update of efsa€¦ · 12th eurl-ar workshop 2018 5 april 2018, 10:00 – 18:00 kgs. lyngby,...
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12th EURL-AR Workshop 2018 5 April 2018, 10:00 – 18:00 Kgs. Lyngby, Denmark
Update of EFSA
P.-A. Beloeil BIOCONTAM Unit
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OUTLINE
JIACRA II project
Scientific Opinion on Outcome Indicators
2016 EU Summary Report on AMR
New EC Mandate on AMR monitoring
New EC Mandate on WGS
3
Considerable variations between countries and between the human and animal sectors
OVERALL ANTIMICROBIAL CONSUMPTION IN THE ANIMAL AND HUMAN SECTORS
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
*Only community consumption was provided for human medicine
» Several countries have reduced their consumption substantially, in particular in the animal sector.
» Indicates that there is an obvious potential for reduction in other countries, particularly among the highest users.
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Consumption of antibacterials for systemic use (ATC group J01) in the community and hospitals, EU/EEA countries, 2015, expressed as DDD per 1 000 inhabitants and per day
CONSIDERABLE VARIATIONS IN CONSUMPTION BETWEEN COUNTRIES WITHIN THE ANIMAL AND HUMAN SECTORS
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
For Austria, Czech Republic, Germany, Iceland and Spain, only community data were reported.
AMC in humans
Spatial distribution of overall sales of all antimicrobials for food-producing animals, in mg/PCU, for 30 countries, 2015
AMC in animals
» For polymyxins, consumption in animals outweighed that reported for humans.
» The consumption of 3rd- and 4th-gen. cephalosporins in humans by far outweighed that reported in animals.
5 How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
No use for animals in Finland, Iceland and Norway
CONSUMPTION OF 3RD- AND 4TH-GENERATION CEPHALOSPORINS (left) AND POLYMYXINS (right)
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Considerable variations between countries in consumption patterns between the human and animal sectors and within the sectors
CONSUMPTION OF FLUOROQUINOLONES
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
CONSUMPTION VS. RESISTANCE TO (FLUORO)QUINOLONES
7 How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
In humans Invasive E. coli, 2015
In food-producing animals* Indicator E. coli, 2014-2015
The dots represent the EU/EEA MSs involved in the analysis.
* The category ‘food-producing animals’ includes broilers, turkeys, pigs and calves for 2014-2015.
Multivariate approach*:
E. coli Fluoroquinolones
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AMC in Hospitals
AMC in Community
AMC in Poultry AMC in Pigs
AMR in Pigs
AMR in Poultry AMR
in Humans
+
+ 0.84 0.22
β = 0.83 p < 0.0001
R2=0.69
0.45 0.71
β = 0.70 p < 0.0001
R2=0.49
0.54 0.61
* Diagram of the PLS-PM of resistance to fluoroquinolones in human invasive E. coli (2014 and 2015) considering resistance to fluoroquinolones in indicator E. coli from animals (pigs 2015 and poultry 2014), consumption of fluoroquinolones and other quinolones in humans (2014–2015 average, expressed in DDD per 1,000 inhabitants and per day), in animals (pigs in 2015 and poultry in 2014, expressed in DDDvet/kg of estimated biomass)
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
9 How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
AMC in Hospitals
AMC in Community
0.52 0.69
0.55 0.66
β = 0.78 p = 0.008
AMC in Poultry AMC in Pigs
AMR in Pigs
AMR in Poultry
AMR in Humans
+
+
β = 0.75 p = 0.01
R2=0.57
R2=0.60
Multivariate approach*:
Salmonella spp.
