The European Antimicrobial Resistance Surveillance System is part of an integrated public health strategy to counter the occurrence and spread of drug resistant bacteria
Prof Hajo Grundmann
Project Leader, Scientific Coordinator, European Antimircrobial Resistance Surveillance System (EARSS)
The development and spread of antimicrobial resistant bacteria threaten the effective treatment of infections and could counter some of the major achievements of modern medicine. Tuberculosis, gonorrhoea, malaria, and childhood ear infections are among the diseases that have become hard to treat.
Resistant microbes emerged just four years after drug companies began mass-producing penicillin in 1943. The first bacterium to resist was Staphylococcus aureus. Normally a harmless passenger in the human body, it can cause complicated pyogenic infections, bacteraemia, pneumonia or toxic shock syndrome.
Resistance is a natural phenomenon but has been worsened by increased transmission of infections, and particularly by the overuse of antibiotics. At the same time, the once copious supply of new antibiotic compounds started to dry up in the 1980s as drug companies turned to more profitable markets. Now, for some infections,we have no effective drugs at all.
The impact on hospital care
In Europe, the highest proportion of resistant bacteria is found in hospitals. About 70% of bacteria that cause infections in hospitals are resistant to at least one of the drugs commonly used to treat infections. The emergence of strains resistant to virtually all antibiotics is alarming. Some multiple-resistant strains of Staphylococcus aureus, for example, can cause serious hospital-acquired infections. Few compounds are effective against them – the one most frequently prescribed is an older antibiotic, vancomycin, which has some undesirable side-effects.
Vancomycin resistance has resulted in another hospital bug, Enterococcus spp. Resistant strains were first reported in England and France in 1987. Some researchers claim that it is only a matter of time before Staphylococcus aureus acquires resistance to vancomycin.
Following a ‘Microbial Threat’ conference in Denmark in September 1998, scientists, doctors and public health specialists concluded that ‘an effective European surveillance system should be in place and must have the agreement and active involvement of all parties’. The European Commission’s Directorate-General for Health and Consumer Affairs and the Dutch Ministry of health, Welfare and Sports set up the European Antimicrobial Resistance Surveillance System (EARSS) in 1998. In 2001, at a follow-up conference in Sweden, the Commission decided that all member states should join the EARSS initiative.
EARSS encourages and helps to sustain national surveillance efforts. Selection of pathogens started in 1999 with data on two bacteria: Streptococcus pneumoniae and Staphylococcus aureus. In 2001 this was extended to Eschericia coli, Enterococcus faecalis and E. faecium. These bacteria were selected according to epidemiological (community v hospital acquisition) and ecological (transmission v selection) paradigms.
EARSS collaborates closely with:
- European Surveillance of Antimicrobial Consumption (ESAC).
- Self-Medication with Antibiotics and Resistance (SAR).
- Antibiotic Resistance Surveillance and Control in the Mediterranean Region (ARMed).
EARSS works in partnership with the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and two of the society’s subcommittees in particular:
- European Committee on Antimicrobial Susceptibility Testing (EUCAST).
- Study group for Antimicrobial Resistance Surveillance (ESGARS).
The EARSS network is the perfect basis for an integrated public health strategy for containing antimicrobial resistance.