Multisectoral Strategies Against Antibiotic Resistance in Europe—Global Issues, Local Actions

European countries with formally comprehensive antimicrobial resistance (AMR) governance frameworks do not always achieve commensurate epidemiological outcomes. Existing benchmarking instruments, which rely either on aggregate mortality counts or on self-reported policy implementation scores, are poorly suited to detecting this dissociation between policy adoption and clinical impact. This study aims to empirically detect and characterize governance–outcome decoupling in the management of AMR across selected European countries, with France as the focal case. We employed a most-similar systems comparative design including Sweden, The Netherlands and Norway as top-performing comparators, and Italy and Greece as contrasting Southern European cases. Outcomes were measured using a normalized indicator developed for this study, the Proportion of Deaths Attributable to AMR relative to Deaths due to Sepsis (PDAA/DS), constructed from MICROBE platform estimates for 2019 and 2021. Implementation profiles were derived from the WHO TrACSS country self-assessment dataset and from a structured review of national strategy documents and surveillance reports. Cross-national rankings were triangulated with ECDC ESAC-Net antibiotic consumption data. The PDAA/DS revealed a stable cross-national performance gradient (Sweden 4.02% in 2019; France 7.67%; Greece 10.32%) and discriminated three distinct configurations of the policy–outcome relationship: embedded governance in the top-performing comparators (high implementation, low PDAA/DS), negative coherence in Italy (low implementation, high PDAA/DS), and policy decoupling in Greece (moderately high self-reported implementation, high PDAA/DS). France, despite reporting maximum implementation across six of nine TrACSS dimensions, occupies an intermediate position consistent with a partial decoupling pattern. A strong ecological correlation between national antibiotic consumption and PDAA/DS (r = 0.886, R2 = 0.785, n = 6) supports the construct validity of the indicator and is consistent with consumption volume being a principal correlate of cross-national variation. Effective AMR governance is not captured by the breadth of policy adoption but by the depth of clinical embedding. The PDAA/DS indicator, by normalizing AMR mortality against the broader sepsis burden, enables discrimination between coherent and decoupled governance configurations that are invisible to existing benchmarking tools. France’s profile suggests that the marginal return on additional policy adoption is now low, and that the priority should shift toward operational embedding instruments: prescriber-level surveillance feedback, structured pharmacist–prescriber consultations, and binding justification requirements for prescribing deviations.