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Questions on antimicrobial resistance

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News of 13/11/2018

Antimicrobial resistance is a major public health issue in France: resistance to antibiotics calls into question the efficacy of treatments for infections occurring in humans and animals alike. At its annual symposium on this issue, ANSES will be presenting the result of its two reports on national trends in resistance in animals (Resapath report) and sales of veterinary antimicrobials. The information gathered in the context of this national monitoring of medicinal product sales is one of the essential elements, together with monitoring of bacterial resistance, needed for assessing the risks associated with antimicrobial resistance. Three of ANSES's directors tell us more about the issues in this area: Jean-Pierre Orand, Director of the French Agency for Veterinary Medicinal Products, Jean-Yves Madec, Scientific Director in charge of Antimicrobial Resistance and Gilles Salvat, Director for Animal Health and Welfare.

In 2016, the overall objective to reduce animal exposure to antimicrobials was achieved, following a 37% reduction in five years. Do the 2017 results for sales of veterinary antimicrobials confirm this progress?

Jean-Pierre Orand: Following the success of the first Ecoantibio plan, the new 2017-2021 plan aims to ensure that the decline in animal exposure to antibiotics is sustained. This exposure has decreased by 3.6% over the last year. Exposure to antimicrobials regarded as critical continued to decline in 2017 for all species, with a fall of 87.8% for fluoroquinolones and 94.2% for newer-generation cephalosporins, compared to 2013. In 2017, exposure to colistin had fallen by 48% compared to the average exposure for 2014 and 2015. All stakeholders need to continue their efforts to achieve the objective of a 50% reduction in exposure to colistin in five years, as set by the new Ecoantibio plan that will run until 2021. These results for 2017 seem to indicate that there is a limited transfer of uses to other classes of antimicrobials, but a threshold effect does seem to have appeared. It will be particularly important in the next few years to monitor these changes in the use of antimicrobials and assess their consequences on the development of bacterial resistance.

With regard to the development of resistance, do the results from Resapath's national monitoring, which were published today, confirm these trends?

Jean-Yves Madec: First of all, remember what Resapath does: it collects antibiogram data on pathogenic bacteria isolated from sick animals. It can therefore monitor changes in resistance to antimicrobials associated with animal infections, detect the emergence of certain antimicrobial resistance phenomena and characterise their molecular mechanisms. This year again, the network recorded a decrease in resistance to critical antibiotics, in particular that of E. coli to third- and fourth-generation cephalosporins. As in recent years, these declines can be observed in all sectors, and are sometimes considerable, as with cattle and dogs, for instance.

The overall decline or stabilisation seen over the past few years continued in 2017. Over the last ten years, the most striking phenomenon is probably the decrease in resistance to tetracycline in the poultry sectors, and to a lesser extent in the pig sector. In addition, over the period 2011-2017, the proportion of multi-resistant bacterial strains fell significantly in all species, except in horses, for which an increase can be observed for the past three years.

These results are consistent with the considerable reductions in animal exposure to antibiotics, in the context of the Ecoantibio plans. Over the last five years, the fall in animal exposure to antimicrobials has contributed to reducing certain percentages of resistance in bacteria isolated from healthy animals at the slaughterhouse. The Ecoantibio 2 plan should enable this reduction in resistance to be consolidated across all antibiotics.

France is the only European country with a network for monitoring resistance. How far does its scope extend?

Jean-Yves Madec: In 36 years of monitoring pathogenic bacteria in France, this network has become an established part of the animal antimicrobial resistance landscape. Its scope has expanded each year; it currently has more than 70 member laboratories and collects over 56,000 antibiograms throughout France. The quality of the data it produces is the result of constant vigilance by the players in effective use of the analytical methods, data collection and transmission, and interpretation of the results in light of the latest scientific knowledge. It therefore represents a combined effort by all involved, and particularly the member laboratories. The major challenge represented by the development of antimicrobial resistance in animal and human bacteria requires an integrated approach across all types of medicine, and Resapath is making a contribution to this vision. As a member of the National Observatory for Epidemiology of Bacterial Resistance to Antimicrobials (ONERBA), the network provides an obvious interface between veterinary and medical data. In Europe, the Resapath network led by ANSES constitutes a unique model in a context where many other Member States are considering the implementation of similar schemes for monitoring their national plans. In this regard, ANSES is using its Resapath network to help promote this model of monitoring resistance, as part of the European Joint Action (EU-JAMRAI) initiated in September 2017 and coordinated by France, which includes a veterinary component.

More generally, what are your recommendations for preserving the effectiveness of antibiotic treatments in animals?

Gilles Salvat: The dynamic for the prudent and responsible use of antimicrobials in veterinary medicine must be maintained. The actions taken by farmers and veterinarians, such as limiting the use of cephalosporins in the swine sector, provision of training modules for farmers, or the drafting of good practice guides, accompanied by the Ecoantibio 2017 plan, have helped achieve the various objectives. Efforts must be sustained, by continuing to support both farmers and veterinarians. These are the objectives of the Ecoantibio 2 plan (2017-2021). The decline in the use of antimicrobials necessarily requires the continued improvement of health control on farms, the development of alternatives to antimicrobials, the study of the economic impact of the recommended measures, and better knowledge of the sociological component of the reliance on antimicrobials. In this respect, ANSES's research programmes, which are firmly focused on animal welfare, will help achieve this.