Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021

The increasing occurrence of antimicrobial resistance (AMR) in bacterial infections has emerged as one of the biggest threats to global health. Recent studies estimated that AMR was associated with 1.27 million attributable deaths worldwide in 2019 and more than 33,000 deaths in the European Union and European Economic Area (EU/EEA) in 2015. Although there is evidence that the prevalence of AMR is especially pronounced in low-income countries, high-income countries are also affected. In the EU/EEA, deaths due to infections with antibiotic-resistant bacteria increased 2.5-fold between 2007 and 2015, and a rise in resistance proportions was observed in important bacteria, such as vancomycin-resistant Enterococcus faecium.

In Germany, measures to limit the spread of antibiotic resistance are bundled in the German antibiotic resistance strategy (DART). One element of DART is the surveillance of antibiotic resistance, which is implemented as the continuous national antibiotic resistance surveillance (ARS) of the Robert Koch Institute. However, ARS lacks clinical data (e.g. case fatality rate or diagnoses), and the national representativeness depends on voluntarily participating laboratories, where coverage varies between German regions.