Fluoroquinolones
* Diagram of the PLS-PM model of resistance to fluoroquinolones in Salmonella spp. from humans (in 2014 and 2015) considering resistance to fluoroquinolones in Salmonella spp. from animals (in pigs in 2015 and in poultry in 2014), consumption of fluoroquinolones and other quinolones in humans (average 2014–2015, expressed in DDD per 1,000 inhabitants and per day), in animals (in pigs in 2015 and in poultry in 2014, expressed in DDDvet/kg of estimated biomass)
COMPLETE SUSCEPTIBILITY IN INDICATOR E. COLI FROM PIGS (2015)
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● Complete susceptibility: susceptibility to all the antimicrobial classes tested of the harmonised panel tested
● North-South gradient
● Extended to:
o Broilers,
o Turkeys and
o Calves
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
OVERALL LINK AMC - COMPLETE SUSCEPTIBILITY INDICATOR E. COLI – FOOD-PRODUCING ANIMALS
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● Statistically-significant negative association between total AMC and complete susceptibility in food-producing animals
» Prudent use should concern all antimicrobial classes consumed
» Complete susceptibility: a potential candidate for an epidemiological indicator (wide ranges in AMC and CS)
2013
2014 - 2015
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
FROM SUMMARY JIACRA II “Overall, this report confirms the positive association between AMC and AMR in both humans and food-producing animals and underlines the need to ensure prudent use so as to reduce the consumption of antimicrobials in both food-producing animals and humans”
12 How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
13
OUTLINE
JIACRA II project
Scientific Opinion on Outcome Indicators
2016 EU Summary Report on AMR
New EC Mandate on AMR monitoring
New EC Mandate on WGS
14
INDICATORS FOR MEASURING PROGRESS MADE IN IMPLEMENTING ACTION PLANS AGAINST AMR (1)
Primary indicator
• Overall sales of veterinary antimicrobials (in mg/PCU)
Secondary indicators
• Sales of 3rd- and 4th-generation cephalosporins (in mg/PCU)
• Sales of quinolones (in mg/PCU), specifying the proportion of fluoroquinolones
• Sales of polymyxins (in mg/PCU)
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
Primary indicator
• Consumption of all antimicrobials for systemic use (in DDD/1,000 inhabitants per day)
Secondary indicators
• Ratio of the consumption of broad-spectrum penicillins, cephalospo-rins1, macrolides and fluoroquinolo-nes to the consumption of narrow-spectrum penicillins, cephalospo-rins2 and macrolides
• Consumption of glycopeptides, 3rd- and 4th-generation cephalosporins, monobactams, carbapenems, fluoroquinolones, polymyxins, piperacillin and enzyme inhibitor, linezolid, tedizolid and daptomycin
AMC in humans
AMC in animals
1 Second- and third-generation cephalosporins 2 First-generation cephalosporins
+
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INDICATORS FOR MEASURING PROGRESS MADE IN IMPLEMENTING ACTION PLANS AGAINST AMR (2)
Primary indicator
• Proportion of E. coli completely susceptible to antimicrobials tested in the EU monitoring*
Secondary indicators
• Proportion of samples containing ESBL-/AmpC-producing E. coli*
• Proportion of E. coli resistant to three or more antimicrobial classes*
• Proportion of E. coli resistant to fluoroquinolones*
* All indicators are weighted for all food-producing animals (broilers, turkeys, pigs, calves)
How antimicrobial consumption and resistance data fusion increases knowledge and situational awareness
Primary indicator
• Proportion of meticillin-resistant Staphylococcus aureus (MRSA) and
• 3rd-generation cephalosporin resistant E. coli (3GCR E. coli).
Secondary indicators
• Proportion of Klebsiella pneumoniae with combined resistance to aminoglycosides, fluoroquinolones and 3rd-generation cephalosporins
• Proportion of penicillin resistant and macrolide resistant Streptococcus pneumoniae
• Proportion of carbapenem-resistant Klebsiella pneumoniae
AMR in bacteria
from Humans
AMR in bacteria
from Animals
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OUTLINE
JIACRA II project
Scientific Opinion on Outcome Indicators
2016 EU Summary Report on AMR
New EC Mandate on AMR monitoring
New EC Mandate on WGS
17
Important resistance to fluoroquinolones (CIP) in Broilers and Turkeys
Very low resistance to C3G (CTX)
Very low co-resistance to CIAs: There are outliers for Broilers!
