Every year, on the occasion of the European Antibiotic Awareness Day on 18 November, the actors involved in the prevention of bacterial resistance to antibiotics (or antimicrobial resistance) publish a report on the consumption of antibiotics and antibiotic resistance, in human and animal health and in the environment in France.
This summary puts into perspective the consumption of antibiotics in human and animal health and their evolution. Thus, we observe at the same time a steady decrease in prescriptions for human health and a reduction in the exposure of animals to antibiotics. In human health as in animal health, the indicators of consumption of critical antibiotics are down.
Regarding the resistance of bacteria to antibiotics, the common indicator of the resistance of Escherichia coli strains to cephalosporins is decreasing, in human health, in the city, in establishments for dependent elderly people and in health establishments as well as in health animal.
Actions to prevent bacterial resistance to antibiotics are built according to the “One Health” approach. The 2022-2025 national strategy for the prevention of infections and antibiotic resistance in human health further strengthens actions for the proper use of antibiotics, infection prevention and control. It defines priority human health indicators and target values to be achieved by 2025.
Over the years, successes have been recorded, more marked in animal health, but must be maintained. Actions are also developing in the field of the environment.
A mapping of all the antimicrobial resistance surveillance systems, the analysis of the obstacles and motivations for setting up these collaborations and their evaluation have made it possible to identify areas for improvement in an integrated surveillance perspective. “One Health”. A dozen recommendations made by ANSES and Public Health France have thus been issued and will be published in 2023.
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Prevention of antibiotic resistance: a “One Health” approach
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Two summaries are also published today concerning the consumption of antibiotics and bacterial resistance in healthcare establishments (Mission Spares), as well as in community care and establishments for dependent elderly people (Mission Primo). These results complement recent data on the consumption of antibiotics in the city sector over the period 2011-2021.
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Consumption of antibiotics and bacterial resistance to antibiotics in France: key points 2021
- In human health, 93% of antibiotics were dispensed in community medicine and 7% in health establishments; among those dispensed in the city, about 15% come from a hospital prescription.
- In 2021, the consumption of antibiotics in the city sector recorded a recovery of 5% in Defined Daily Doses (DDD) and 6% in the number of prescriptions compared to 2020, in parallel with the gradual abandonment of barrier measures, the recovery circulation of common winter infections and medical consultations.
- France remains among the European countries that consume the most antibiotics (4th place since 2018) according to ESAC-Net monitoring data. It is therefore essential to continue to promote and amplify actions in favor of the proper use of antibiotics among all the players concerned: citizens, patients, human and animal health professionals, and decision-makers.
- Bacterial resistance in Enterobacteriaceae, in particular in Escherichia coli, seems to be on the decline in 2021 with regard to resistance to 3rd generation cephalosporins, but over several years the evolution is fluctuating. This underlines the importance of maintaining a high level of prevention of infections with resistant bacteria in the three care sectors: city, Ehpad and ES.
Antibiotic resistance in human health: what is the current situation after the COVID-19 epidemic?
After a fall in 2020, antibiotic prescriptions in community medicine are on the rise
Despite a continuous decline for 10 years in the consumption of antibiotics in the city, France remains the 4th most consuming European country behind Greece, Romania and Bulgaria.
After an accelerated drop in prescriptions and consumption in 2020, concomitant with measures to manage the COVID-19 epidemic (confinements, adoption of barrier gestures, drop in medical consultations), the year 2021 was accompanied by a resumption of common winter infections, medical consultations and antibiotic prescriptions, particularly in the last trimester.
About 80% of antibiotic prescriptions were made in city care, as usual, with a peak at the end of the year due to the return of winter illnesses.
This recovery concerns all age groups up to 64 years old, but the most significant change in prescriptions and consumption of antibiotics is observed in children aged 0 to 4 years old: they have increased to return almost to the same level as in 2019, before the COVID-19 pandemic.
Fig – Antibiotic prescriptions by age group and for the entire population. France, human health, 2011-2021
But the consumption of antibiotics continues to drop in 2021 for residents of nursing homes without a pharmacy for indoor use
For the first time, data concerning residents in nursing homes without a pharmacy for indoor use (PUI) who are subject to individual reimbursement by Health Insurance (consumption and duration of accommodation) have been extracted. They made it possible to produce indicators specific to residents in nursing homes without PUI (84% in 2015) for the period 2015-2021.
Between 2015 and 2021, the consumption of antibiotics in EHPADs without PUI is trending downwards and, as in the city sector, a very sharp decrease was observed in 2020.
