Antibiotic resistance, with less consumption of less resistant bacteria
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Against the silent pandemic of antibiotic resistance, reducing the use of antibiotics works. The good news comes from a European multi-agency report: “Countries that have reduced antibiotic consumption in both animals and humans have seen a decrease in antibiotic-resistant bacteria.”
Applying the "One Health" approach, which recognizes the link between human and animal health, the report on antibiotic consumption and antimicrobial resistance in Europe shines a light of hope on one of the world's major public health emergencies . The dossier is drawn up by the European Center for Disease Prevention and Control (ECDC), the European Food Safety Authority (EFSA) and the European Medicines Agency (EMA).
Antibiotic consumption and resistance
The relationship joint effort, called JIACRA IV, is based on the integrated analysis of antimicrobial consumption (AMC) and the presence of antimicrobial resistance (AMR) in bacteria from humans and food-producing animals. Between 2014 and 2021, total antibiotic consumption in food-producing animals decreased by 44%, while it remained relatively stable in humans.
A systematic review therefore analyzes the associations between AMC and AMR for selected combinations of bacteria and antimicrobials. And it finds that measures implemented to reduce antibiotic consumption in food-producing animals and humans have been effective in many countries.
"Positive associations were observed between the consumption of some antimicrobials and resistance to these substances in bacteria from both humans and food-producing animals. For some combinations of bacteria and antimicrobials, antimicrobial resistance in bacteria from humans was associated with antimicrobial resistance in bacteria from animals which, in turn, was related to AMC in animals"(1).
The results suggest that measures implemented to reduce antibiotic consumption in food-producing animals and humans have been effective in many countries.
The E.coli case
For the first time Under the project, the three agencies analyzed trends in antimicrobial consumption and antimicrobial resistance for Escherichia coli (E. coli) in humans and food-producing animals.
From the analysis It emerges that bacteria of the genus E. coli in both animals and humans are becoming less resistant to antibiotics thanks to the reduction in their overall consumption. And this, EFSA comments, shows that the worrying trends in antibiotic resistance can be reversed.
Between 2014 and 2021 In 10 of the 20 countries that significantly reduced total antibiotic consumption in food-producing animals, the intestinal bacterium E.coli from animals became increasingly susceptible to antimicrobials, showing “complete susceptibility” or “zero resistance” to a range of important antibiotics. In other words: those drugs work.
In the same way, in 9 of the 19 countries that reduced antibiotic consumption in humans, E.coli originating from human invasive infections became increasingly susceptible (hence “complete susceptibility” or “zero resistance”) to antibiotics.
"These results show that overall reduction of AMC can help reduce antimicrobial resistance. This also highlights the importance of measures that promote human and animal health, such as vaccination and better hygiene, thus reducing the need for antimicrobials"(2).
«Less use of antibiotics in livestock production it pays: in most countries that have reduced the use of antibiotics we have observed a corresponding decrease in resistance levels. This means that efforts at the national level are needed. Furthermore, this highlights the EU's commitment to the One Health approach, safeguarding both animal and global public health.», said Bernhard Url, executive director of EFSA
The silent pandemic
It is a beacon of hope, given the threat that antibiotic resistance poses to global public health (3).
Bacterial infections resistant to antibiotics cause an estimated 35 deaths in the EU every year, a figure comparable to the impact of influenza, tuberculosis and HIV/AIDS combined. Of these, a third of the deaths (11 thousand victims) occur in Italy. And the impact on European healthcare systems should not be forgotten, estimated by the Organization for Economic Co-operation and Development (OECD) at an approximate cost of 11,7 billion euros per year.
«A greater commitment aimed at reducing unnecessary antibiotic consumption is crucial to addressing the public health threat posed by antimicrobial resistance. Furthermore, strengthening vaccination programs and improving infection prevention and control practices in communities and health facilities are essential to reduce the need for antibiotics.», said Andrea Ammon, director of the ECDC.
Last resort antibiotics, the risks
In humans The use of important classes of antibiotics, such as carbapenems, third- and fourth-generation cephalosporins, and quinolones, is associated with resistance to these antibiotics in E. coli present in humans. The resistance of bacteria in humans can also be linked to that present in food-producing animals, as is the case with Campylobacter jejuni and Campylobacter coli, which can be found in animals and transmitted to people through food.
These are phenomena to be monitored also because some of these drugs, such as carbapenems, are broad-spectrum antibiotics, also effective against multi-resistant bacteria, antibiotics of last resort for which any detection of resistance is a cause for concern.
Similarly any trace of resistance to fluoroquinolones, antibiotics used in the treatment of even very serious bacterial infections, is worrying. According to an EFSA/ECDC study, between 2013 and 2022, in human patients, at least half of the reporting countries observed increasing trends in resistance to fluoroquinolones in isolates of Salmonella Enteritidis and Campylobacter jejuni, usually associated with poultry. This is a worrying fact for public health because “on the rare occasions when Salmonella or Campylobacter infections progress to serious illness, fluoroquinolones are among the antimicrobials used to treat”, explains EFSA.
A systematic review, released at the end of February 2024, highlighted that resistance of Salmonella and Campylobacter bacteria to commonly used antimicrobials continues to be frequently observed in both animals and humans (4).
Sabrina Bergamini
Note
(1) Antimicrobial consumption and resistance in bacteria from humans and food-producing animals https://www.efsa.europa.eu/en/efsajournal/pub/8589
(2) Fourth joint inter-agency report on integrated analysis of antimicrobial consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the European Union (JIACRA IV – 2019–2021) https://www.efsa.europa.eu/it/node/18280
(3) Dario Dongo, Sabrina Bergamini. Antibiotic resistance, the silent pandemic. Egalité. 15.12.23
(4) Continued efforts needed to fight antimicrobial resistance (AMR) in humans and animals https://www.efsa.europa.eu/en/news/continued-efforts-needed-fight-antimicrobial-resistance-amr-humans-and-animals
