Event report - Addressing Antimicrobial Resistance in Spain: A call to boost prevention and control measures in Europe

September 19, 2023

The European AMR Patient Group together with the Foro Español de Pacientes organised a high-level event on Antimicrobial Resistance on the 19th of September 2023, at the European parliament Local Office in Madrid. The purpose of the event was to gather EU policymakers, doctors, nurses and patients to discuss the alarming situation around AMR in EU in general and in Spain in particular. Organised at the occasion of the Spanish presidency, the event was web streamed and gathered about 70 participants on-site and on-line.  

The purpose of this event was to improve awareness and understanding of AMR, to strengthen ongoing activities on AMR and to advance solutions on how to address it, particularly prevention measures which should be further adopted by patients and healthcare professionals alike, improving outcomes for individuals and for society.  

The focus was put on the urgency to deal with the AMR “silent pandemic” on European and global levels, underlining the importance of the One Health approach. Prevention, screening systems, precise medication and, most importantly, the spreading of the awareness among patients and healthcare professionals were identified as key elements by the speakers.  

Main takeaways from speakers 

Lina Gálvez, MEP, S&D  

  • AMR is a global issue affecting humans, animals, and the environment. The One Health approach is the most effective way to tackle it. 
  • To combat AMR, it is crucial to adhere to Open Science rules1 when collecting and sharing data across member states. 
  • The EU needs to provide more public support and funding for research and development of new antibiotics, including investments in alternative treatments. 
  • Public ownership of research is essential for an improved EU health ecosystem. 

Antimicrobial Resistance in Spain: setting the scene  

Dr. Dominique Monnet, Head of Section, AMR and Healthcare Associated Infections, European Centre for Disease Prevention and Control 

  • In 2020, there were more than 800,000 infections with antibiotic-resistant bacteria in the EU/EEA. 
  • Humans and animals do not become resistant to antibiotic treatments, but bacteria carried by humans and animals can. This occurs in animal farming, the community, healthcare settings, and through travel, demonstrating the importance of the One Health approach. 
  • There is a clear relation between the percentage of patients treated with antibiotics in hospitals and the percentage of patients with resistances. On the other hand, the higher percentage of antibiotic prescriptions that have been reviewed and changed, the lower resistance to antibiotics was identified. 
  • The Organisation for Economic Cooperation and Development (OECD) issued a report containing an economic assessment of a mixed-intervention package to address the existing AMR trend. A combination of interventions, including improved hygiene practices, antimicrobial stewardship, diagnostic measures, and public awareness campaigns, was estimated to create significant savings in healthcare expenditure.   

The European response: EU actions and updates  

Stefan Schreck, Adviser for stakeholder relations, DG SANTE, European Commission  

Most relevant initiatives at EU level to tackle the AMR issue:  

  • Under the Council Recommendation on AMR2 adopted on 13 June, member states have agreed to set measures for infection prevention, surveillance, monitoring, and innovation in antimicrobial resistance and consumption. 
  • The new Recommendation is expected to be launched in early 2024, and it should cover the following aspects: updating and implementing quality One Health national action plans, supporting infection prevention and control, promoting AMR stewardship, strengthening surveillance, supporting awareness raising, training, and education, improving access to antimicrobials, improving and fostering collaboration among member states.  
  • EU4health aims to support member states in the implementation of effective AMR policies and measures under the new Recommendation with the EU co-funding 50 million euros.  
  • The new Regulation on serious cross-border health threats aims to strengthen EU capacities against infectious diseases. AMR is addressed by introducing new elements in prevention, preparedness, and response that further enhance current mechanisms and instruments. For example, the possibility of the EU declaring a public health emergency, strengthening epidemiological surveillance, and increasing the power of the Health Security Committee to issue opinions. 
  • The creation of the Health Emergency Preparedness and Response (HERA) further demonstrates the interest in supporting the preparedness and response in medical contamination measures, including antibiotics.  
  • The EU’s commitment to prevention and control is also reflected in the expanded mandates of the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA). 
  • The proposed reform of the EU pharmaceutical legislation aims at modernizing the EU pharmaceutical sector through a patient-centred and innovative industry approach. It would entail new measures on the proper use of antimicrobials, access to antibiotics, and development. 
  • Lastly, the EU Global Health Strategy outlines key priorities such as delivering better health and well-being across the life course, strengthening health systems, advancing universal health coverage, reinforcing the prevention of health threats including the AMR pandemic through the One Health approach.  