Consumption continued to decline in 2021 (10.3 in DDD and -9.6% in prescriptions). The protocols put in place to ensure the protection of residents were not relaxed until May and then August 2021, and all barrier gestures continued to be respected, in particular the wearing of masks indoors.
Consumption of antibiotics in healthcare establishments: an increase in broad-spectrum antibiotics
In healthcare establishments (ES), where almost 20% of antibiotics are prescribed, the consumption of antibiotics (expressed in DDD) measured by the mission SPARES, is lower than in 2020, with in particular lower consumption of macrolides and fluoroquinolones. However, the consumption of other antibiotics considered broad-spectrum by the European Center for Disease Prevention and Control (ECDC) – eg 3rd generation cephalosporins, carbapenems and antibiotics active against methicillin-resistant staphylococci) – has progressed.
Antibiotic-resistant Enterobacteriaceae infections: continued vigilance
Regarding enterobacteriaceae found in urinary tract infections, in city patients and in nursing homes, the results reported by the Primo mission are mixed.
In patients at home
For strains of E. coli isolated from urine samples in patients living at home, resistance to 3rd generation cephalosporins has been decreasing since 2015, but resistance to fluoroquinolones has been increasing since 2019). In 2021, they continue to evolve according to these trends.
Among residents in nursing homes
For strains of E. coli isolated from urinary samples from nursing home residents, resistance is generally higher than for patients living at home. Resistance to 3rd generation cephalosporins has been fluctuating since 2011. In 2021, it is decreasing compared to 2020 and 2019, but is higher than in 2011. Resistance to fluoroquinolones has been decreasing more or less markedly since 2013. 2021, it increases.
In health facilities
In 2021, antibiotic resistance measured by the mission SPARESespecially in Enterobacteriaceae, has returned to a level similar to 2019. Nevertheless, the number of external reports of infections/colonizations with emerging highly resistant bacteria (BHRe) remains lower than it was in 2019, raising fears of a -declaration and a drop in screening in the context of a pandemic, with a risk of low-noise dissemination of these bacteria in hospitals.
Promise
This year, Public Health France becomes a member of Promise. Promise is a meta-network under construction, of professionals in the fight against antibiotic resistance in human, animal or environmental health. It aims to promote synergies by creating a “One Health” community allowing networks/academic teams to share best practices and their expertise, and to coordinate their action.
Prevention of bacterial resistance to antibiotics: tools and devices made available to the general public and health professionals
In human health, a range of tools are available to human health professionals for the prevention of infections and the proper use of antibiotics. As part of the 2022-2025 national strategy for the prevention of infections and antibiotic resistance, Public Health France, in collaboration with Health Insurance, have launched the campaign ‘antibiotics, good treatment, it is first of all to use them well‘. Its objective: to remind you that antibiotics are only effective in the event of bacterial infections and that they must be taken only on medical advice.
In animal health, prevention actions are carried out by Écoantibio plans, which combine changes in regulations and the development of tools and actions to support the commitment of professionals. The European joint action against antibiotic resistance and healthcare-associated infections (EU-JAMRAI) as well as the establishment of the Promise meta-network led by Inserm support the development of “One Health” actions .
Examples of available support tools
Among the many tools available, the proper use of antibiotics is supported by prescription assistance tools such as “Antibioclic”, “Antibiogarde”, “ePopi”.
The “Antibio’Malin” thematic module aims to provide information and practical advice for everyone on infections, the proper use of antibiotics and antibiotic resistance. It is available on the Santé.fr internet platform.
The e-Bug educational project offers fun and free tools to facilitate teaching about microorganisms, transmission, prevention and treatment of infections and antibiotic resistance to students up to high school.
Downloadable prevention posters available to order are also available.
Follow the evolution of antibiotic resistance indicators with our Géodes observatory
Indicators of antibiotic consumption and antibiotic resistance in the city sector and in health establishments are available via our platform Géodes. They make it possible to better monitor and understand the evolution of antibiotic resistance indicators in France thanks to interactive visualization and by territory.
Access our indicators
- Pathologies :
- Determinants:
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Find out more about antibiotic resistance in France
Learn more about antibiotic resistance in Europe and worldwide
Links to the websites of organizations and institutions involved in the fight and prevention of antibiotic resistance in Europe and worldwide.
- EU-JAMRAI
- European Antibiotic Awareness Day (European center for disease prevention and control)
- Global Antimicrobial Stewardship Alert Week (World Health Organization):