Sweden sees AMR rising, compliance impacted by healthcare crisis

Antimicrobial resistance is on the rise, prompting the Swedish government to invite the European Centre for Disease Prevention and Control (ECDC) and the European Commission to review Sweden’s AMR strategy.

More than 35,000 people in the EU die each year from infections caused by antimicrobial-resistant bacteria, or AMR, according to the ECDC. Although Sweden has a low incidence of AMR in a European context, it does not lack challenges.

“We all know that more can and must be done in Sweden to prevent infections. It is about vaccinations, but it is also about having healthcare workers with the appropriate knowledge and competence in healthcare hygiene,” Sweden’s Social Affairs Minister, Jakob Forssmed, commented at the recent Swedish AMR conference (Stramadagen) in Stockholm.

“Despite the fact that we’ve just gone through a pandemic where issues on healthcare hygiene were high on the agenda, the situation in Sweden has worsened.”

AMR rising, compliance falling

According to Forssmed, the levels of antibiotic use, healthcare-associated infections, and antimicrobial-resistant bacteria in Swedish hospitals are edging upwards, and health workers’ compliance with healthcare hygiene guidelines has deteriorated.

An analyst at the Swedish Public Health Authority told Euractiv that cases of infections caused by multi-resistant bacteria – which must be reported under the Swedish Infection Control Act, such as skin germs MRSA and intestinal bacteria ESBL – increased by 12 per cent, from 13,565 in 2022 to 15,168 in 2023.

Sweden’s AMR strategy, with an inter-agency cooperation function and an action plan, is said to have served the country well. But now, according to Jakob Forssmed, it needs to be sharpened.

In line with this policy, the Swedish government has invited the ECDC and the EU Commission to Sweden to assess the potential for improvement, the minister explained.

Many health professionals who have been or are involved in the Swedish AMR network STRAMA attended the conference. STRAMA has gained international attention during its 25 years of operation for its multi-faceted and successful work tackling the incidence of AMR throughout the country.

Each of Sweden’s 21 regions now has its own STRAMA group. At the same time, resources are unevenly distributed, and, in many cases, groups rely on voluntary commitment from doctors and nurses. 

Living in a post-pandemic era

There are several co-working explanations for the observed challenges in maintaining low levels of antimicrobial resistance in Sweden, Gunnar Kahlmeter, a consultant in clinical microbiology at the Växjö Hospital in southern Sweden, told Euractiv.

“We are living in a post-pandemic era with a healthcare system that is under pressure and has a high occupancy bed rate, which, for example, makes it difficult to isolate patients in single rooms,” said Kahlmeter.

“At the same time, Swedish hospitals also receive patients who have been in other parts of the globe, like soldiers from Ukraine, who sometimes carry particularly nasty multi-resistant bacteria that can easily spread in the hospital full of patients,” he remarked.

Kahlmeter said that in Sweden, they have become very good at preventing the spread of resistant bacteria, but he explained that the general economic situation is now contributing to a slightly higher incidence of antimicrobial-resistant bacteria. Epidemiological causes and outbreaks in different wards, such as neonatal units, could also contribute to this downward trend he said.

Kahlmeter welcomes the forthcoming assessment of Sweden’s AMR situation by the ECDC and the EU Commission.

“It is always good to have someone to shed light on things that are difficult to discover,” he told Euractiv.

Eyeing a strong declaration

In early May, Jakob Forssmed invited the Global Leaders Group on Antimicrobial Resistance to Sigtuna, one of Sweden’s oldest cities, outside Stockholm.

The primary aim was to discuss AMR topics, especially the upcoming high-level meeting at the United Nations General Assembly in September, where the minister said the ambition is to achieve a strong declaration on how to combat AMR.

[By Monica Kleja, edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]

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