Pierre-Alexandre Beloeil (EFSA), on behalf of the JIACRA expert working group Vienna, 18 November 2015

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Consumption and Resistance Analysis (JIACRA) BACKGRUN escription of existing monitoring/surveillance systems 2011 and

1 Integrated Analysis of ata on Resistance and Consumption from the uman and Animal ectors in urope - he JIACRA Report Pierre-Alexandre Beloeil (FA), on behalf of the JIACRA expert working group Vienna, 18 November 2015 Joint Interagency Consumption and Resistance Analysis (JIACRA) BACKGRUN escription of existing monitoring/surveillance systems 2011 and 2012 data from the U s, I, N and C atasets used have been collected for purposes that were not a priori an integrated analysis 1

Joint Interagency Consumption and Resistance Analysis (JIACRA) Resistance in almonella, C. jejuni and C. coli, indicator.

2 Joint Interagency Consumption and Resistance Analysis (JIACRA) ata on ales of Veterinary s at package level All food-producing animal species ata not available by animal species Normalised data for the animal population that can be subjected to treatment armonised collection of data Joint Interagency Consumption and Resistance Analysis (JIACRA) Resistance in almonella, C. jejuni and C. coli, indicator. coli and enterococci armonised set of antimicrobials and protocols CFFs used to interpret resistance onitoring performed on a voluntary basis in indicator bacteria 2

Joint Interagency Consumption and Resistance Analysis (JIACRA) AC-Net o o Consumption data from the community (primary care) and from hospitals ata collected at the package level AR-Net o o Invasive

3 Joint Interagency Consumption and Resistance Analysis (JIACRA) AC-Net o o Consumption data from the community (primary care) and from hospitals ata collected at the package level AR-Net o o Invasive isolates from bloodstream infections (BIs) in Including. coli FW-Net o o Clinical A of almonella and Campylobacter from Clinical breakpoints Joint Interagency Consumption and Resistance Analysis (JIACRA) 3

4 Joint Interagency Consumption and Resistance Analysis (JIACRA) Joint Interagency Consumption and Resistance Analysis (JIACRA) 4

5 Joint Interagency Consumption and Resistance Analysis (JIACRA) Joint Interagency Consumption and Resistance Analysis (JIACRA) RPRING CNUPIN IN UAN /1000 inhabitants/day vs. mg/kg estimated biomass pearman s rank correlation: rho = 0.87; p-value<

6 Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F ANIICRBIAL CNUPIN AN RIANC IN ANIAL ummary indicator of Cattle Pigs Poultry All animal species addressed together Uneven use of substances among animal species ale ata at National Level (mg/pcu) Consumption data ther species Comparison Cattle Pigs Poultry Weighting according to PCU Resistance ata at National Level Resistance data ther species Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F ANIICRBIAL CNUPIN AN RIANC IN ANIAL consumption (mg/estimated biomass) vs. summary indicator of Resistance ummary indicators of resistance Combining two or three animal species: Broilers/ Pigs / Cattle o Weighted mean of Resistance per species o PCU: weight to allow comparability between consumption data o Implicit Assumption: xcretion proportional to estimated biomass 6

7 Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F ANIICRBIAL CNUPIN AN RIANC odeling and Graphical Comparisons odeling the probability of resistance and consumption Logistic regression accounts for the true nature of data o Grouped data: group=country o verdispersion o mall sample sizes: profile likelihood CLs o Proclogistic using A software ensitivity analysis to influential points Joint Interagency Consumption and Resistance Analysis (JIACRA) 7

8 Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F CNUPIN IN UAN AN F-PRUCING ANIAL onnages of Active ubstances and stimated Biomass In 2012, in the 26 U/A countries, the amounts of active substance of antimicrobials sold equalled: tonnes in tonnes in food-producing stimated biomass, expressed as 1000 tonnes: for for Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F CNUPIN IN UAN AN F-PRUCING ANIAL otal 2012 (expressed in mg/kg of estimated biomass) In umans mg/kg (range: mg/kg) In Animals mg/kg (range: mg/kg) 8

CNUPIN IN UAN AN F-PRUCING ANIAL Comparison of Biomass-Corrected Consumption of s (milligrams per kilogram estimated biomass) in and by country in 26 U/A countries in 2012 Joint Interagency

9 CNUPIN IN UAN AN F-PRUCING ANIAL Comparison of Biomass-Corrected Consumption of s (milligrams per kilogram estimated biomass) in and by country in 26 U/A countries in 2012 Joint Interagency Consumption and Resistance Analysis (JIACRA) Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F CNUPIN IN UAN AN F-PRUCING ANIAL elected antimicrobial classes - 26 U/A countries in 2012 ighest elling Classes o In human medicine: Pen, acro, FQ o In food-producing : et, Pen, u 9

10 Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F CNUPIN IN UAN AN F-PRUCING ANIAL 3 rd -and 4 th -generation cephalosporins -26 U/A countries in 2012 Consumption of 3 rd - and 4 th -generation cephalosporins much lower for than for Population corrected consumption of fluoroquinolonesin and foodproducing by country in 26 U/A countries in 2012 Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F CNUPIN IN UAN AN F-PRUCING ANIAL In most countries, the consumption of fluoroquinolones was lower for than for, but there was more variation between countries than for cephalosporins. 10

