Article • EURECA study

Combating CRAB and carbapenem resistant bacteria

Antimicrobial resistance mortality is set to surpass cancer and traffic-related deaths by 2050, according to the UK National Health Service (NHS).

Report: Melisande Rouger

portrait of Belén Gutiérrez-Gutiérrez
Belén Gutiérrez-Gutiérrez, coordinator of the EURECA project.

Carbapenem-resistant Acinetobacter (CRAB) and carbapenem resistant Enterobacteriaceae, two of the most common bacteria involved in these types of infections, are the object of the COMBACTE-CARE’s EUropean prospective cohort study on Enterobacteriaceae showing REsistance to CArbapenems (EURECA). European Hospital asked Belén Gutiérrez-Gutiérrez, coordinator of the project, how it will improve knowledge of risk and prognosis factors, and what is the best available treatment.

‘According to a report published by the UK National Health Service (NHS) in 2016, antimicrobial resistance mortality will increase from the current 700,000 to 10 million annual deaths by 2050 – unless extraordinary steps are taken to control it,’ Belén Gutiérrez-Gutiérrez pointed out. ‘To give an idea, 10 million deaths per year are more than the current number of cancer or traffic-related deaths.'

UN declaration acknowledges the gravity

‘The United Nations ­member states also signed a ­declaration acknowledging the ­gravity of drug resistant bacteria. Carbapenem-resistant gram-negative bacteria Acinetobacter baumannii, carbapenem-resistant Pseudomonas-aeruginosa, and carbapenem and 3rd generation cephalosporin-resistant have been defined as first priorities by the WHO in its list of antibiotic resistant bacteria that are a risk to human health.’

Currently 53 hospitals in ten countries take part in the study, with 836 patients enrolled – so 40% of the total estimate. These patients will serve to improve knowledge of risk and prognosis factors, and best available treatment in infections due to CRAB and carbapenem resistant Enterobacteriaceae. They will also serve as a historical comparative cohort for new clinical trials to develop new antibiotics.

First results to be aired at ECCMID 2018

It’s key is to raise not only public awareness but also among HC professionals and the pharmaceutical industry of how important it is not to abuse antibiotics and use them only when strictly necessary

Belén Gutiérrez-Gutiérrez

‘The study will close by February 2018 and we hope to communicate our first results during the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), which will take place in Madrid in April next year. First, we must raise public awareness of increasing antibiotic resistance and its relationship with antibiotic overuse. It’s key is to raise not only public awareness but also among HC professionals and the pharmaceutical industry of how important it is not to abuse antibiotics and use them only when strictly necessary. Then we must analyse how these microorganisms are transferred and prevent them in the hospital and the community.

We must also reduce the unnecessary use of antibiotics in animals for human purposes, and promote new diagnostic tools to early detect infection and reduce the unnecessary use of antibiotics when there is no infection. Last but not least, we must develop new antibiotics and optimise antibiotics that are already available.’

How the coordination role began

‘We had just finished including cases from INCREMENT, another international observational study on bloodstream infections (BSIs) due to extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL) and/ or carbapenemase-producing Enterobacteriaceae, when Dr Jesús Rodriguez-Baño, who leads the EURECA study, asked me to coordinate it. I am part of a great local team of seven professionals, who help me coordinate and manage the study together with the COMBACTE Clin-Net, Stat-Net and Lab-Net networks.'

Other research projects

'Until recently I was coordinating the INCREMENT project. Now I’m coordinating INCREMENT-SOT, a study in transplanted patients with BSIS due to extended spectrum β-lactamase-producing Entero-bactamase (ESBL) or carbapenemase-producing Enterobacteriaceae, together with Reina Sofia Hospital in Cordoba and 12 October Hospital in Madrid. I am also part of the research team in another international project, the MODERN study, on ESBL transmission and epidemiology.’

Facing the challenges of drug resistant bacteria

‘At the Infectious Diseases and Clinical Microbiology Unit in Virgen Macarena University Hospital, in Seville, we have a team of specialists who are responsible for controlling and managing patients with nosocomial infection. Multidisciplinary work, joining infectious diseases physicians, microbiologists, nurses, pharmacists and preventive medicine specialists, is essential for these patients. We need to diagnose the infection due to a drug resistant bacteria early, to treat it with the best available therapy, and to rigorously manage treatment to guarantee a successful outcome. Also, it’s key to take isolation measures and develop antimicrobial stewardship.’

The importance of a multidisciplinary international network

Our objective is to work all together in the same direction to fight these infections

Belén Gutiérrez-Gutiérrez

‘In our daily work as infectious diseases physicians, we increasingly have to manage patients with infection due to bacteria resisting almost any type of antibiotics. You realise how necessary and important it is to have a multidisciplinary and international network such as COMBACTE. Our objective is to work all together in the same direction to fight these infections.’


A specialist in internal medicine, Belén Gutiérrez-Gutiérrez MD works in the Infectious Diseases and Clinical Microbiology Unit at Virgen Macarena University Hospital, Seville, Spain. Gaining her PhD at Seville University and a degree in epidemiology and clinical research from the University of Granada, today she is involved in various international antimicrobial resistance research projects. 

EURECA is a prospective observational study within the COMBACTE-CARE project, which is promoted by the Innovative Medicines Initiative (IMI), a consortium between the EU and the European Federation of Pharmaceutical Industry Associations (EFPIA). The project focuses on combating carbapenem-resistant Gram-negative bacteria.


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