Consumers, Health, Agriculture and Food Executive Agency

resistance (AMR)The road to more prudent use of antimicrobials and antibiotics

Antimicrobial

Antimicrobial resistance (AMR) is the ability of microorganisms, such as bacteria, to become increasingly resistant to an antimicrobial to which they were previously susceptible. An estimated 25 000 people die in the EU each year from resistant infections – many of which are health-care-associated infections (HCAI). With the rise of AMR comes the threat of common infections becoming fatal. Failing to address this serious health threat could lead to millions of lives being lost each year.

Tackling an urgent health issue One of the biggest health concerns today is the global rise of antimicrobial resistance, which stands to negate the huge benefits that had emerged from the discovery of penicillin and other antibiotics. The impending move to a ‘post-antibiotic era’, in which common infections are once again fatal, could be catastrophic for the people in Europe and beyond.

The new One Health Action Plan against antimicrobial resistance was launched to tackle the challenge, involving many different sectors, from public health, agriculture and food safety to bio-safety and the environment.

Adopted in 2017, the Action Plan against AMR provides added value to Member States in delivering innovative, effective and sustainable responses to the problem, focusing on the appropriate use of antimicrobials for humans and animals, preventing and controlling infection, and increasing the development and availability of new, effective antimicrobials, in addition to other measures to prevent and treat infections and strengthen cooperation with Member States and stakeholders. The aim is to make

the EU a best-practice region, boost research and shape the global agenda on this topic. The European Commission has already adopted the plan’s new guidelines on the prudent use of antimicrobials in human health.

The Commission has also joined forces with the World Health Organisation, the Organisation of Economic Cooperation and Development, the Food and Agriculture Organisation, the World Organisation for Animal Health and other international bodies to help combat AMR.

Safer healthcare meets innovation Three out of the four key priorities of the Third EU Health Programme (2014-2020) are directly related to AMR. The most relevant is the fourth priority on facilitating access to better and safer healthcare for citizens, which clearly calls for ‘Measures to prevent antimicrobial resistance and control healthcare-associated infections’.

The EU is also funding important research and innovation projects that are developing new antibiotics, vaccines and other methods to prevent infection.

Support for combatting AMR also comes from the Programme priority intended to ‘Contribute to innovative, efficient and sustainable health systems’.

The Programme’s second priority, protecting citizens from serious cross-border health threats, is also relevant to AMR, particularly since resistant organisms can be spread across borders though movements of people, animals and food.

The European Centre for Diseases

Prevention and Control has estimated that

in the EU there are about

4.1 million infections in healthcare

settings each year and around 25 000

patient deathsfrom antimicrobial

resistance.

E. Coli resistance to third-generation antibiotics (cephalosporins) by country in Europe, 2014

Source: European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2014. Stockholm: ECDC, 2015 ©European Centre for Disease Prevention and Control, 2015

< 1%

1% to < 5%

5% to < 10%

10% to < 25%

25% to < 50%

≥ 50%

No data reportedor less than 10 isolates

Not included

Liechtenstein

Luxembourg

Malta

Non-visible countries

Europe comes together to combat AMREU-JAMRAI joint action European Joint Action on Antimicrobial resistance and health-care associated infections

Duration 36 months, launched 01/09/2017 EU funding € 4 178 162 Countries AT, BE, BU, CZ, DE, DK, EE, EL, ES, FR,

HR, IT, LT, LV, NL, NO, PL, PT, RO, SE, SI

The overall aim of this joint action is to help Member States develop and implement the EU’s One Health Action Plan against AMR in an effective manner. Current efforts by national, EU-level and global authorities to address AMR and healthcare-associated infections (HCAI) are leading to important recommendations and best practices in the field. However, there is a need to ensure that policies for controlling AMR and HCAI are effectively adopted across EU countries, taking into account national specificities, global regulations and other European initiatives. The EU-JAMRAI project is bringing together different European

More knowledge and a new effort to combat AMRDirect grant agreement formalising the Cooper-ation with OECD for economic burden and health impact of antimicrobial resistance

Duration 24 months, launched 1/01/2016 EU funding € 340 000

A project is focusing on estimating the economic bur-den caused by AMR and the effectiveness and efficiency of actions aimed at tackling AMR. The project aims to turn current know ledge into clinical practice and effec-tive public health policies to tackle antimicrobial re-sistance in people. One of the main outcomes will be hard evidence on the expected relative effectiveness and cost-effectiveness of policies aimed at tackling re-sistance in humans. The project findings will guide the policy-making process through a var iety of channels.

