site.btaBulgaria Among EU Countries with Rising Antimicrobial Resistance, OECD Expert Says

Michele Cecchini, Head of Public Health at the Organisation for Economic Co-operation and Development (OECD), said on Thursday Bulgaria is among the EU countries where antimicrobial resistance (AMR) is increasing and is likely to be one of the countries with the highest levels of AMR by 2035. He was speaking at a national forum on infection prevention and control and antimicrobial resistance in the context of health system management, held at the National Centre of Infectious and Parasitic Diseases.

High levels of AMR are also reported in Poland, Romania and Greece, Cecchini said. The figures are high because antibiotics are often not used in accordance with guidelines. Some 19% of antibiotics prescribed by general practitioners do not comply with the medicines' prescribing instructions. Antibiotic use in Bulgaria increased by 8% between 2019 and 2024, he said.

Investing in better hospital hygiene should be a priority for Bulgaria, Cecchini said. Taking the necessary measures could save around EUR 2 million a year, he added.

Johan Van Eldere, Secretary-General of the European University Hospital Alliance, said he was not optimistic about AMR because it will not disappear; it will remain and continue to increase. Resistance existed long before antibiotics began to be used, and human activity is accelerating the emergence of resistant genes, he said. Resistance cannot be eliminated, as it develops easily and is very difficult to eradicate.

A World Health Organization report tracking annual changes in resistance rates for some of the most important antibiotics shows that resistance is increasing worldwide, Van Eldere said. Europe is surrounded by regions with very high levels of resistance, with Russia among those most affected. China and India also have extremely high levels, and resistant genes will continue to enter Europe. Resistance is not confined to hospitals, Van Eldere said. The spread of resistant genes among the general population is increasing, meaning that many people are already carrying them when admitted to hospital, he added. Even in Norway and Canada, where stringent measures are in place, the spread of resistant genes is increasing.

Van Eldere called for a reduction in antibiotic prescribing. Infection prevention and control are the most effective tools against hospital-acquired infections and their spread, but the best course of action is to improve the education and capacity of the healthcare workforce, he said.

Prof. Iva Hristova, Director of the National Centre of Infectious and Parasitic Diseases, said infection prevention is fundamental to good medical practice and requires the involvement of a wide range of specialists. She called for joint efforts to clarify the challenges and identify concrete steps to address them.

The forum was organized by the One Health Association with the support of the Health Ministry. It is part of the activities under Bulgaria's National Action Programme against AMR for 2026-2029. The event aims to bring together institutions, healthcare facilities, professional, non-governmental and patient organizations, academia, industry and other stakeholders to agree on common priorities and action to curb AMR and prevent infections under the One Health approach.