The Center for Disease Dynamics, Economics & Policy

A few weeks ago, CDDEP Associate Director Hellen Gelband wrote about a new study on “forgotten" antibiotics – drugs that have been approved but are no longer in common use. Just this week, the European Centre for Disease Prevention and Control (ECDC) released a report on surveillance data, gathered through HAI-net, on surgical site infections (SSIs) and ICU infections in Europe through 2007.  One of the identified markers of increasing multidrug resistance in these infections?  The use of colistin – one of the “forgotten” antibiotics – to treat them.

Results in 2007 confirmed the high burden of ICU-acquired infections in participating countries and showed worrying trends in antimicrobial resistance in gram-negative bacteria; in particular for Acinetobacter spp. and Pseudomonas aeruginosa.  The frequent use of ‘last-resort’ antimicrobials such as colistin confirmed the high incidence of life-threatening ICU-acquired infections with multiresistant bacteria… Remarkably, colistin use accounted for as much as 1.9% of total antimicrobial use [in ICUs], 88.2% of which for documented treatment, indicating documented carbapenem resistance in infections with gram-negatives.

The report through 2007 includes data from 17 countries across the European region. Other trends include:

• Approximately 4 million patients suffer healthcare-associated infections in the EU annually, resulting in 37,000 deaths.


• Of the 260,414 operations included in the report, 5,478 resulted in a surgical site infection (SSI).  SSIs lengthened the average length of hospital stays from 8.7 days to 15.8 days.


• In ICUs, oxacillin resistance in S. aureus isolates has decreased, while resistance in gram-negative species has increased.  Particularly worrying are levels of resistance in Acinetobacter spp. – a microorganism most frequently associated with hospital-acquired pneumonia – with 73% of samples resistant to carbapenem antibiotics and 3.6% resistant to colistin.  Carbapenems are also considered a class of last-resort drugs.


• In 2007, 7% of patients staying more than two days in the ICU acquired pneumonia.  There was large variation among countries, however the most frequently isolated microorganisms were P. aeruginosa, S. aureus, E. coli, Klebsiella spp., and Enterobacter spp. ICU patients who acquired pneumonia were 2.29 times more likely to die than those without the infection.

The report notes methodological differences in infection reporting across the EU region, and we can only imagine what it would take to establish this kind of surveillance on a global scale.  Nevertheless, the ECDC report complements some of the U.S. trends we’re seeing on ResistanceMap, particularly the rise of gram-negative, multidrug resistant pathogens in hospitals.

You can download the full report, as well as a 2008-2009 update for SSIs, on the ECDC website.

Image credit: Flickr: richardoyork