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 occurance 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.
The agencies published the second JIACRA report in July 2017. It presents data from the agencies' monitoring networks from 2013–15 and reflects improved surveillance across Europe:
- 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 (JIACRA II)
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 is 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, are widely used in the veterinary sector;
- third- and fourth-generation cephalosporins and quinolones, which are considered critically important for human health, are 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 first JIACRA report in January 2015, presenting data from their monitoring networks from 2011-12:
- 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 (JIACRA I)
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 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.
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:
- 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
For more information, see: