Objective             To quantify the health burden of antimicrobial-resistant (AMR) infections in Belgian acute-care hospitals for 2018-2023 and examine its trends.

Methods              Clinically significant bloodstream isolates reported to the national EARS-BE network (172 371 antimicrobial-susceptibility-testing (AST) results from 30-34 (the exact number varied by year) accredited hospital laboratories) were analysed for 13 pathogen-antibiotic phenotypes across seven WHO-priority species. Incidence was corrected with pathogen- and year-specific population-coverage factors and infection-site multipliers derived from the 2022 Belgian point-prevalence survey, then converted to disability-adjusted life-years (DALYs) and attributable death with the Burden of Communicable Diseases in Europe (BCoDE) v2.0.0 toolkit. Trends in burden were evaluated with negative-binomial regression, expressed as incidence-rate ratios (IRRs).

Results                 In 2023 AMR infections produced 118 DALYs (85% years-of-life lost) and 4.22 deaths per 100 000 inhabitants. Four phenotypes generated 65% of the burden: third-generation-cephalosporin-resistant Escherichia coli (3GCREC, 33%), macrolide-resistant Streptococcus pneumoniae (MRSP, 22%), third-generation-cephalosporin-resistant Klebsiella pneumoniae (3GCRKP, 11%) and methicillin-resistant Staphylococcus aureus (MRSA, 9%). Vancomycin-resistant enterococci and colistin-resistant phenotypes contributed <3%. Total DALYs declined by 21% in 2020-2021 (IRR 0.79, 95% CI [0.65;0.95]), driven by declines in 3GCREC and MRSA, and partially rebounded in 2022-2023.

Conclusions         Belgium’s hospital AMR burden remains concentrated in this studied set of selected phenotypes and proved responsive to system-wide changes during the pandemic period. Sustained stewardship and targeted control of 3GCREC, MRSP and MRSA are critical for translating the temporary pandemic-era relief into durable reductions, providing a timely baseline for the next National One-Health AMR Action Plan.