The patient perspective in the fight against AMR in Spain  

Andoni Lorenzo Garmendia, President, Spanish Patient Forum (FEP) 

  • A holistic approach is central in the fight against AMR as it affects everyone.  
  • It is an urgent issue that needs to be addressed with a clear strategy and that’s why we have the One Health strategy.  
  • Information must circulate at every level and the strategy has to be followed by authorities, governments, healthcare professionals and patient associations.  
  • Patients need to be well-informed and trained about antibiotic usage through general practitioners, guides, and reports. 
  • Patients need to get involved and become an integral part of the One Health approach.  
  • Media dissemination is crucial for raising awareness about AMR among the public. 
  • We need to tackle this issue together and at every level. We can’t have patients who are feeling guilty because they didn’t have the proper information, we need to work together on prevention, and we need to invest in research into safe and effective drugs.  
  • AMR doesn’t discriminate, we are all in this together.  

Sonia Sánchez, Patient - Represeting Iñaki Morán, founder and president of EPOC ESPAÑA (National Association of COPD patients and caregivers) 

  • Representing Mr. Iñaki Morán, who couldn’t be there as he was unfortunately hospitalised in ICU, Ms. Sanchez shared his and her journey of fighting against AMR after undergoing a lunch transplant.  
  • It is a very difficult journey as you are fighting against a disease and against AMR at the same time. Your life is put on hold during the many hospitalisations and the new diseases your body is not able to fight against, while the drugs you are being given are ineffective.  
  • AMR is a real threat. 35 000 of people die in Europe because of AMR every year and many others, like Mr. Morán and Ms. Sánchez, see their quality of life deeply affected.  
  • AMR patients frequently experience a sense of guilt and helplessness, which calls for a greater involvement of patient associations through support and information networks. 
  • To win a fight against superbugs we need to invest more in research, education, training, prevention and best practices in hospitals and at home.  
  • It’s a global problem that requires a global solution.  

Antimicrobial resistance in primary care and intensive care settings 

Dr. Vincente Olmo Quintana, Secretary of the Working Group on Medicines Management, Clinical Inertia and Patient Safety, Spanish Primary Care Doctors’ Association (SEMERGEN) 

  • In Spain, over a third of the population takes antibiotics each year and 90% of them are prescribed in primary care.  
  • Diagnostic uncertainty, negative clinical evolution, lack of data on aetiology and resistance, therapeutic empiricism, self-medication, lack of training, induced prescription, and non-compliance with therapeutic orders are predisposing factors for high antibiotic consumption. 
  • The Plan Nacional frente a la Resistencia a los Antibióticos (PRAN) was established in different Spanish regions to promote the optimization of antibiotics prescription, improvement of prognosis, minimization of adverse effects, control of AMR, and use of cost-effective treatments. It created a multi-level network of information sharing from regions to communities through the use of common guidelines and best practices. 
  • In primary care, the following actions are required to contrast AMR: correct interpretation of antibiograms, knowledge of resistance maps, prescription of short treatment guidelines, delayed prescribing, training of professionals and patients, and sensitization of citizens to the proper use of antibiotics. 
  • Overall, AMR requires a joint focus on human and animal health, the development of new antibiotics, and the preservation of existing ones. 

