Antimicrobial Resistance (AMR)
Antimicrobial resistance (AMR) occurs when microorganisms (bacteria, viruses, fungi, and parasites) evolve mechanisms to survive exposure to antimicrobial drugs that would normally kill them or inhibit their growth. AMR is recognised as one of the greatest threats to global public health.
Why AMR Matters
According to the WHO, AMR has reached alarming levels worldwide. Resistant infections lead to:
- Longer hospital stays and higher medical costs
- Treatment failures and increased mortality
- Reduced effectiveness of surgical procedures and cancer treatments
- Threats to food safety and agricultural productivity
A cross-sectoral threat
As stated in the EU One Health Action Plan against AMR: “resistant bacteria and infectious diseases do not respect borders”.
AMR in the Nordic Countries
The Nordic countries - Denmark, Finland, Iceland, Norway, and Sweden - have been at the forefront of AMR surveillance since the 1990s. Key facts:
- Denmark launched DANMAP in 1995, one of the world’s first integrated AMR surveillance programmes
- The density of publicly available bacterial genomic datasets in the Nordic countries is more than 750% higher than the global average (2.96 sequence datasets per 1,000 humans vs. 0.38 globally)
- All Nordic countries follow EUCAST guidelines for standardised susceptibility testing
- Each country operates national surveillance programmes: DANMAP, FINRES-Vet, Icelandic AMR-AMU Report, NORM-Vet, and Swedres-Svarm
How AMR is Monitored
AMR surveillance relies on several methods:
Culture-based methods
Clinical microbiology laboratories perform antimicrobial susceptibility testing (AST) on bacterial isolates. Results are interpreted using EUCAST breakpoints to classify bacteria as susceptible, susceptible with increased exposure, or resistant.
Molecular methods
- Whole-Genome Sequencing (WGS) - Used for characterising high-priority resistant bacteria (e.g., CPE, MRSA, VRE)
- PCR - Targeted detection of specific resistance genes
- Metagenomics - Culture-independent analysis of resistance genes in complex samples (e.g., wastewater)
Reporting and international systems
Nordic countries report to:
- EARS-Net - European Antimicrobial Resistance Surveillance Network
- GLASS - WHO Global Antimicrobial Resistance and Use Surveillance System
- EFSA - European Food Safety Authority (animal and food data)
Relationship to AMU
AMR and Antimicrobial Use (AMU) are closely linked. Overuse and misuse of antimicrobials accelerates the development and spread of resistance. This is why integrated surveillance of both AMR and AMU is essential - a core principle of the One Health approach.
Challenges
See Challenges to Integrated Surveillance for current obstacles to cross-border AMR monitoring, including:
- Reporting of Aggregated Data
- AST Reporting
- Clinical Isolate-Diagnosis Link
- Real-Time Data Sharing
- Sampling Bias