Antibiotics are medicines that treat and prevent various bacterial infections in humans and are a mainstay of modern medicine. But they also have their downsides: Antimicrobial resistance, often abbreviated as AMR, is on the rise worldwide. This includes resistance to other medicines used to fight infections caused by fungi or viruses.

The main cause of AMR is the misuse and overuse of antibiotics / antimicrobial treatments in humans, animals and plants, leading to the development of drug-resistant pathogens. 

Those involved in the healthcare system thus hold a particularly high level of responsibility: that includes doctors, nurses, pharmacies – but also pharmaceutical manufacturers, and not least the patients themselves. In this context, taking responsibility not only means ensuring prudent administration and intake of antibiotic medicines, but also responsible manufacturing including controlled production.

We are committed to minimizing the environmental impact of antibiotic production at all sites!

Prevention is a key element in production for Fresenius Kabi. As a leading manufacturer of intravenous antibiotics, the business sector has a dual responsibility: on the one hand, to produce essential medicines and make them available worldwide, and on the other hand, to ensure responsible manufacturing. By applying the standard, we ensure proper control of waste and wastewater so that any antibiotic residues are minimized, controlled, and effectively treated, thereby reducing environmental risks and minimizing the potential for antimicrobial resistance.  

Careful handling of antibiotic residues is particularly important: If they enter the environment via wastewater, they can contribute to the development of resistant pathogens there. “To counteract and prevent this, we are committed to minimizing environmental impact in antibiotic production at all our sites,” says Kirsten Nyland, Senior Vice President Environmental & Occupational Management at Fresenius Kabi. Since 2020, Fresenius Kabi has been a member of the Antimicrobial Resistance Industry Alliance (AMRIA) and is working together with other companies on solutions. “Because: How we handle these resources today will determine whether antibiotics will still be effective tomorrow,” Nyland adds.  

A flagship project has been implemented at the site in Santiago de Besteiros, Portugal: It became the first Fresenius Kabi site to receive BSI Kitemark™ certification for minimized AMR risk in the production of ceftriaxone. The certification confirms that the manufacturing processes there comply with the “AMR Industry Alliance Antibiotic Manufacturing Standard”.   Recently, the Fresenius Kabi site in Kutno, Poland, also received the certification to produce amikacin and linezolid. At the production unit in Graz, Austria, AMR certification was a natural next step. The site had long adhered to stringent environmental and quality standards, making BSI Kitemark™ certification for minimized AMR risk in the production of amikacin a confirmation of existing best practices.   The certifications also recognize the sites’ environmental management – in particular the measures taken to control and reduce antibiotic residues in wastewater and waste streams. Fresenius Kabi is thus working on an ongoing basis to make a measurable contribution to the containment of AMR.  

Why Helios and Quirónsalud have established consistent antibiotic management

Helios and Quirónsalud use antibiotics to treat bacterial infections in their hospitals. That is precisely why it is crucial to prevent the emergence of resistant pathogens at an early stage, because AMR in hospitals can prolong the length of stay, increase the risk of complications, and influence mortality.  

Helios is actively taking on this challenge: “In order to detect abnormalities and possible incorrect use of antibiotics, their consumption needs to be monitored. That is why we introduced antibiotic reporting in all Helios hospitals as long ago as 2012,” says Dr. Felix Giebel, Chief Physician in the Department of Infection Prevention and Hospital Hygiene and Head of the Infectious Diseases Division. “The burden of antimicrobial resistance is already high and may continue to increase – meaning even fewer antibiotics could be effective in the future. Only targeted antibiotic management can prevent or at least curb that.”  

Helios and Quirónsalud rely on interdisciplinary teams and digital tools

Effective hygiene measures are a key lever for preventing AMR – with the aim of avoiding nosocomial infections, in other words, those acquired during a stay in hospital. Helios goes even further:  

Helios introduced a holistic antibiotic stewardship program in 2019. It includes certified digital training of antibiotic stewardship experts (ABS), the implementation of ABS-trained physicians in every clinical unit, the introduction of a digitally controlled prescription of antibiotics, and a central infection monitoring system, referred to as “Surveillance”. Practical measures and guidelines for the hospitals are derived from this program on an ongoing basis.  

