Analysis of antimicrobial consumption and resistance ('JIACRA' reports)

The European Medicines Agency (EMA) works closely with the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) to analyse the potential relationship between the consumption of antimicrobials by humans and animals and the occurrence of antimicrobial resistance.

The European Union (EU) agencies deliver their findings in joint inter-agency antimicrobial consumption and resistance analysis (JIACRA) reports.

The JIACRA reports analyse data from humans and food-producing animals from the agencies' five EU-wide monitoring networks to better understand the occurrence of antimicrobial resistance across Europe and any trends occurring, providing valuable insights for policy-makers across the EU.

This reflects the European Commission's 'One Health' approach to antimicrobial resistance, by addressing the human and veterinary sectors together in a holistic and coordinated approach.

The reports focus on particular combinations of antimicrobials and bacterial species considered important for public health.

Report on 2019-21 (JIACRA IV)

The fourth JIACRA report presents data from the three agencies mainly collected between 2019 and 2021.

Highlights include:

• Antimicrobial resistance has decreased in countries that have reduced the use of antibiotics in both humans and animals
• The susceptibility of E. coli to antimicrobials in humans and animals increases when there is an overall decrease in the consumption of antibiotics
• In humans, the use of carbapenems, 3^rd- and 4^th-generation cephalosporins, and quinolones is associated with resistance to these classes of antibiotics in E. coli infections
• In food-producing animals, the use of quinolones, polymyxins, aminopenicillins and tetracyclines is associated with resistance to these antibiotics in E. coli infections in food- animals
• There is a link between bacterial resistance in humans and food-producing animals for certain bacterial species, such as Campylobacter jejuni and Campylobacter coli.

This report includes a multi-agency analysis of trends in antimicrobial use and resistance in E. coli for both humans and animals, for the first time.

In line with the 'One Health' approach, the agencies call for:

• continued efforts to tackle antimicrobial resistance at national EU and global levels;
• harmonised surveillance of antibiotic use and antimicrobial resistance in the human and animal sectors;
• further research in the field of antimicrobial resistance.

The full report and a simplified version became available in February 2024.

EMA/ECDC/EFSA fourth joint report on the integrated analysis of the antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA (JIACRA IV)

Simplified summary - EMA/ECDC/EFSA fourth joint report on the integrated analysis of the antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA (JIACRA IV)

Report on 2016–18 (JIACRA III)

The third JIACRA report presents data from the agencies' monitoring networks from 2016-18.

It highlights that:

• the use of antibiotics has decreased and was lower in food-producing animals than in humans;
• the use of a class of antibiotics called polymyxins (which includes colistin), which are increasingly used in hospitals to treat multidrug-resistant infections, nearly halved in food-producing animals;
• important differences remain across the EU in the use of antibiotics by country and by antibiotic class;
• aminopenicillins, third- and fourth-generation cephalosporins and quinolones (fluoroquinolones and other quinolones) were used more in humans than in food-producing animals, while polymyxins (colistin) and tetracyclines were used more in food-producing animals than in humans;
• the use of carbapenems, third- and fourth-generation cephalosporins and quinolones (fluoroquinolones and other quinolones) in humans is associated with resistance to these antibiotics in Escherichia coli infections in humans. Similar associations were found for food-producing animals;
• there are links between antimicrobial consumption in animals and antimicrobial resistance in bacteria from food-producing animals, which in turn is associated with antimicrobial resistance in bacteria from humans. For example, associations were found between resistance to Campylobacter spp. bacteria in food-producing animals and in humans.

The results presented in this report suggest that measures taken at country level to reduce the use of antibiotics are proving to be effective.

The agencies call for continued efforts to tackle antimicrobial resistance at national, EU and global level across the healthcare sectors.

The agencies delivered the third JIACRA report in June 2021.
 

EMA/ECDC/EFSA third joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals (JIACRA III)

Report on 2013–15 (JIACRA II)

The second JIACRA report presents data from the agencies' monitoring networks from 2013–15 and reflects improved surveillance across Europe.

It highlights that:

• important differences remain across the EU in the use of antibiotics in animals and humans;
• overall antibiotic use in food-producing animals was higher than in humans, although this varies across countries;
• a class of antibiotics called polymyxins (which includes colistin), which are increasingly used in hospitals to treat multidrug-resistant infections, were widely used in the veterinary sector;
• third- and fourth-generation cephalosporins and quinolones, which are considered critically important for human health, were more often used in humans. In addition, their use to treat infections caused by E. coli and other bacteria in humans is associated with resistance to these antibiotics in E. coli found in humans;
• resistance to quinolones, used to treat salmonellosis and campylobacteriosis, in humans is associated with their use in animals.

The report emphasises the need to promote responsible use of antibiotics in both humans and animals.

In addition, the three agencies recommend further research to understand better how use of antibiotics and resistance affect one another.

The agencies published the second JIACRA report in July 2017.

ECDC/EFSA/EMA second joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals

Reference Number: 10.2903/j.efsa.2017.4872

Report on 2011-12 (JIACRA I)

The first JIACRA report presents data from the agencies' monitoring networks from 2011-12.

This was the first time that data from humans and food animals in Europe were analysed together.

It highlighted:

• important differences across the EU in the use of antibiotics in animals and humans;
• that the use of certain antimicrobials in animals and humans is associated with resistance to these antimicrobials;
• higher consumption of several antimicrobials extensively used in animal husbandry in animals than in humans;
• higher consumption of antimicrobials critically important for human medicine, such as third- and fourth-generation cephalosporins, in humans;
• a positive association between antimicrobial consumption in animals and resistance in bacteria from humans.

The agencies published the first JIACRA report in January 2015.

ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals - Joint interagency ant...

Reference Number: 636088/2013 Summary:

Joint Interagency Antimicrobial Consumption and Resistance Analysis (JIACRA) Report

Agencies' monitoring networks

The EU agencies monitor data collected by the EU Member States, European Economic Area Member States and Switzerland. This is a way to pool data from different countries so it can be monitored and analysed together, to provide a Europe-wide overview.

This work involves setting up data-collection networks across the Member States and sometimes dedicated IT systems, and agreeing methodologies to harmonise data collection so it can be compared across several countries.

ECDC monitors human consumption of antimicrobials through the European Antimicrobial Resistance Surveillance Network (EARS-Net) and antimicrobial resistance in bacteria found in humans through the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and the Food-and-Waterborne Diseases and Zoonoses Network (FWD-Net).

EMA monitors animal consumption of antimicrobials through the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC).

EFSA monitors antimicrobial resistance in bacteria found in food-producing animals, and in food for humans, through the Scientific Network for Zoonosis Monitoring Data.

Outcome indicators

EMA, EFSA and ECDC have developed a list of harmonised outcome indicators to enable Member States to assess their progress in reducing the use of antimicrobials and combatting antimicrobial resistance.

The indicators address both the human and animal sectors and they reflect antimicrobial consumption and antimicrobial resistance in the community, in hospitals and in food-producing animals.

The indicators are based on data gathered through the agencies' monitoring networks.

The agencies published the list of indicators in October 2017:

• ECDC, EFSA and EMA joint scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals

  ECDC, EFSA and EMA joint scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals

  ECDC, EFSA and EMA joint scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals

  ECDC, EFSA and EMA joint scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals

  ECDC, EFSA and EMA joint scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals

  ECDC, EFSA and EMA joint scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals

For more information, see:

• Request for a joint ECDC, EFSA and EMA scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food producing animals
• Annex to the request for a joint ECDC, EFSA and EMA scientific opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animal...