In 1928 Alexander Fleming discovered penicillin. The following decades witnessed a healthcare revolution in which routine infections were no longer a death sentence. Owing to their variety of uses, we have become increasingly accustomed to and reliant on antibiotics. At the same, however, bacteria have responded by developing resistance to the antibiotics we use to treat infections.
Broadly, antimicrobial resistance (AMR) occurs when micro-organisms survive exposure to a medicine that would normally kill them or stop their growth. While the evolution of resistant strains is a natural phenomenon, the use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. One example is the over-use of antibiotics in farming, to compensate for dirty and overcrowded living conditions. Other causes include over-prescribing antibiotics and poor infection control. The rise in resistance is compounded by a lack of new antibiotics being developed. The consequences of AMR are manifold, and include prolonged illness, higher health care expenditures, and an increased risk of death.
In 2014 the World Health Organisation (WHO) looked at resistance across 114 countries and found that AMR was already occurring, citing high levels of resistance across all regions of the world. The WHO now considers AMR to be “one of the greatest challenges to global public health today”. The UK Government has also stressed the importance of AMR, mentioning it in the 2015 National Risk Register of Civil Emergencies. They explained that “without effective antibiotics, even minor surgery and routine operations could become high-risk procedures, leading to increased duration of illness and ultimately premature mortality.”
Public awareness to AMR is growing. In 2014 the British public confirmed AMR was a key concern when it chose antibiotics to be the focus of our £10 million prize fund, the Longitude Prize. The prize supports those working towards developing diagnostic tests that will determine the need for antibiotics. More recently, we commissioned a poll by Populus which found that almost one third (30%) of those surveyed consider the risk that antibiotics become ineffective to be the greatest health threat to the UK.
Despite growing awareness, there is little accessible information on how the threat posed by AMR is evolving, and how it differs by country. There are a myriad of bacteria to consider, and each may acquire different levels of resistance to a range of antibiotics. As a result, it is extremely difficult for a non-specialist to gain an accurate picture of the threat posed by AMR.
Our interactive data visualisation aims to show how Europe is faring in the fight against resistance to antibiotics. It uses the latest available data (released this week) from the European Centre for Disease Prevention and Control (ECDC). The visualisation shows acquired resistance of five common bacteria (such as E. coli) to a range of antibiotics for each of the EU/EEA member states.
The most striking result is the large variation in resistance levels across Europe. For a given bacteria and antibiotic, resistance rates can range from 2% in one country to over 70% in another. Broadly, countries in the south and east of Europe tend to report higher resistance percentages than those in the north of Europe. The ECDC has said that “these differences are most likely related to differences in antimicrobial use, infection control and healthcare utilisation practices in the countries” (p1).
Among the five bacteria shown, resistance of Klebsiella pneumoniae is of particular concern. K. pneumoniae is a common cause of urinary tract, respiratory tract and bloodstream infections. It can spread rapidly between patients in healthcare settings and is a frequent cause of hospital outbreaks. The visualisation shows that resistance of K. pneumoniae to a range of antibiotic groups increased significantly between 2011 and 2014 for the EU/EEA.
While the data visualisation focuses on Europe, AMR is a global problem. WHO Director General Margaret Chan recently commented at the World Health Summit that “drug resistant pathogens are notorious globetrotters”. During WHO’s World Antibiotic Awareness Week, it is important we all do our part in combatting resistance to antibiotics. You can start by washing your hands.
Notes for the data visualisation: All data come from the 2014 Antimicrobial Resistance Surveillance in Europe report published by the European Centre for Disease Prevention and Control. All figures have been rounded to the nearest integer. The order of the antibiotics is determined by the level of the resistance for the EU/EEA as a whole. Regions are based on the United Nations classification system, with the exception of Cyprus (which is classified as Western Asia, but is included in the report). The EU/EEA figures are based on a population-weighted mean. For Escherichia coli combined resistance refers to resistance to fluoroquinolones, third-generation cephalosporins and aminoglycosides. For Klebsiella pneumoniae combined resistance refers to resistance to fluoroquinolones, third-generation cephalosporins and aminoglycosides. For Pseudomonas aeruginosa combined resistance refers to resistance to at least three antimicrobial groups out of piperacillin + tazobactam, ceftazidime, fluoroquinolones, aminoglycosides and carbapenems. For aminoglycosides used to treat Enterococcus faecalis, the figures refer to the percentage of invasive isolates with 'high-level' resistance. For all other bacteria, the figures indicate the percentage of invasive isolates with resistance. Some significant trends in the overall data were not observed when only data from laboratories consistently reporting for all four years were included. In these cases, the changes have not been marked by circles. The descriptions of the bacteria are based on information published by the U.S. Centers for Disease Control and Prevention (CDC) and Public Health England (PHE). For more information on data collection and analysis, please consult the EARS-Net reporting protocol.
 Information and resources on the government’s plans to slow the growth of antimicrobial resistance. The term antimicrobial includes: antibiotic, antiprotozoal, antiviral and antifungal medicines.
 WHO Factsheet on AMR.
 “The antibiotics in our food” by Lance B. Price. Two-thirds of all of the antibiotics produced globally each year are used in animal agriculture.
 WHO infographic on the causes of antibiotic resistance
 WHO Antimicrobial Resistance: Global report on surveillance 2014
 WHO Worldwide country situation analysis: response to antimicrobial resistance
 National Risk Register of Civil Emergencies (2015 edition) (p.15)
 Longitude prize website
 Populus interviewed a random sample of 2,298 UK adults aged 18+ online between 16 – 18 October 2015. Polls were conducted across the country and the results have been weighted to the profile of all adults. Populus is a founder member of the British Polling Council and abides by its rules. Further information at www.populus.co.uk.
 The European Centre for Disease Prevention and Control. The ECDC host the European Antimicrobial Resistance Surveillance Network (EARS-Net) which is the main surveillance system for AMR in Europe.
 Antimicrobial resistance surveillance in Europe 2014 report by ECDC.
 Summary of the latest data on antibiotic resistance in the EU by ECDC (p2).
 Population weighted mean resistance in EU/EEA.