Antimicrobial resistance in animal health: resistance rates level off while sales of antimicrobials continue to fall
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News of 16/11/2016
Resistance to antimicrobials is recognised as a major human and veterinary health problem at the international level. ANSES has long been an active player in the fight against antimicrobial resistance, and every year since 2009 it has organised a science day devoted to this theme, open to all stakeholders. This scientific event, held today at the headquarters of the OIE, is fully in line with the inter-Ministerial approach aiming to strengthen and coordinate efforts to more effectively combat antimicrobial resistance. The event includes an annual review of the work of the Agency and its partners in the field of animal health. The report by the French Agency for Veterinary Medicinal Products entitled "Sales survey of veterinary medicinal products containing antimicrobials in France in 2015", published today, shows a 20.1% decrease in the exposure of animals to antimicrobials in France over the last four years, thus confirming the positive impact of national plans to encourage the rational use of antimicrobials. According to the report by the French Surveillance Network for Antimicrobial Resistance in Pathogenic Bacteria of Animal Origin, 2015 saw a decrease in resistance to third-generation cephalosporins in several sectors, and the levelling out of resistance to fluoroquinolones after several years of decline. However, there was a slight upward trend in resistance to other antimicrobials in almost all the production sectors. This will need to be confirmed before being regarded as significant, but it is a point that warrants vigilance. Efforts should therefore be continued and all the parties concerned should maintain their mobilisation for the rational use of antimicrobials in veterinary medicine, with the aim of preserving their therapeutic efficacy in animals and humans.
ANSES is today holding its annual scientific conferences dedicated to antimicrobial resistance in animal health, at the headquarters of the World Organisation for Animal Health (OIE). This day of discussions includes presentations of the sales survey of veterinary medicinal products containing antimicrobials in France, carried out by the French Agency for Veterinary Medicinal Products (ANMV), and the 2015 annual report of the French Surveillance Network for Antimicrobial Resistance in Pathogenic Bacteria of Animal Origin (Résapath), coordinated by ANSES's Lyon and Ploufragan laboratories.
Monitoring of sales of antimicrobials in 2014-2015
Monitoring of sales of antimicrobials is one of the important sources of information used for the assessment and management of risks related to antimicrobial resistance. Each year, the ANMV publishes an annual survey.
The end to discounts, rebates and reductions established by the Act on the future of agriculture, food and forestry with effect from 1 January 2015 led to the players involved in veterinary medicinal product distribution and/or prescription accumulating stocks of drugs, which makes it difficult to interpret the various indicators of antimicrobial sales for the two years 2014 and 2015. The sales and exposure indicators calculated in the report published today therefore took into account the average of the data for the years 2014 and 2015.
A fall in the exposure of animals observed for all species
Over the years 2014 and 2015, the average total volume of sales was close to 650 tonnes of antimicrobials per year, a decrease of 28.4% compared to 2011. A fall in animal exposure to antimicrobials has been observed for all species compared to 2011 (cattle -9.5%, pigs -24.1%, poultry -22.1%, rabbits -17.8%, cats and dogs -9.5%).
Exposure to fluoroquinolones and newer-generation cephalosporins
Third- and fourth-generation cephalosporins and fluoroquinolones are considered as particularly important in human medicine because they are among the only alternatives for the treatment of certain infectious diseases in humans.
Compared to 2013, the year taken as a reference in the Act on the future of agriculture, food and forestry, exposure to fluoroquinolones and newer-generation cephalosporins has decreased respectively by 22.3% and 21.3%.
2015 report by the French Surveillance Network for Antimicrobial Resistance in Pathogenic Bacteria of Animal Origin
The Résapath network collects antibiogram data on pathogenic bacteria of animal origin isolated from sick animals. It can therefore monitor trends in resistance to antibiotics in pathogenic animal bacteria, detect the emergence of certain antimicrobial resistance phenomena and characterise their molecular mechanisms.
