Antimicrobial resistance can spread from country to country through the movement of people and animals or when food, feed and other possible vehicles of antimicrobial resistance are traded. Therefore, it is necessary to coordinate efforts at European and global level.

It is an important global economic and social concern that cannot be successfully tackled by way of isolated, sectoral efforts. Instead, an active and holistic risk-based approach in line with the “One Health” initiative is demanded. It involves cross-sectoral cooperation (human and veterinary medicine, agriculture, environment and trade) at national and international level.


In 1999, with the emergence of strong concerns about the increase in the risks for health arising from antimicrobial resistance, the European Commission imposed a ban on the use of certain antimicrobial agents to increase the weight gain. 

As from 1st January 2006, by Regulation (EC) No. 1831/2003, the European Union banned the use of the remaining antimicrobials used as growth promoters in animals.  

Action plan against the rising threats from Antimicrobial Resistance (2011 – 2016)

In 2011, the Commission launched a 5-year Action Plan intended to face the rising threats from antimicrobial resistance. It is based on a holistic approach in line with the “One Health” initiative, involves all sectors and covers all aspects of antimicrobial resistance. First, the plan aims at reinforcing the prevention and control of antimicrobial resistance in the human, veterinary and food sector. It also intends to ensure the availability of antimicrobial agents and to extend their effectiveness. It consists of 12 specific actions to be taken in the human and/or veterinary sector, including 7 areas where the measures below are most needed:

  1. Promotion of the proper use of antimicrobials;  
  2. prevention of microbial infections and their spread;
  3. development of new antimicrobials or effective alternatives for treatment;  
  4. cooperation with international partners to contain the risks of spread of antimicrobial resistance as a result of trade activities, international travels and environmental pollution;
  5. improvement of the monitoring and surveillance of antimicrobial resistance and consumption of antimicrobials in human and veterinary medicine;  
  6. promotion of research and innovation;
  7. improvement of communication, education and training.

The concrete initiatives aimed at implementing the actions of the Plan include:

  • the proposals of the new Regulations of the European Parliament and the Council concerning veterinary medicines and medicated feed (Action 2 – “Strengthen the regulatory framework on veterinary medicines and on medicated feed”);
  • the Guidelines on the prudent use of antimicrobial agents in veterinary medicine developed and published by the European Commission in accordance with Action 3 “Introduce recommendations for prudent use of antimicrobial agents in veterinary medicine”;
  • the implementing decision of the Commission No. 652 of 12 November 2013 establishing harmonized monitoring and reporting methods on antimicrobial resistance of zoonotic bacteria (i.e. bacteria causing diseases and/or infections that can be transmitted naturally, directly or indirectly between animals and humans – zoonotic diseases) and commensals. This is to provide a larger and more representative comparability of the information, obtained at European level, on the data from the main chains of animal origin – poultry, cattle and pigs (Action 10 “Strengthen surveillance systems on AMR and antimicrobial consumption in animal medicine”). The results of the first year of implementation of the decision on the Italian territory are included in the Report.   

The results obtained by all 28 Member States are processed and published on the EFSA website in a summary report on the trends and the sources of zoonoses, zoonotic agents and antimicrobial resistance.  

Please consult:

  1. data of 2013 published in 2015
  2. data of 2014 published in 2016

The AWP (Antimicrobials Working Party) is based at the EMA. This group, consisting of a pool of European experts on antimicrobial resistance, provides advice to the Committee for Medicinal Products for Veterinary Use (CVMP) on the use and authorization of antimicrobials and provides recommendations on the development of guidelines on AMR.

Strengthening the data collection system relating to antimicrobial consumption, both in human and veterinary medicine, is a fundamental condition for the fight against antimicrobial resistance.

For this reason, the European Commission asked the EMA to develop an approach for the collection and reporting of standardized and harmonized data on the use of veterinary antimicrobial agents, based on national sales data. Italy has participated in this project since 2010.

The EMA has also developed a new interactive database, accessible to operators and to all citizens, which allows them to get informed on the sales data per specific countries or per specific classes of antimicrobials, as well as to create graphs or custom-made maps.


EFSA

EFSA is also involved in the surveillance of antimicrobial resistance. It monitors and analyses the situation concerning antimicrobial resistance of zoonotic bacteria and commensals isolated from food and animals throughout Europe, and provides independent scientific support and advice to risk managers on the risks to human and animal health related to the possible emergence, spread and transfer of antimicrobial resistance in the food chain and in animal populations.

Data on the zoonoses situation are sent annually to EFSA, which aggregates them in an annual summary report of the European Union, both as Community Summary Reports and single National Annual Reports.

Please consult the reports.

Moreover, since 2011, EFSA prepares an annual report on the zoonoses, food-borne outbreaks and antimicrobial resistance in cooperation with ECDC. This shows the evolution of the European situation by also presenting data on the resistance of zoonotic bacteria isolated from humans.

ECDC

ECDC is a European Agency founded in 2005 with the purpose of identifying, assessing and communicating the risks for public health arising from all infectious diseases, both known and emerging, including those caused by zoonotic agents. The European network for the Surveillance of Human Gastrointestinal Infections caused by SalmonellaCampylobacter and E. Coli Verocitotossici (Enter-Net), as well as the European Antimicrobial Resistance Surveillance System (EARSS) that annually monitors the levels of antimicrobial resistance in 7 indicator microorganisms causing human infections (Streptococcus pneumoniteStaphylococcus aureusEnterococcus faecalisEnterococcus faeciumEscherichia coliKlebsiella pneumoniaPseudomonas auruginosa) refer to ECDC.

Please consult:


OIE has dedicated a specific section of its Terrestrial Animal Health Code on the prudent and responsible use of antimicrobials in the veterinary sector, describing all obligations that each single operator of the veterinary medicine supply chain (from the pre-authorization to the final consumer)  is required to meet.  

Moreover, the Manual of Diagnostic Tests and Vaccines for Terrestrial Animals includes a section on the laboratory methodologies for determining antimicrobial resistance (Part 3 – “Laboratory methodologies for bacterial antimicrobial susceptibility testing”).

OMS

OMS has developed a Global Action Plan (Global Action Plan for antimicrobial resistance) to combat antimicrobial resistance with the purpose of ensuring, for as long as possible, the continuity of  successful therapeutic treatments and the prevention of infectious diseases with effective and safe medicinal products of guaranteed quality, used responsibly and accessible to all those who need them.  

It identifies 5 strategic objectives:

  1. improving awareness and understanding of antimicrobial resistance through public communication programmes and the appropriate training of healthcare staff;
  2. strengthening the knowledge through the continuous and careful surveillance of the phenomenon in order to ascertain its spread and evolution and to identify quickly appropriate corrective measures;
  3. reducing the incidence of infections through prevention measures in order to contain the use of antimicrobials;
  4. optimizing the use of antimicrobial medicines;
  5. increasing investments in new medicines, diagnostic tools and vaccines, taking into account the needs of all countries.

Data di pubblicazione: 19 gennaio 2017, ultimo aggiornamento 19 gennaio 2017

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