Dr. María Cruz Soriano Cuesta, intensive care doctor at the Ramón y Cajal Hospital in Madrid, Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) 

  • Several studies have shown that approximately 50% of patients acquire an infection in the ICU, which is frequently caused by a multi-resistant microorganism infection. 
  • The mortality rate for infected patients is twice as high as that of uninfected patients, with a greater negative impact on patients infected by a multidrug-resistant organism. 
  • The fight against AMR requires ICU-Stewardships programs, Multi-Drug Resistant Organisms (MDRO) research, and improved patient safety culture. Prevention measures must be accompanied by the optimization of MDRO treatments, including early detection and treatment, as well as the best antibiotic options. 

Medical innovation to fight AMR and infections  

Jessica Imbert, Director External Affairs, MedTech Europe 

  • While the access to AMR infection prevention and control technologies is relatively low, AMR infection prevention steps can be identified across four main sections of a patient's pathway in healthcare structures - from hospital admission to discharge. 
    • First step upon patient arrival: A solid screening system in hospitals is crucial for identifying the type of infection and providing precise medication. 
    • Second step in the hospital ward: Healthcare professionals must adopt good professional practices. 
    • Third step during surgery: Surgical antibacterial solutions – such as, antibacterial sutures, antibacterial implants, coded endoscopes, and good sterilization systems - are key to prevent the spread of AMR infections in the Operating Room (OR). 
    • Fourth step in the recovery phase and discharge: Home environments and medical devices must be disinfected and sterilized.  
  • Prevention and diagnostic information are crucial to ensure better AMR infection control. 

Priorities of the Spanish Presidency of the EU Council  

 Ricardo Carapeto García, Head of Area Environmental Risk Assessment, (Veterinary), Spanish Agency of Medicines and Medical Products (AEMPS). Coordination Unit of the National Plan on Antimicrobial Resistance (PRAN) 

  • The priorities on AMR of the EU Spanish Presidency are based on the pharmaceutical package set by the European Commission in April 2023. It includes a draft regulation3 and a draft directive4 under the proposal for a Council recommendation on stepping up EU action to combat AMR. The European Parliament adopted a resolution welcoming the European Commission’s proposal on 1 June 20235, while the Council adopted the recommendation on 13 June 20236
  • The Council’s recommendation calls for strengthening national action plans, reinforcing monitoring and follow-up, extending infection prevention and control, and increasing antimicrobial stewardship and prudent use of antimicrobials. Also, it recommends for targets against antimicrobial resistance and consumption, the improvement of awareness, education and training, stimulating antimicrobial research, development and innovation, improving cooperation, and greater global action. 
  • The EU Spanish Presidency aims to promote the discussion on the integration of AMR surveillance systems, increased availability of antibiotics, and the development of new antibiotics. 

In conclusion  

We can see a significant increase in the number of infections and attributable deaths for almost all bacterium–antibiotic resistance combinations, especially in healthcare settings. 35 000 people die annually in the EU due to AMR complications. To stop this trend and see these numbers decrease, a holistic approach with global solutions is needed.  

AMR is an issue that doesn’t discriminate, concerns every European citizen and needs to be tackled using the One Health approach.
 
National plans need to be supported and reinforced at European level and with European funding. Governments, authorities, healthcare workers and researchers, pharmaceutical and MedTech companies as well as EU citizens need to work hand in hand to spread awareness, share best practices and concrete solutions to stop this “silent pandemic”.  

The list of national and European initiatives is long which is a very encouraging fact, but there is an urgent need to roll out concrete solution on the global scale, boost prevention, preparedness, thorough screenings in hospitals to allow for adequate medication prescription and especially concentrate on research to increase availability of antibiotics and develop new ones. 

The European AMR Patients Group together with the Foro Español de Pacientes would like to thank all of our esteemed speakers for sharing their views and expertise and proposing solutions to this paramount issue. We would also like to thank all of the participants and we invite you to reach out to us if you would like to have more information about the event or the European AMR Patients group work.  Don’t hesitate to contact us at: secretariat@healthfirsteurope.org