promoting the ‘One Health’ approach, which looks at AMR prevention from an interdisciplinary perspective (i.e., an approach which combines the medical, dental, animal and environmental sectors).
Finally, Ms. Seebohm provided participants with an overview of what European doctors know about antibiotics and antibiotic resistance based on the latest statistics from the ECDC. Optimistically, more than 70% of doctors agreed to having good opportunities to provide advice on prudent use of antibiotics to patients, however 45% of doctors said they have insufficient time and no resources available for not being able to give out advice or resources to patients. Ms Seebohm emphasised that these figures show that not only do we need action in terms of developing guidelines and strategies on the prudent use of antibiotics, but also in the organisation of primary care so that doctors have sufficient time and resources to properly share information with patients.
Ms Emma Kollatou, Manager of Government Affairs and Public Policy at MedTech Europe spoke next about the role of medical technologies in the fight against AMR and HAIs. Ms Kollatou emphasised how medical technologies can help fight AMR throughout the patient pathway, from prevention to diagnosis, to controlling infection spread through tracking and monitoring to stop the spread of resistant bacteria. In her presentation, Ms Kollatou spoke in particular about how In Vitro Diagnostics can help patients at the community level by differentiating between a viral and bacterial infection, and at the hospital level through faster diagnosis which leads to more timely and appropriate treatement and better patient outcomes. In all, medical technologies can help society as a whole through more accurate infection diagnoses which will help to ensure the efficacy and prudent use of antibiotics for generations to come.
Among her recommendations, Ms Kollatou noted that at the European level, the joint action group EU-JAMRAI is coming to an end soon, which means there is a need for joint-action guidelines to be issued. She echoed Ms Seebohm’s call to engage with the ‘One Health’ approach, and also advocated for promoting a prevention culture.
The final speaker of the workshop was Ms Sian Williams, Policy and Advocacy Adviser at Wellcome Trust, UK. Ms Williams talked about the political will on AMR, warning that although it is strong, it is still at risk. She highlighted how we can help to reinforce a mandate for change through collective action, which requires better understanding of antimicrobial resistance at the public level. However, awareness alone is not enough to spark collective action and behavioural change, but rather, people may need a deeper connection to the issue in order to bring about real change. Ms Williams provided the participants with knowledge on how to approach effective patient education and messaging on AMR based on the latest research.
Framing is key in public education on AMR, and Ms Williams advised the Patient Group members on key framing advice from the Wellcome Trust, which included the recommendation that the fundamentals of AMR should be explained succinctly. AMR needs to be emphasised as a universal issue that is solvable, but which requires immediate action. She also highlighted the power of human-focused patient stories and noted the opportunity that the AMR Patient Group provides to encourage patient voices within AMR advocacy.
The workshop included questions and answers sessions and open group discussion where we heard from our members about their concerns regarding AMR and the biggest issues they face as patient representative groups. From the discussion, a recurring issue was raised regarding the difference in approach to antibiotics regulations across borders. This concern further added weight to recommendations that were heard from multiple speakers to adopt a joint ‘One Health’ approach to AMR in Europe at the political, medical and community policy action levels. The work of EU-JAMRAI needs to be carried forward into the future. Overall, the group was in agreement that patients tend to trust their doctors and healthcare professionals, and education on AMR needs to come from all levels. Patients can be both leaders and supporters in the fight against AMR.
In terms of messaging on AMR, the most effective approach is evidence-based and simple messaging, with a focus on human stories to aid understanding and encourage collective action. Ms Sian Williams also gave a prudent example of why AMR concepts need to be clearly explained: many people do not realise that the “resistance” element of AMR applies to the bacteria or microbe, and not to the person themself. This understanding enables people to see that AMR is not an individual or personal problem, but a global community health crisis. Another key recommendation that came from the workshop was the necessity of educating children and their parents to ensure the next generation has a full understanding of the concepts relating to AMR and effective infection prevention measures, especially that of good hand hygiene practices. The effects of the Covid-19 pandemic on AMR rates are still unknown and may overall be contextual. However, it is crucial that good hygiene practices remain into the future and that the importance of AMR action must stay firmly on the global health agenda. The first workshop successfully laid out the groundwork and tools needed to succeed in achieving the AMR Patient Group mission: to educate and raise patient awareness about AMR, to build a consistent patient voice on AMR across Europe, and to broaden the AMR debate to include infection prevention control measures.
To conclude this event summary, here is a great analogy that our AMR Patient Group member Neda Milevska-Kostova from the International Alliance of Patients’ Organizations (IAPO) contributed to the workshop: “Antibiotics are like a fire extinguisher. You need to have one, but you hope you never need to use it”.