Quirónsalud hospitals also provide examples of their firm commitment to research and sustainability. In 2020, Quirónsalud Barcelona Hospital launched the “PROA” programme, in Spanish “Programa de Optimización del Uso de Antimicrobianos”. It promotes targeted and rational antibiotic use based on standardized guidelines, interdisciplinary teams, and ongoing monitoring of prescriptions, and is firmly embedded in the hospital’s quality and infection-prevention policies. Another example is the ARGOS project, developed by Quirónsalud colleagues. It is an integrated infection control and prevention program, using evidence, collaboration, and AI to guide safer antibiotic use. 

Further information    

AMR occurs when microorganisms have changed in such a way that they no longer respond to antibiotics, i.e. they have become resistant. If such resistant pathogens enter the environment, they can spread infections and make diseases that were previously easily treatable become life-threatening. AMR thus affects us all. The WHO has warned that without countermeasures, up to 10 million people a year could die from the consequences by 2050.  

Surgery to resolve a life-threatening diaphragmatic hernia has successfully been performed on a preterm baby weighing little more than 500 grams for the first time ever – an unprecedented procedure and medical breakthrough that brings hope.

Born three months preterm weighing just 490 grams, the little girl was barely bigger than an adult’s hand. Doctors delivered her by C-section on January 23, 2025 after her mother developed pregnancy-related complications. Senior Consultant in Obstetrics and Gynecology Dr. Friederike Senger discovered during an ultrasound before the little girl had even taken her first breath that she had a life-threatening defect. In this condition known as a diaphragmatic hernia, the abdominal organs move up into the chest cavity. This makes breathing almost impossible and would previously have been considered inoperable in such a tiny infant.

“Based on this diagnosis, we had to tell the girl’s parents that their daughter had only a very slim chance of surviving. I assured them, though, that we would do everything medically possible to try to save their tiny newborn,” recalls Dr. Kai Siedler, Chief Physician for Pediatrics and Adolescent Medicine at the Helios hospital in Pforzheim.

An interdisciplinary team from two Helios sites – and a strong will to live

Thanks to highly specialized care with state-of-the-art ventilation technology and special feeding strategies, the neonatal team led by Chief Physician Dr. Kai Siedler and Senior Physician Alexandra Weber successfully stabilized the little girl, saving her life. In the days that followed, they were even able to start giving her breast milk, drop by drop via a tiny feeding tube.

An interdisciplinary team of surgeons and pediatricians from two Helios sites operated on the frail little girl when she was just 19 days old and weighed only 540 grams. Chief Physician Dr. Thomas Ringle and Senior Physician Max Böttinger-Hummel from the pediatric surgery department at Helios Klinikum Pforzheim and Prof. Dr. Stefan Gfrörer, Chief Physician for Pediatric Surgery at Helios Klinikum Berlin-Buch used special magnifying loupes to perform the procedure. They successfully closed the hole in the diaphragm and returned the organs to their correct position – in a newborn whose organs had only just begun to develop.

“We broke new ground with this surgery at such an extremely low birth weight. Without it, the child would have had no chance of surviving. The perfect cooperation between our experienced interdisciplinary team of surgeons, pediatric intensive care physicians, and intensive care nurses was key to its success. Our little patient’s sheer determination to live also impressed us time and again though,” emphasizes Dr. Thomas Ringle.

Aftercare by a highly committed team of nurses

After the successful surgery, the little girl received round-the-clock care from the dedicated nursing team in the pediatric intensive care unit, then on the intermediate care ward. She made excellent progress: There were no complications, her breathing stabilized, she gained weight, and began drinking on her own.

On 3 June, 130 days after her birth, the little patient could be discharged from hospital weighing 2,150 grams. She will continue to be treated as an outpatient and will return to the children’s hospital for any procedures she may need in the future.

Dr. Kai Siedler hails the surgery as a milestone: “This case shows what modern medicine can achieve today – but above all what is possible when a highly motivated team works together. We are proud of everyone involved.”

Despite their tremendous concern, the baby’s parents were always optimistic: “We were terrified that we might lose our child, but we never lost hope. We owe the fact that our daughter is alive today and thriving like she is to the courage and skill of the physicians and the entire pediatric care team. We will forever be grateful that we chose this hospital.”

This success once again highlights the outstanding expertise and exceptional teamwork of the Fresenius Helios staff in caring for high-risk preterm infants. And it should set a precedent: The experience gained from this procedure will be shared with the international medical community.