RESISTANCE TO CIAS IN INDICATOR E. COLI
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Important resistance to fluoroquinolones (CIP) in Broilers and Turkeys
Very low resistance to C3G (CTX)
Very low to no combined resistance to CIAs
RESISTANCE TO CIAs IN SALMONELLA SPP.
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RESISTANCE TO CIA IN CAMPYLOBACTER, 2015-2016
Important resistance to fluoroquinolones (CIP)
Low resistance to Macrolides (ERY)
Low combined resistance to CIAs in poultry: there are outliers for broilers!
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Indicator E. coli from broilers
Decreasing trends in AMR observed in MSs where control programme is in place
TRENDS
Austria Belgium Croatia Denmark
Finland France Germany Hungary
Netherlands Norway Poland Spain
Switzerland
0
25
50
75
100
0
25
50
75
100
0
25
50
75
100
0
25
50
75
100
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
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Year
% R
esis
tan
t is
ola
tes
AMR AMP CIP CTX NAL TET
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North-South gradient
COMPLETE SUSCEPTIBILITY - INDICATOR E. COLI - BROILERS (2016)
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Prevalence (in %)
SPECIFIC MONITORING OF …
ESBL-/AmpC-producing E. coli - 2016
ESBL AmpC ESBL + AmpC
Meat from broilers (27 MSs) 35.9 26.8 2.0
Broilers (27 MSs) 35.4 24.4 2.6
Fattening turkeys (11 MSs) 36.6 7.2 1.7
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ESBL PREVALENCE IN BROILERS (2016)
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15 carbapenemase producers from poultry and its meat in 2 MSs
Routine monitoring of resistance
● Cyprus: 1 isolate from broilers
Specific monitoring: ESBL-/ AmpC-/carbapenemase producing E. coli
● Cyprus: 8 isolates from meat from broilers
Voluntary specific monitoring of carbapenem-producing E. coli
● Romania: 2 isolates from broilers and 1 isolate from broiler meat,
● OXA-48-producing E. coli detected
● Cyprus: 1 isolate from broiler meat, and 1 isolate from broiler.
RESISTANCE TO CARBAPENEMS IN BROILERS 2016
25
OUTLINE
JIACRA II project
Scientific Opinion on Outcome Indicators
2016 EU Summary Report on AMR
New EC Mandate on AMR monitoring
New EC Mandate on WGS
26
EC mandate (1)
EC mandate requesting “Technical support to collect and analyse WGS data in the joint ECDC-EFSA molecular typing database”.
ECDC and EFSA shall evaluate the possible solutions to expand the current ECDC-EFSA molecular database (currently containing PFGE and MLVA) for the analysis, development and management, in collaboration with relevant EURLs, of the WGS data collection system for foodborne pathogens from sources of food, feed, animals and the related environment as well as from human sources for L. monocytogenes, Salmonella and E. coli, at least. (Deadline, April 2019)
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EC mandate (2):
Directive 2003/99/EC Art. 7(3) and 9(1) + Annexes II (B) IV
Decision 2013/652/EU
2014 - 2020
New Decision
2021 - …
EFSA Tech. Spec. on the harmonised monitoring and reporting of AMR in
Salmonella, Campylobacter, indicator commensal E. coli and Enterococcus
spp. transmitted through food
EFSA Tech. Spec. on the harmonised monitoring and reporting of MRSA in
food-producing animals and food
EFSA Tech. Spec. on randomised sampling for harmonised monitoring of AMR in zoonotic and commensal
bacteria
2011-2016 Action Plan against
the rising threats of AMR
June 2017 The European ‘One Health’ Action Plan against AMR
New EFSA Tech. Spec. on the harmonised monitoring of AMR in bacteria transmitted through food
by March 2019
2012
2014
2019
2016 - 2017
Audits of implementation in the MSs performed
by Dir. F of the EC
2019-2020: Drafting of the legislation by the EC
2020: Negotiation EC - MSs
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THANK YOU FOR YOUR ATTENTION