The project results will make a substantial contribution to the current knowledge on antimicrobial resistance

control, a scientific field that remains understud-ied. The economic model itself is available

to academics and stakeholders. End users will be able to run the model

with their own inputs, and conduct alternative or complementary

analyses to help individual EU countries tackle antimicrobial resistance.

and global networks of policy makers, experts and organisations related to AMR and HCAI to achieve this aim.

The joint action is producing guidelines and tools that enable EU Member States to improve the management of AMR and HCAI at national and local levels, considering hospitals, long-term care practitioners and community representatives. These efforts involve evidence-based tools and capacity-building, along with training and organisational change.

EU-WHO join hands to tackle the threat of AMRDirect grant agreement formalising the Coopera-tion with WHO

Duration 21 months, launched 10/05/2016 EU funding € 750 000 Increased antibiotic consumption may be related to inappropriate prescriptions from doctors, patients’ non-adherence to prescriptions and the availability of ‘over-the-counter’ antibiotics. Use of antibiotics in livestock is also widespread, both to treat and prevent infections, and as animal growth promoters. The rationalisation of antibiotics via stewardship programmes is crucial to help reduce the consumption rate. This includes targeted prescribing, the development of rapid diagnostic tests and widely available surveillance data.

The project is focused on two specific objectives, namely describing policies in use to contain AMR in human health, and understanding the contexts in which they work and present the evidence.

In addition, the project will work on a book on AMR, to be published jointly with the Commission and the OECD. The book will take stock of the state of knowledge re-garding the effectiveness and cost-effectiveness of actions aimed at tackling AMR, present good practices, and discuss the adoption of good practices at national level and their transfer to other EU countries.

The Dutch lead efforts in combating AMR and enforcing multi-sectoral collaboration Ministerial Conference on Antimicrobial resistance under the Dutch EU Presidency

Duration Conference 9-10 February, 2016 EU funding € 100 000 Countries EU Member States plus CH, NO

The Netherlands held the Presidency of the Council of the European Union during the first half of 2016. The Ministe-rial Conference on Antimicrobial Resistance under the Dutch Presidency was one of the most important events in the health area during the Presidency. Sixteen European Minis-ters or Vice-Ministers of Health and of Agriculture partici-pated in this event.

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Find out more

European Centre for Disease Prevention and Control (ECDC)https://ecdc.europa.eu/en/antimicrobial-resistance

Directorate-General for Health and Food safety of the European Commission (DG SANTE)https://ec.europa.eu/info/departments/health-and-food-safety_en

Consumers, Health, Agriculture and Food Executive Agency (Chafea)http://ec.europa.eu/chafea/index.html

Database of actions co-funded under the EU Health Programmeshttp://ec.europa.eu/chafea/projects/database.html

Discussions focused on identifying progress in tackling AMR and further actions required to do so. Beyond obtaining the ministers’ commitment to the One Health National Action Plans, the conference proposed other EU action plans, an EU One Health Network on AMR and a joint approach for dealing with international bodies outside the EU. Stronger legislation on antibiotic use in animals was also discussed, as was how Europe could set an example for the rest of the world.

Prudent antibiotics prescription for childrenARPEC project Antibiotic Resistance and Prescribing in European Children

Duration 40 months, launched 01/09/2010 EU funding € 683 048 Countries BE, DE, EE, EL, ES, IT, LT, NL, PT, SI, UK

Children are often prescribed antibiotics unnecessarily, increasing the risk of antimicrobial resistance at an early age. The EU-funded ARPEC project focused on improving the quality of prescribing by paediatricians in training, and in clinical practice across Europe. One of the project activities was a survey on antimicrobial prescription

databases and analysed antibiotic resistance data for children. The project also conducted two studies involving hundreds of hospitals and thousands of children from 41 countries to identify the rate of antimicrobial resistance across Europe.

The project also developed an online training programme on prescribing antibiotics.

The project’s work confirms that children receive too many broad-spectrum antibiotics, raising the risk of antimicrobial resistance.

Pictures ©iStock, 2018