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Methicillin-resistant Staphylococcus aureus (MRSA) in a Petri Dish. Source: RKI.

Antibiotic Resistance and Hospital Infections

Every use of antibiotics promotes the development of resistance: sensitive bacteria are killed but the resistant ones survive and continue to proliferate. Antibiotic-resistant pathogens therefore often occur where many antibiotics are used, for example in hospitals, but also in agriculture.

When an antibiotic loses its efficacy, everyone is at risk: infections with resistant pathogens are usually more difficult to treat and can take a more complicated course. Particularly at risk of such infections are people with a weak immune system, autoimmune diseases, children with an immature immune system and older people with a weakening immune system. Other risk groups include organ transplant patients, cancer patients undergoing chemotherapy, people with diabetes and patients undergoing invasive surgery.

The development of antibiotic resistance cannot be prevented, but can at best be slowed down. Antibiotic resistance is increasing worldwide and is one of the biggest challenges for global health today.

Numbers in Germany and tasks of RKI

In Germany, an estimated 400,000 to 600,000 patients suffer a hospital acquired infection each year; 10,000 to 20,000 of them die. Typical problems for health care providers are surgical site infections, urinary tract infections and pneumonia.

Since the early 1990s, bacteria resistant to antibiotics (and therefore difficult to treat) play an increasing role in hospital acquired infections. At the Robert Koch Institute, scientists investigate the molecular-genetic properties of the resistant microorganisms. Moreover, they analyse how resistant pathogens spread and provide data on antimicrobial resistance and antibiotic use online. Regularly updated guidelines are published on how hospital infections can be avoided with hygiene measures.

Since 2020, RKI has had the legal mandate to compile a list of multi-resistant bacterial pathogens together with the Federal Institute for Drugs and Medical Devices (BfArM) and to develop criteria for classifying a newly authorised antibiotic as a reserve antibiotic. Based on the list of pathogens and criteria, the Federal Joint Committee (G-BA) can classify antibiotics as reserve antibiotics; the additional benefit of these antibiotics is then considered proven and pharmaceutical companies do not have to prove it via studies (§ 35a SGB V reserve antibiotics).

Antibiotics and One Health

Antibiotics are used almost everywhere: in human and veterinary medicine, agriculture and aquaculture. Their use leads to increased evolutionary pressure and the spread of antibiotic resistance in all these areas.


Antibiotics can save lives, but not every use of antibiotics in human medicine makes sense. The Robert Koch Institute has established a nationwide system for monitoring antibiotic consumption in hospitals (Antibiotic Consumption Surveillance, AVS). The institute also collects data on the development of resistance (Antibiotic Resistance Surveillance, ARS). ARVIA ("ARS and AVS Integrated Analysis") is a project funded by the Federal Ministry of Health with the aim of analysing the data on antibiotic consumption and antibiotic resistance from both surveillance systems at hospital level in relation to each other. The aim is to support hospitals in their activities to achieve rational antibiotic consumption and fulfil legal requirements. In addition, the project SAMBA evaluates the establishment of a nationwide surveillance of outpatient antibiotic use, including a feedback report system for doctor's offices.

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For information on programmes and measures to limit antibiotic resistance in the veterinary sector, see the information provided by the Federal Office of Consumer Protection and Food Safety.

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Antibiotic-resistant bacteria are also found in the environment, for example in water and soil. The genes that confer resistance properties can also occur in the environment. The assessment of infection risks in bodies of water is the task of the German Environment Agency and the relevant authorities at federal state and municipal level.

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Date: 22.02.2024