Antimicrobial Resistance and Health in Europe: A Systematic Review and Meta-Analysis

Abstract

Background: Antimicrobial resistance (AMR) poses a critical threat to public health, undermining the effectiveness of existing treatments and contributing to increased morbidity, mortality, and healthcare costs. Europe has reported rising resistance rates across major bacterial pathogens, highlighting the urgent need for evidence synthesis to guide policy and interventions. Objectives: This systematic review and meta-analysis aimed to synthesize evidence from high-quality clinical trials and observational studies to estimate the prevalence, health outcomes, and determinants of AMR in Europe. Methodology: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we systematically searched PubMed, Embase, Web of Science, and Cochrane Central from 2000 to 2025. Eligible studies included randomized controlled trials, cohort, and case-control studies reporting AMR prevalence or associated outcomes in European populations. Risk of bias was assessed using RoB 2 and ROBINS-I tools. A random-effects meta-analysis with Hartung–Knapp adjustment was performed, stratifying by pathogen, resistance mechanism, clinical setting, and sub-region. Results: Preliminary synthesis suggests increasing resistance in Escherichia coli and Klebsiella pneumoniae across Southern and Eastern Europe, with multidrug-resistant infections associated with prolonged hospital stays, higher treatment costs, and increased mortality. Subgroup analyses indicated significant heterogeneity driven by regional differences and study design. Conclusion: AMR remains a growing health crisis in Europe with substantial clinical and economic consequences. Coordinated surveillance, antimicrobial stewardship, and strengthened infection control are essential to mitigate its burden and achieve sustainable public health outcomes.