Résapath continued to grow in 2015, and now encompasses 74 member laboratories (69 in 2014). In 2015, 41,298 antibiograms were collected (36,989 in 2014).
Concerning critical antimicrobials, in 2015:
- the highest rates of resistance to third- and fourth-generation cephalosporins are around 6 to 7%. They are found in calves, dogs and cats, and Equidae. In the other species, they are equal to or less than 3%, especially among hens and chickens (2.5%), pigs (2.6%), adult cattle (2.4%) and turkeys (1.2%). A significant decrease is still being observed in hens and chickens, companion animals and, to a lesser extent, calves. For other species, the rate has stabilised at a low level.
- the highest rate of resistance to fluoroquinolones is found in cattle (22%), where it has nonetheless stabilised in contrast to previous years. Conversely, Equidae, hens/chickens and turkeys are consistently the animal species with the lowest rates (5 to 7%).
In general, a trend towards stabilisation was observed in 2015. These results remain positive, but vigilance should be maintained, particularly with regard to fluoroquinolones in poultry.
For the other antimicrobials, 2015 saw an overall slowdown in the evolution of rates of antimicrobial resistance, which until then had been falling. This will need to be confirmed next year before being regarded as significant. However, because it concerns the majority of studied antimicrobials in almost all the sectors, it is therefore a point that warrants vigilance.
Lastly, a general downward trend has been observed in the phenomenon of multidrug resistance (resistance to at least three classes of antimicrobials) over the last few years for all species, except for cattle, in which rates were stable for the 2011-2015 period but rose between 2014 and 2015.
Pursue efforts regarding the prudent and rational use of antimicrobials
In France, many measures have been taken to promote the rational use of antimicrobials (National EcoAntibio Plan 2017 which sets a target of a 25% reduction in five years in the use of antimicrobials in France, raising awareness in many sectors on good practices and the rational use of antimicrobials, Act on the future of agriculture, food and forestry, etc.). The decline in exposure to antimicrobials observed in recent years confirms the positive impact of the various measures taken regarding the rational use of antimicrobials.
In general, ANSES reiterates the recommendations made in its Opinion of 2014 on the assessment of the risks of emergence of antimicrobial resistance associated with patterns of antimicrobial use in the field of animal health. Indeed, better awareness in the sectors and their readiness to engage in the prudent use of antimicrobials led ANSES to recommend the establishment of long-term tools for monitoring practices, by animal species, sector and type of production.
Regarding the control of risk practices in veterinary antimicrobial therapy, ANSES recommends in particular:
- ceasing the use of antimicrobials in prevention,
- reserving the use of newer-generation antimicrobials (cephalosporins and third- and fourth-generation fluoroquinolones) for specific situations to be identified well in advance by sector, and to be strictly supervised,
- favouring the use of narrow-spectrum antimicrobials specifically targeting the bacterium in question.
In addition, ANSES stresses that the fight against antimicrobial resistance also requires the provision of tools to target antimicrobial treatment more effectively, and the development of alternatives to the use of these compounds.
It is also necessary to advance knowledge of the mechanisms of development and dissemination of antimicrobial resistance, the circulation of resistance genes in the environment and in human and animal populations, and the factors leading to different ways of using antimicrobials and their impact on antimicrobial resistance.
Special focus on colistin
The article published in November 2015 describing the first plasmid-mediated mechanism of resistance to colistin led to the establishment of reinforced surveillance for this antimicrobial. After increasing until 2007, exposure to colistin changed little between 2008 and 2011, and has been decreasing over the last four years. This exposure has fallen by 25.3% compared to 2011 (all species and routes of administration combined).
For more information
- 2015 sales survey of veterinary medicinal products containing antimicrobials in France (pdf) (Soon in English)
- 2015 report by the network for the surveillance of antimicrobial resistance in pathogenic bacteria of animal origin (pdf) (Soon in English)
- 2015 report on post-MA surveillance of veterinary medicinal products (pdf) (Soon in English)
- Our close-up: Monitoring sales of veterinary antimicrobials