Neonatal burden of antimicrobial resistance in 2021 across Western Europe: a MICROBE-based analysis

Abstract Background Antimicrobial resistance (AMR) poses a major global health challenge, affecting not only the elderly but also neonates. This study analyzes the estimates of neonatal AMR burden in 2021 across Western Europe, identifying key infections, pathogens, and risk factors to guide public health strategies. Methods Estimates of the burden of AMR in neonates were extracted from the Measuring Infectious Causes and Resistance Outcomes for Burden Estimation (MICROBE) tool by the Institute for Health Metrics and Evaluation. The burden attributable to AMR in 2021 was expressed as rates of Disability-Adjusted Life Years (DALYs) per 100,000 population and 95% Uncertainty Intervals (UIs). Correlation between national prevalence of low birthweight (LBW) and AMR-attributable DALYs was performed using the Pearson coefficient. LBW data were extracted from the OECD website. Results Bloodstream infections (BSIs) accounted for 84% of neonatal AMR burden in Western Europe. Italy had the highest AMR-attributable DALY rate for BSIs (2,540 per 100,000; 95% UI: 1,931-3,150), mainly due to E. coli (35%) and S. aureus (20%). A clear geographic pattern emerged, with Mediterranean countries showing higher burdens. LBW prevalence was strongly correlated with AMR-related DALYs (r = 0.85, p < 0.001); each 1% increase in LBW prevalence was associated with an increase of 372 DALYs per 100,000 (95% CI: 245-499, p < 0.001). Conclusions Neonatal AMR burden is highly concentrated in BSIs and strongly associated with LBW prevalence. Public health actions should focus on prenatal care, prevention of prematurity and LBW, and enhanced microbiological surveillance. Coordinated efforts are needed to reduce neonatal vulnerability and share best practices across countries with high burden. Key messages • Bloodstream infections drive the neonatal AMR burden in Western Europe. • Low birthweight is a key risk factor for neonatal AMR-related deaths and disability.