The Commission welcomes the Political Declaration reached on 26 September at the United Nations General Assembly (UNGA) to step up action against antimicrobial resistance (AMR). A new Political Declaration, endorsed by UN member countries—including EU Member States committed to concrete actions to address AMR across all sectors, through a One Health approach that acknowledges that human, animal and environmental health are intrinsically linked. AMR is increasingly recognised as one of the most urgent health challenges, responsible for approximately 1.3 million deaths globally each year, including 35,000 in the EU/EEA. If unaddressed, this figure could escalate to an alarming 390,000 deaths annually in the EU/EEA by 2050. The economic ramifications are equally concerning, with AMR costing the EU/EEA over €11 billion annually. Despite the magnitude of this threat, innovation in the development of new antimicrobials has not kept pace. The UNGA declaration outlines critical targets, including a 10% reduction in global AMR-related deaths by 2030 and a decrease in antibiotic use within the agri-food sector. It calls for urgent action and heightened incentives for research and development (R&D). At the EU level, AMR is a top public health priority, addressed through measures such as targets to reduce antibiotic consumption in humans, rules to limit antibiotics in livestock, Research and Development investment to support the development of novel antibiotics, and strengthened environmental monitoring to prevent antibiotic residues from contaminating soil and water. The Commission has also launched a campaign to raise AMR awareness among young people, promoting a whole-society approach. The EU advocates for a stronger global One Health response to AMR. Through the EU4-Health Programme, HERA has funded a range of initiatives aimed at expediting innovation for AMR products in advanced stages of development. The commitments enshrined in the UNGA Political Declaration resonate with HERA’s ongoing efforts to combat AMR. HERA actively collaborates with initiatives such as the Global Antibiotic Research and Development Partnership (GARDP), which has been allocated €20 million to support clinical trials focused on serious sepsis, paediatric antibiotics, and drug-resistant gonorrhoea. Additionally, HERA is aiding the World Health Organization (WHO) in updating pathogen priority lists and advancing medical countermeasures

Misuse of antibiotics and the presence of antibiotic residues in food products can be difficult to control. These kinds of situations are common in many poor countries, where the need for antibiotics rises due to the incidence of infectious diseases. Products made from animals that have these residues in them may cause hypersensitivity reactions, bone marrow depression, cancer, mutagenicity, teratogenicity, and disturbance of normal gut flora. These residues have the potential to cause several adverse effects, including immunopathological reactions, nephropathy (gentamicin), hepatotoxicity, reproductive problems, toxicity to the bone marrow (chloramphenicol), carcinogenicity (sulphamethazine, oxytetracycline, furazolidone), and mutation. They may also cause increased resistance to antibiotic treatments and, given the current high levels of antimicrobial resistance, establishing permanent resistance surveillance programs at the national level is essential. Therefore, adherence to strict withdrawal timings and guidelines is necessary to guarantee that animal products are safe for human consumption.

The ESPAUR report includes national data on antimicrobial prescribing and resistance, antimicrobial stewardship implementation, and awareness activities. In early 2024, the Global Antimicrobial Resistance Surveillance System on Emerging Antimicrobial Resistance Reporting (GLASS-EAR) issued a request for information to Antimicrobial Resistance (AMR) National Focal points enrolled in GLASS-EAR to rapidly assess the current global situation in view of the increased identification of isolates of hypervirulent K.  (hvkp) ST23 carrying carbapenemase genes reported in several countries. The report highlights the global spread of K. pneumoniae ST23 strains with diverse resistance profiles and virulence characteristics, posing challenges for healthcare systems worldwide, including an outline of the situation as applicable to Europe and the UK. Total antibiotic consumption increased by 2.4% between 2022 and 2023 (in part linked to a national surge in group A Streptococcus (GAS) cases between Sept 2022 and March 2023), to 17.6 Daily Defined Dose (DDD) per 1,000 inhabitants per day (DID). This report details considerable challenges ahead – with rising numbers of infections and proportions that are drug resistant and widening gaps in inequalities. It also highlights key differences in burden by ethnicity and socio-economic class. These areas also represent avenues for change however, with the potential to further our understanding of trends and population differences, and in developing interventions to help redress these increases. This will be the focus of the early stage of the 2024-2029 AMR National Action Plan activity. The continued strengthening of our capabilities to monitor and mitigate AMR will be essential to the endeavour.

This study aims to systematically synthesize the evidence on the economic costs associated with Antibiotic Resistance (ABR) in community-acquired urinary tract infections (CA-UTIs), using published studies comparing the costs of antibiotic-susceptible and antibiotic-resistant cases. In fact, this review included 15 studies with a total of 57,251 CA-UTI cases, all studies were from high- or upper-middle-income countries. A total of 14 (93%) studies took a health system perspective, 13 (87%) focused on hospitalized patients, and 14 (93%) reported UTI pathogens. E. coli, K. pneumoniae, and P. aeruginosa are the most prevalent organisms. A total of 12 (80%) studies reported mortality, of which, 7 reported increased mortality in the ABR group. All 13 hospital-based studies reported hospital length of stay (LOS), of which, 11 reported significantly LOS in the ABR group. A total of 8 (53%) studies reported costs in monetary terms-none discounted the costs. All 8 studies reported higher medical costs spent treating patients with ABR CA-UTI in hospitals. The highest excess cost was observed in UTIs caused by carbapenem-resistant Enterobacterales. No meta-analysis was performed for monetary costs due to heterogeneity. ABR was attributed to increased mortality, hospital LOS, and economic costs among patients with CA-UTI.

The Authors conducted a systematic literature review for studies evaluating the costs and cost-effectiveness of pharmaceutical and non- pharmaceutical interventions aimed at reducing, monitoring and controlling antibiotic resistance (ABR) in patients. They focused on critical or high-priority bacteria, as defined by the WHO, and intervention costs and incremental cost- effectiveness ratio (ICER). Following Preferred Reporting Items for Systematic review and Meta-Analysis guidelines, extracted unit costs, ICERs and essential study information including country, intervention, bacteria- drug combination, discount rates, type of model and outcomes. Among 20 958 articles, 59 (32 pharmaceutical and 27 non-pharmaceutical interventions) met the inclusion criteria. Non- pharmaceutical interventions, such as hygiene measures, had unit costs as low as $1 per patient, contrasting with generally higher pharmaceutical intervention costs. Several studies found that linezolid- based treatments for methicillin-resistant S. aureus were cost- effective compared with vancomycin. Infection control measures such as hand hygiene and gown usage and PCR or chromogenic agar screening for ABR detection were highly cost- effective. Comparisons were hindered by within study differences.