Update of EFSA€¦ · 12th EURL-AR Workshop 2018 5 April 2018, 10:00 – 18:00 Kgs. Lyngby, Denmark Update of EFSA P. -A. Beloeil BIOCONTAM Unit

12th EURL-AR Workshop 2018 5 April 2018, 10:00 – 18:00 Kgs. Lyngby, Denmark

Update of EFSA

P.-A. Beloeil BIOCONTAM Unit

2

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

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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


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


CONSUMPTION VS. RESISTANCE TO (FLUORO)QUINOLONES


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)



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


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


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”


13

OUTLINE

JIACRA II project





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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)


Primary indicator

• Consumption of all antimicrobials for systemic use (in DDD/1,000 inhabitants per day)


• 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*


• 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)


Primary indicator

• Proportion of meticillin-resistant Staphylococcus aureus (MRSA) and

• 3rd-generation cephalosporin resistant E. coli (3GCR E. coli).


• 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

16

OUTLINE

JIACRA II project





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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

16

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





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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

Update of EFSA€¦ · 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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