This bomb has already exploded. It could cause more deaths than cancer in a year and a trillion dollars in losses

• In the past, when a child had a severe infection, the main thing to do was to pray, or maybe apply a cold compress to the forehead or use cupping.
• Now, thanks to antibiotics and vaccinations, we live on average 23 years longer than in 1900. However, the problem of antibiotic resistance has emerged
• We are sitting on a "ticking bomb" - this is what specialists say about it, who experience every day the return of the treatment crisis from before the antibiotic era.
• Unfortunately, it is safe to say that - although without a spectacular and one-time noise - this bomb has long since exploded. It works almost imperceptibly, causing deadly and extremely expensive damage
• According to the WHO, if effective preventive and therapeutic measures are not taken, by 2050 the number of deaths due to infections caused by antibiotic-resistant bacteria could reach 10 million per year, exceeding the death toll from cancer.

Currently, up to the age of 40, the main cause of death is injuries and accidents. Thanks to antibiotics, women have stopped dying from puerperal fever and soldiers from infected wounds. However, antibiotic resistance has appeared, which is keeping specialists and institutions around the world awake at night.

- Unlike violent and sudden events, such as terrorist attacks, which trigger an immediate crisis and mobilize rapid reactions, antibiotic resistance is a silent but no less dangerous chronic condition that gradually undermines the foundations of modern medicine - points out Dr. Anna Olczak-Pieńkowska , Head of the Department of Public Health, Epidemiology and Vaccinology at the Military Institute of Medicine - State Research Institute.

He emphasizes that this “silent bomb” of infection, the effects of which accumulate over years, leads to an increase in the number of infections caused not only by antibiotic-resistant, but also by multi-drug-resistant microorganisms, including those resistant to all available drugs. This is a bomb whose effects cannot be quickly eliminated, but causes long-term devastation: it extends the time and cost of hospitalization, increases mortality, causes long-term complications - in other words, all the most painful effects for the patient and the healthcare system.

As for the financial consequences, the expert notes, the significance of the problem is evidenced by the fact that their estimation is carried out by institutions such as the World Bank, the Organisation for Economic Co-operation and Development (OECD), the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation (WHO).

Below we present an expert analysis by Dr. Anna Olczak-Pieńkowska on the problem of antibiotic resistance. There are also recommendations on how to combat this very dangerous phenomenon.

It is difficult to precisely estimate the effects of the phenomenon due to the lack of uniform, coordinated monitoring systems, fragmentation and non-representativeness of available data, or differences in the methodology of collecting information on infections in hospital and non-hospital care. The most frequently cited analysis on this topic published in 2019 in the prestigious journal Lancet (Cassini et al., 2019) shows that around 4.5 million deaths per year worldwide are related to infections caused by antibiotic-resistant bacteria . In the European Union, mortality due to infections with drug-resistant microorganisms is 31-39 thousand deaths per year, including around 2 thousand in Poland .

According to the forecasts of the World Health Organization, if effective preventive and therapeutic measures are not taken, by 2050 the number of deaths due to infections caused by antibiotic-resistant bacteria may reach 10 million per year, exceeding the mortality rate due to cancer (in 2022, approximately 9.7 million deaths due to cancer were recorded worldwide, which is about one sixth of all deaths globally).

The data also show that in the EU/EEA (European Union/European Economic Area) countries, the annual costs associated with antibiotic resistance amount to approximately EUR 11.7 billion (approximately EUR 24 per capita). Globally, in 34 OECD and EU/EEA countries, the total health and economic costs of antibiotic resistance are estimated at approximately USD 66 billion per year (OECD, 2024).

Patients infected with drug-resistant bacteria spend more than 9.5 million extra days in hospitals in the EU/EEA each year, which is equivalent to the total annual number of acute hospital beds available in a country the size of Portugal (OECD, 2023). Infections caused by antibiotic-resistant bacteria result in an average increase in hospital stay of 6–12 days compared to infections caused by bacteria susceptible to most available antibiotics.

Treating infections caused by antibiotic-resistant pathogens is significantly more expensive, with additional costs ranging from EUR 10,000 to EUR 40,000 per patient in Europe and North America (ECDC, 2022).

Examples:

• The cost of standard treatment for an infection caused by Klebsiella pneumoniae bacteria based on available data is approximately PLN 100-150, and the duration of therapy is approximately 7-10 days, while in the case of infections caused by the same species armed with antibiotic resistance mechanisms, therapy may cost, depending on the drug needed, PLN 200-300, but also over PLN 10,000. Moreover, the therapy is longer and more toxic with a higher risk of complications.
• Another example - treatment of Staphylococcus aureus or E. coli infections sensitive to antibiotics costs about PLN 50-100, while treatment of infections caused by resistant strains costs about PLN 50-1,500, or several thousand PLN (again depending on the choice of an effective drug).