11 Joint Interagency Consumption and Resistance Analysis (JIACRA) Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F ANIICRBIAL CNUPIN AN RIANC IN UAN Positive association between total consumption of 3 rd - and 4 th -generation cephalosporins and occurrence of resistance to 3 rd -generation cephalosporins in.coli from human BIs Positive association between total consumption of fluoroquinolones and occurrence of fluoroquinolone. coli from human BIs No association between consumption of fluoroquinolones and the occurrence of fluoroquinolone almonella spp.,. nteritidis and. yphimurium from cases of human infection 11

12 Joint Interagency Consumption and Resistance Analysis (JIACRA) Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F ANIICRBIAL CNUPIN AN RIANC IN ANIAL Bacteria class P-value Indicator. coli etracyclines < rd gen. cephalosporins <0.05 Fluoroquinolones <0.05 Fluoroquinolones & quinolones <0.05 C. jejuni and C. coli etracyclines C. jejuni: <0.05 acrolides C. jejuni: C. coli: <0.05 <0.05 Fluoroquinolones C. jejuni: <0.05 Fluoroquinolones & quinolones C. jejuni: <0.05 almonella spp. etracyclines < rd gen. cephalosporins <0.05 Fluoroquinolones N Fluoroquinolones and other quinolones <

13 Joint Interagency Consumption and Resistance Analysis (JIACRA) CPARIN F ANIICRBIAL CNUPIN AN RIANC IN ANIAL A. B. C. Indicator. coli A. ales of Resistance to B. ales of CP Resistance to CX C. ales of FQ and Q Resistance to CIP Joint Interagency Consumption and Resistance Analysis (JIACRA) 13

14 Joint Interagency Consumption and Resistance Analysis (JIACRA) For both cephalosporins and fluoroquinolones, positive associations found between occurrence of indicator. coli from food-producing and occurrence of. coli from. Resistance in. coli causing bloodstream infections in could be correlated with usage of antimicrobials in food-producing and in. Joint Interagency Consumption and Resistance Analysis (JIACRA) CNUPIN AN RIANC : ANIAL UAN No associations between consumption of 3 rd - and 4 th - generation cephalosporinsin food-producing and occurrence of resistance to this sub-class in selected bacteria from. Positive associations for consumption of fluoroquinolones in food-producing and occurrence of. coli from, but not for almonella spp. and Campylobacter spp. Positive associations for consumption of macrolides in food-producing and the occurrence of Campylobacter spp. from human cases of infection. Positive associations for consumption of tetracyclines in food-producing and the occurrence of almonella spp. and Campylobacter spp. from. 14

15 Joint Interagency Consumption and Resistance Analysis (JIACRA) LIIAIN ata on antimicrobial food-producing are not available by species ifferences in systems for collection and reporting of data on antimicrobial consumption and bacteria from and have limited the potential for direct comparison cological analyses = hypotheses generating study ue to characteristics of data, interpretation criteria, and units of measurement, results should be interpreted with caution! Joint Interagency Consumption and Resistance Analysis (JIACRA) CNCLUIN arked variations between countries both in the overall consumption figures and for consumption of the 3 rd - and 4 th -generation cephalosporins and fluoroquinolones Associations between consumption of selected antimicrobials and the occurrence of bacteria frequently observed pidemiology of resistance is complex, and several factors aside from antimicrobial consumption influence the occurrence of resistance 15

16 Joint Interagency Consumption and Resistance Analysis (JIACRA) ICUIN PIN FR FUUR ANALY o improve integrated analyses, more detailed and comprehensive data are required Factors, such as Consumption ata per animal species Resistance ata from all countries, in relevant animal species and food at a detailed level would be required. ther factors that would have to be considered are: Resistance to other antimicrobials (co-selection phenomenon) ravel Imports of meat Joint Interagency Consumption and Resistance Analysis (JIACRA) AR: A PUBLIC AL PRIRIY IN URP! U Action Plan: 7 areas -12 actions uman Veterinary 1. Appropriate use 4. Prevention of infections 6. evelopment new antibiotics 9. urveillance 8. International cooperation 11. Research & Innovation 12. Communication, education 2 & 3. Appropriate use 5. Prevention of infections 7. Need for new antibiotics? 10. urveillance 16

Joint Interagency Consumption and Resistance Analysis (JIACRA) ACKNWLGN U ember tates and other reporting countries he urveillance/onitoring Networks involved o AR-Net, AC-Net and FW-Net o cientific

17 Joint Interagency Consumption and Resistance Analysis (JIACRA) ACKNWLGN U ember tates and other reporting countries he urveillance/onitoring Networks involved o AR-Net, AC-Net and FW-Net o cientific Network for Zoonosis onitoring ata o VAC Joint Interagency Consumption and Resistance Analysis (JIACRA) hank you for your attention! A ument_library/report/2015/01/wc pdf FA oc/4006.pdf CC ations/antimicrobial-resistance-jiacrareport.pdf 17

Integrated Analysis of Data on Resistance and Antimicrobial Consumption from the Human and Animal Sectors in Europe The JIACRA Report

Integrated Analysis of Data on Resistance and Consumption from the Human and Animal Sectors in Europe The JIACRA Report Pierre-Alexandre Beloeil (EFSA), on behalf of the JIACRA expert working group BfR-Symposium