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ECDC/EFSA/EMA First Joint Report on the Integrated 30 January 2015 636088/2013 ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from 1 humans and food-producing animals Joint Interagency Antimicrobial Consumption and Resistance Analysis (JIACRA) Report Abstract The ECDC, the EFSA and the EMA have for the first time jointly explored associations between consumption of antimicrobials in humans and food-producing animals, and antimicrobial resistance in bacteria from humans and food-producing animals, using 2011 and 2012 data currently available from their relevant five EU monitoring networks. Combined data on antimicrobial consumption and corresponding resistance in animals and humans for EU MSs and reporting countries were analysed using logistic regression models for selected combinations of bacteria and antimicrobials. A summary indicator of the proportion of resistant bacteria in the main food-producing animal species was calculated for the analysis, as consumption data in food-producing animals were not available at the species level. Comparison of antimicrobial consumption data in animals and humans in 2012, both expressed in milligrams per kilogram of estimated biomass, revealed that overall antimicrobial consumption was higher in animals than in humans, although contrasting situations were observed between countries. The consumption of several antimicrobials extensively used in animal husbandry was higher in animals than in humans, while consumption of antimicrobials critically important for human medicine (such as fluoroquinolones and 3rd- and 4th-generation cephalosporins) was higher in humans. In both humans and animals, positive associations between consumption of antimicrobials and the corresponding resistance in bacteria were observed for most of the combinations investigated. In some cases, a positive association was also found between antimicrobial consumption in animals and resistance in bacteria from humans. While highlighting findings of concern, these results should be interpreted with caution owing to current data limitations and the complexity of the AMR phenomenon, which is influenced by several factors besides antimicrobial consumption. Recommendations to address current data limitations for analyses of this type were identified. In any case, responsible use of antimicrobials in both humans and animals should be promoted. 1 For citation purposes: ECDC (European Centre for Disease Prevention and Control), EFSA (European Food Safety Authority) and EMA (European Medicines Agency). ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food- producing animals. Stockholm/Parma/London: ECDC/EFSA/EMA, 2015. EFSA Journal 2015;13(1):4006, 114 pp. doi:10.2903/j.efsa.2015.4006 Table of contents 1. Summary and recommendations ............................................................. 9 1.1. Summary ............................................................................................................ 9 1.2. Recommendations .............................................................................................. 10 2. Terms of reference and scope ................................................................ 11 3. Acknowledgements ............................................................................... 12 4. Description of the existing monitoring or surveillance systems ............. 13 4.1. Surveillance of antimicrobial consumption in humans .............................................. 14 4.1.1. Description of collected data ............................................................................. 14 4.1.2. Strength of the system ..................................................................................... 14 4.1.3. Impediments to comparing the data .................................................................. 15 4.1.4. On-going actions to improve the system ............................................................. 15 4.2. Surveillance of antimicrobial consumption in food-producing animals ........................ 16 4.2.1. Description of collected data ............................................................................. 16 4.2.2. Strength of the system ..................................................................................... 16 4.2.3. Impediments to comparing data ........................................................................ 16 4.2.4. On-going actions to improve the system ............................................................. 17 4.3. Surveillance of antimicrobial resistance in humans ................................................. 17 4.3.1. Surveillance of antimicrobial resistance in humans through FWD-Net ..................... 17 4.3.2. Surveillance of antimicrobial resistance in humans through EARS-Net .................... 19 4.4. Monitoring antimicrobial resistance in food-producing animals and food .................... 20 4.4.1. Description of collected data ............................................................................. 20 4.4.2. Strength of the system and impediments to comparing data ................................. 21 4.4.3. On-going actions to improve the system ............................................................. 21 5. Methodological considerations and included data .................................. 22 5.1. Consumption of antimicrobials by humans and food-producing animals ..................... 23 5.1.1. Numerator ...................................................................................................... 23 5.1.2. Denominator ................................................................................................... 23 5.2. Rationale for the analysis of consumption and resistance in bacteria from food- producing animals and humans .................................................................................. 24 5.3. Rationale for selecting particular combinations of organism and antimicrobial for detailed analysis ....................................................................................................... 24 5.4. Method for analysis of the relationship between antimicrobial consumption and resistance ................................................................................................................ 25 5.4.1. Consumption and resistance data from food-producing animals ............................. 25 5.4.2. Consumption and resistance data from humans ................................................... 26 5.4.3. Statistical methodology .................................................................................... 27 6. Consumption of antimicrobials in humans and food-producing animals 28 6.1. Total tonnes of active substance and estimated biomass ......................................... 28 6.2. Reporting consumption in humans by numbers of DDD per 1 000 inhabitants and per day and by milligrams per kilogram estimated biomass ................................................. 30 6.3. Population biomass-corrected consumption of antimicrobials in humans and food- producing animals ..................................................................................................... 30 ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals 636088/2013 Page 2/114 6.4. Comparison of overall consumption, expressed as milligrams per kilogram estimated biomass, by antimicrobial class ................................................................................... 33 6.5. Comparison of consumption, expressed as milligrams per kilogram estimated biomass, of 3rd- and 4th-generation cephalosporins by country ..................................................... 33 6.6. Comparison of consumption, expressed as milligrams per kilogram estimated biomass, of fluoroquinolones by country .................................................................................... 34 6.7. Discussion on comparison of consumption ............................................................. 35 6.7.1. Limitations ...................................................................................................... 35 6.7.2. Discussion on results ....................................................................................... 36 7. Antimicrobial consumption in food-producing animals and resistance in bacteria from food-producing animals ....................................................... 37 7.1. Comparison between consumption of antimicrobials for food-producing animals and resistance in food-producing animals ........................................................................... 37 7.2. Discussion of the comparison between consumption of antimicrobials in food-producing animals and resistance in bacteria from food-producing animals ..................................... 44 7.2.1. Limitations of data ........................................................................................... 44 7.2.2. Interpretation of results ................................................................................... 45 8. Antimicrobial consumption in humans and resistance in bacteria from humans ..................................................................................................... 50 8.1. Consumption of 3rd- and 4th-generation cephalosporins
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