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Research and innovation
News article8 March 2019Directorate-General for Research and Innovation

EU researchers find link between resistance to antibiotics and sanitation

Antimicrobial resistance (AMR) – the ability of microorganisms to resist antimicrobials such as antibiotics – is directly linked to sanitary conditions and the population’s general state of health: the better the sanitation, the lower the problem of AMR. This is one of the conclusions of a large EU-funded investigation into the AMR problem that gathered data through state-of-the-art DNA analysis of sewage around the globe.

Researchers working on the COMPARE project, funded under the EU research and innovation programme Horizon 2020, found that the world's countries fall within two groups in terms of AMR levels. Western Europe, North America, Australia and New Zealand - generally regions with better sanitary conditions - have the lowest levels of antimicrobial resistance, while Asia, Africa and South America have the highest levels.

Furthermore, Brazil, India and Vietnam have the greatest diversity in resistance genes (meaning that fewer antibiotics can still be used for effective treatment), while Australia and New Zealand have the lowest. Publishing the results today in Nature, the scientists show that improving sanitation could be an effective way to limit the growing burden of AMR.

Carlos Moedas, Commissioner for Research, Science and Innovation, said:

Resistance to antibiotics is a major threat to public health and we need to deal with it urgently. The ground-breaking results of the COMPARE project show that EU investments into research and innovation are paying off, also in this field. Our next research and innovation programme, Horizon Europe, is designed to bring even more support to protecting health and saving lives.

Working with an EU contribution of almost €21 million and coordinated by the Technical University of Denmark, the COMPARE project uses molecular technology to improve identification and mitigation of emerging infectious diseases and foodborne outbreaks. One part of this project analysed raw sewage from 74 cities in 60 countries. It used state-of-the-art DNA technology to look for genes that make bacteria resistant to antibiotics. Using this comparable global data, the researchers have created the first ever world map showing the levels of AMR in predominantly healthy populations. This paves the way for developing an ethically acceptable and economically feasible global surveillance and prediction of AMR.

And their ambition is to go even further and to develop a system to exchange and interpret information in real time, which could be used to manage diseases that threaten to spread across borders and develop into pandemics, such as Ebola, measles, polio or cholera.


Antimicrobial resistance (AMR) is estimated to be responsible for 33,000 deaths per year in the EU alone. The EU has committed to tackling this health threat by EU One Health Action Plan against AMR. Adopted in June 2017, it includes actions to boosts research and to close knowledge gaps. Through successive programmes for research and innovation including the current one, Horizon 2020, the EU has been investing €1.4 billion into this area.

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Publication date
8 March 2019
Directorate-General for Research and Innovation