Super bacteria kill more than influenza, Aids and TB together. Here are the therapies being studied to stop them
On the occasion of World Infection Day, a review of the growth of infections and the drugs and vaccines being studied in the world and in Italy
Key points
Someone has already dubbed it the new silent pandemic: that of antibiotic and antimicrobial resistant super bacteria. An emergency that causes more than 35,000 deaths from infections every year in the European Union, a number greater than the sum of deaths from influenza, tuberculosis and HIV/AIDS. There are 4.3 million patients a year in the EU who contract at least one healthcare-associated infection while in hospital: 1 in 14 hospitalised patients every day. Many of these infections are increasingly difficult to treat: 1 in 3 micro-organisms is now resistant to important antibiotics, thus limiting treatment options. And Italy is among the countries most affected with 12,000 deaths a year. According to the WHO, 39 million deaths worldwide are expected due to antimicrobial resistance by 2050 and globally, it is estimated to cost healthcare systems USD 66 billion per year. There are currently 90 antibiotic drugs in clinical development, 232 in pre-clinical development and 155 vaccines under investigation against resistant bacterial infections worldwide
It is a major health emergency
"Today, in our country, antibiotic resistance causes about 12,000 deaths every year, equivalent to one third of all those recorded among hospitalised patients". The data were released by the president of the Istituto Superiore di Sanità, Rocco Bellantone, who spoke at the four-day conference organised in Rome by the Iss and the Inf-Act Foundation. "These numbers," Bellantone added, "are not mere statistics: they represent people, families, and communities affected by infections that, for the most part, we could have avoided or effectively treated."For Health Minister Orazio Schillaci "Antimicrobial resistance, of which antibiotic resistance is certainly the most important factor, is one of the major global health emergencies, fuelled over time by the often inappropriate overuse of antibiotics in both human, veterinary and livestock settings. It is a threat that for years has been a real silent epidemic present in our communities in our hospitals and closely related to the phenomenon of care-associated infections, with serious repercussions both in terms of patient health and the sustainability of health services, and it is an emergency that today sees Italy strongly committed to being at the forefront'.
Hospitals are using fewer disinfectant gels
Iss surveillance shows that in Italy, in 2024, resistance rates of the most important pathogenic bacteria to the main classes of antibiotics continue to remain high. For some microorganisms there are some signs of improvement, while for others such as Enterococcus faecium resistant to vancomycin, the trend is steadily and worryingly increasing. Also of concern is the low use of hydroalcoholic solution, i.e. hand disinfectant gels, in hospitals: in 2024, the median consumption in ordinary hospital stays was 9.9 litres per 1,000 hospital days. This value is well below the reference standard of 20 litres per 1,000 hospital days set by the World Health Organisation, and is also down from 2023 (10.5). The region with the lowest use of hydroalcoholic solution is Molise (2.6 litres), while at the other extreme is Emilia-Romagna (29.3 litres).
This is how infections and antibiotic consumption grow
The ECDC, the European Centre for Disease Prevention and Control, also raises the alarm on antimicrobial resistance (AMR): 'Despite determined efforts by countries and health professionals, Europe is not on track to meet four of the five antimicrobial targets set by the EU Council for 2030,' the agency warns. "It is time to act - it urges - not react". "Since 2019," reports the Ecdc, "the estimated incidence of circulatory stream infections caused by carbapenemase-resistant Klebsiella pneumoniae has increased by more than 60 per cent, despite the target of a 5 per cent reduction by 2030. Similarly, those caused by Escherichia coli resistant to third-generation cephalosporins increased by over 5%, despite the target of a 10% reduction. Antibiotic consumption also increased in 2024, contrary to the 20% reduction target. Meanwhile, the percentage of first-line antibiotics used - those belonging to the Access group of the World Health Organisation's Aware classification, which should cover at least 65% of total use - has stagnated at around 60%." 'The increase in Amr, together with the shortage of new effective treatments,' the Ecdc emphasises, 'represents a serious and evolving public health crisis in Europe and worldwide'.
The therapies being studied in the world and in Italy
The crux is the overuse of antibiotics that favours the proliferation of resistant super-bacteria with Italy registering a +10% increase compared to the European average in 2024 and the southern regions maintaining first place for consumption, compared to the Centre and the North, despite a reduction of around 5% in 2024. This year, however, nine antibiotics active against multi-resistant infections have been included in the Innovative Medicines Fund, warns Aifa, the Italian Medicines Agency. While worldwide there are 90 antibiotic drugs in clinical development, 232 in preclinical development and 155 vaccines under study. "Italy," recalls the president of Farmindustria Marcello Cattani, "has taken an important step with the Budget Law 2025, allocating 100 million euro per year from the Fund for Innovative Medicines to reserve antibiotics (i.e., of last resort, to be used only in the most serious cases), guaranteeing their permanence until patent expiry". And precisely on the occasion of World Antiobiotic Resistance Day, Pfizer announced the availability in Italy of a new antibiotic combination approved and reimbursed by Aifa for the treatment of serious infections caused by metallo-beta-lactamase-producing Enterobacterales or Stenotrophomonas maltophilia. It is a targeted therapeutic alternative against multiresistant Gram-negative pathogens, including Klebsiella pneumoniae and Escherichia coli, responsible for many nosocomial infections: from hospital-acquired pneumonia to urinary tract infections
