Indicators developed to measure EU progress on tackling antibiotic resistance

A set of outcome indicators has been developed to help EU member states monitor their progress in combatting antimicrobial resistance^[1]
.

The indicators, which are the result of collaboration between the European Food Safety Authority, European Medicines Agency and European Centre for Disease Prevention and Control, cover antibiotic consumption and resistance for both humans and animals. The indicators are divided into primary and secondary categories. Primary indicators broadly reflect the situation around antimicrobial consumption and resistance, and secondary indicators have been designed to provide information on more specific issues.

For human antibiotic use, the primary recommended indicator is total consumption of antibacterial medicines for systemic use — in hospitals and the community — measured by defined daily doses per 1,000 inhabitants and per day.

The first secondary indicator is the ratio of use of broad-spectrum penicillins, cephalosporins, macrolides and fluoroquinolones to use of narrow-spectrum penicillins, cephalosporins and erythromycin, in the community. The second is the proportion of total hospital consumption of glycopeptides, third and fourth generation cephalosporins, monobactams, carbapenems, fluoroquinolones, polymyxins, piperacillin and enzyme inhibitor, linezolid, tedizolid and daptomycin.

For monitoring antibiotic resistance, the joint scientific opinion recommends the primary indicator to be the proportion of methicillin-resistant Staphylococcus aureus (MRSA) and third generation cephalosporin-resistant Escherichia coli — both pathogens are described as being of ‘major public health importance’.

The first secondary indicator is the proportion of Klebsiella pneumoniae with combined resistance to aminoglycosides, fluoroquinolones and third-generation cephalosporins. The second is the proportion of penicillin-resistant and macrolide-resistant Streptococcus pneumoniae, to cover issues seen in both hospital and the community.

Data on the proportion of the emerging threat of carbapenem-resistant K. pneumoniae, should also be used to monitor efforts to tackle resistance, the recommendations state.

Other recommendations cover antibiotics used in food–producing animals including the proportion of E. coli bacteria from food-producing animals that are susceptible or resistant to a number of antimicrobials.

Vytenis Andriukaitis, the European commissioner for health and food safety, said that back in June 2017, when he presented the new EU Action plan on antimicrobial resistance, he had promised that they would define how progress would be measured.

“Without these indicators, we would not be able to assess our progress in tackling the serious health threat posed by [antimicrobial resistance].

“The indicators, presented in the form of a scientific opinion, are the result of close cooperation between the three EU agencies, each drawing on their specific expertise and data from monitoring of antimicrobial resistance and antimicrobial consumption in animals and humans,” he added.

Figures released in October 2017 show sales of antibiotics for use in animals in the UK have fallen to their lowest level since records began, exceeding a government target two years early.

It is estimated that antimicrobial resistance accounts for over 25,000 deaths per year in the EU and over 1.5 billion euros in healthcare costs and loss of productivity.