In one of its key reports, the World Bank stressed that by 2050, global GDP could fall by as much as 3.8% and the annual costs of antibiotic resistance could reach USD 1 trillion if effective countermeasures are not taken.

The World Bank also points out that the economic impact of antimicrobial resistance could be comparable to the effects of the 2008 global financial crisis.

WIM-PIB undertakes a number of activities that go beyond legal standards, which are aimed at strengthening the fight against antibiotic resistance. Despite advanced activities, the problem of antibiotic resistance is endemic and recurrent. One of the key factors of this state is epidemiology that goes beyond the Institute's fence - Poland and Europe are struggling with the spread of resistant strains, which results in an influx of colonized or infected patients from other medical facilities .

The lack of coordination, data exchange and integration of efforts in the areas of medicine, veterinary medicine and the environment also significantly limits the effectiveness of the fight undertaken.

As a result, antibiotic resistance forces the use of expensive “last chance” drugs that are dozens of times more expensive than standard antibiotics. There is also a need to use therapy with more than one drug.

Recently, we have observed that "last-chance" antibiotics are responsible in some periods for over 39% of the increase in antibiotic therapy costs, and after excluding drugs whose costs have fallen (those whose use has been replaced by "last-chance" drugs), even for over 53% of the increase.

Antibiotic resistance also generates additional costs related to longer hospitalization, higher risk of complications and mortality, which burdens the entire healthcare system.

The situation observed at WIM-PIB reflects nationwide and European trends. The increase in the percentage of resistant strains and the related financial and clinical consequences are common in many hospitals.

Recent ECDC data, including reports from the EARS-Net (European Antimicrobial Resistance Surveillance Network), indicate several key and worrying trends regarding the most dangerous microorganisms in Europe.

• Firstly, there is an increase in the frequency of isolation of carbapenem-resistant Gram-negative bacteria, especially Klebsiella pneumoniae and Acinetobacter baumannii, which poses a serious threat to the effectiveness of antibiotic therapy in hospital settings (EARS-Net, 2024).
• Furthermore, the rate of resistance of Escherichia coli strains to fluoroquinolones and third-generation cephalosporins is increasing, which significantly limits the therapeutic options available for the treatment of urinary tract infections and sepsis (EARS-Net, 2024).
• Methicillin-resistant Staphylococcus aureus (MRSA) is also increasing in some regions, despite the overall downward trend in the EU, requiring further vigilance and control measures (EARS-Net, 2024).

The European Union has set ambitious goals for combating the most dangerous pathogens and antimicrobial resistance, basing its actions on the One Health approach. Key EU goals by 2030 (compared to the base year 2019) include, among others, a 20% reduction in the total consumption of antibiotics in humans , a reduction in the percentage of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from blood, a 10% reduction in the percentage of Escherichia coli strains resistant to third-generation cephalosporins in blood isolates, and a 5% reduction in the percentage of Klebsiella pneumoniae resistant to carbapenems in invasive infections.

The latest EARS-Net data indicate that the pace of implementation is still insufficient. Therefore, EU guidelines focus on strengthening epidemiological surveillance, rationalizing the use of antibiotics and implementing effective infection control strategies.

Only the implementation of a comprehensive, multi-sectoral approach, encompassing healthcare, veterinary medicine and environmental protection, can ensure lasting control over the antibiotic resistance epidemic and protect the interests of public health. In the current situation, the actions of individual facilities remain part of a larger puzzle, the effectiveness of which depends on cooperation and coordination on a large scale.

In view of such conclusions, the following recommendations seem extremely urgent:

1. Strengthening the control of hospital infections. Without extensive regional and national coordination activities, especially in the context of the growing number of hospitalizations of patients colonized with multi-resistant pathogens, actions at the level of a single hospital alone are insufficient, and the scale of the problem will grow exponentially.
2. Optimization of antibiotic policy . Rationalization of antibiotic therapy, limiting the use of broad-spectrum antibiotics only to cases with confirmed drug sensitivity, is crucial. Despite the implementation of the systemic policy of the National Antibiotic Protection Program and restrictive access to antibiotics, actions only at the hospital level will not provide full control over the development of resistance.
3. Monitoring antibiotic usage and costs. Regular and detailed analysis of antibiotic usage and costs should be the basis for both managerial and clinical decision-making, enabling treatment optimization and rationalization of expenditure.
4. Continuing education of healthcare personnel. Systematic training in infection control and rational use of antibiotics is essential to limit the development of antibiotic resistance and to raise awareness of staff at all levels of healthcare.

In summary, growing antibiotic resistance translates into a dramatic increase in treatment costs and a serious threat to the safety of patients and medical personnel. This situation requires urgent and coordinated systemic action at the level of the entire health care system, not individual hospitals.

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