Antimicrobial resistance is rising in Bulgaria and by 2035 the country will likely have one of the highest rates in the EU, according to Michele Cecchini, head of the public health division at the Organisation for Economic Co-operation and Development (OECD).

Data from 2019 to 2024 show an 8% rise in antibiotic use in Bulgaria.

Cecchini said antibiotics are too often used outside guidelines. This applies to 19% of the antibiotics GPs prescribe. Poland, Romania and Greece also have high rates of resistance.

Cecchini said Bulgaria's priority should be investing in better hygiene in hospitals. If it takes the necessary steps, he said, the country could save about €2m a year.

He spoke at a national forum with international participation at the National Centre of Infectious and Parasitic Diseases. The full title of the forum is "Infection prevention and control and antimicrobial resistance in the context of health system management: the One Health approach and cross-sector cooperation". The One Health association organised it with the backing of the Ministry of Health, and it is part of the National Action Programme against Antimicrobial Resistance for 2026-2029. The forum brings together institutions, healthcare facilities, professional, non-governmental and patient organisations, academic bodies and industry to agree shared priorities for curbing resistance and preventing infections.

Johan Van Elder, secretary general of the European Alliance of University Hospitals, is not optimistic. He said resistance will not go away. It will stay and keep growing. It existed before antibiotics, but humans speed up the emergence of resistant genes. Resistance is easy to acquire and very hard to remove, Van Elder explained.

He cited a World Health Organization report on the yearly change in resistance rates for the main antibiotics. The report says resistance is growing worldwide. Europe is surrounded by regions with very high resistance, Van Elder said: it is highest in Russia, and very high in China and India. For that reason, resistant genes will keep entering Europe.

The problem is not limited to hospitals, he warned. Resistant genes are spreading more among people, and many patients now arrive in hospital already carrying them. The same is seen in Norway and Canada, despite strict measures there.

Van Elder called for fewer antibiotic prescriptions. He said preventing and controlling infections is the strongest tool against hospital infections and their spread, and that what helps most is higher levels of education and workforce capacity.

Preventing infections is the basis of good medical practice and needs a wide range of specialists to take part, said Prof Iva Hristova, director of the National Centre of Infectious and Parasitic Diseases.