The Department of Health and the Department of Agriculture, Food and the Marine have today (Thursday) published the Ireland - One Health Report on Antimicrobial Use & Antimicrobial Resistance. This report provides for the first time a snapshot of the antimicrobial use (AMU) and antimicrobial resistance (AMR) in both humans and food-producing animals in Ireland.
The World Health Organisation defines antimicrobial resistance as the resistance of a micro-organism to an antimicrobial drug that was originally effective for treatment of infections caused by it.
Antimicrobial resistance or AMR is a global threat and an urgent challenge. It poses a significant risk to human health. The Department of Health (DOH) and the Department of Agriculture, Food and the Marine (DAFM) have adopted the ‘One Health’ approach to AMR and encourage multidisciplinary collaborative efforts across different sectors such as health, agriculture and the environment to achieve the best health outcomes for people and animals.
In keeping with this, both Departments, in collaboration with a wide range of stakeholders, have published Irelands National Action Plan on Antimicrobial Resistance 2017 – 2020, known as iNAP in October 2017 and this first One Health Report is part of the response under Strategic Objective 2 of the iNAP.
This One health report shows that data in Ireland on AMU for humans and food-producing animals is improving all the time. However, gaps remain in the information available, namely;
- Although data for approx. 90% of acute hospital and 95% of public prescription Antimicrobial Use is available there is no data for available for private prescription Antimicrobial Use;
- Surveillance of human AMR reflects invasive infections only (Blood Stream Infections (BSIs) in acute settings) and not on other infections (Urinary Tract Infections (UTIs) and wound infections) outside of the acute setting;
- Currently information from national surveillance of AMU does not include information on the appropriateness of the antimicrobials used in either sector
- There is no specific surveillance for AMR in imported food products
- There is also no systematic surveillance for AMR in the environment
It is important to note that progress is being made in tackling several of these. In addressing these deficits Ireland’s ability to respond to both the current and any future threats will be enhanced as will support improvements in antimicrobial stewardship by providing better evidence for use in decision making.
Future publications of this joint annual report on AMU and AMR will provide the foundation to progressively address the deficits in our knowledge and continue to highlight our collective One Health efforts to tackle this major societal challenge in Ireland.
Commenting on the publication of the report, Minister for Health Simon Harris TD said: “We know that the emergence of AMR worldwide is a real and growing public health crisis and we are likely approaching a tipping point if antibiotic resistance continues unchecked.
"There are some stark reminders of the consequences of AMR when we consider the outbreaks of Carbapenemase producing Enterobacteriaceae (CPE). In adopting the ‘One Health’ approach it is acknowledged that sectors on their cannot properly address this concern in isolation and a joint, co-ordinated approach is required.
"Along with my colleague Minister Creed I welcome the publication of this report and acknowledge the collaboration across the sector to bring this to fruition. This report should be used as a foundation to enhance surveillance and evidence in tackling this global problem.“
Minister Creed said “This timely report brings together data from both sectors to inform future policy decisions as to how best address the development and spread of AMR.”
The report was produced by a subgroup of the National Interdepartmental AMR Consultative Committee which is jointly chaired and hosted by the Department of Health’s Chief Medical Officer, Dr Tony Holohan, the Department of Agriculture, Food and the Marine’s Chief Veterinary Officer, Dr Martin Blake. Both chairs welcomed the One Health Report and acknowledged the work of the subgroup and that this is a significant step forward in surveillance of AMR and AMU for Ireland as a country.
Notes to the Editor
Read the One Health Report on Antimicrobial Use & Antimicrobial Resistance on our website here.
iNAP – Ireland’s National Action Plan on Antimicrobial Resistance is available on our website here.
Department of Agriculture, Food and the Marine AMR information is available here.
What is AMR?
Antimicrobial resistance (AMR) is resistance of a microorganism to a drug that was originally effective for treatment of infections caused by that microorganism. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
Antibiotic resistance refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections. Antimicrobial resistance is a broader term, encompassing resistance to drugs to treat infections caused by other microbes as well.
What is the effect of AMR?
A European Centre for Disease Control/European Medicines Agency (ECDC/EMEA) 2009 Report estimated that in 2007 drug-resistant bacteria were responsible for about 25,000 human deaths per annum in the EU alone, with associated healthcare costs and productivity losses of €1.5bn. The Report also stated that approx. 4 million patients are estimated to acquire a healthcare associated infection in the EU every year. (ECDC JOINT TECHNICAL REPORT 'The Bacterial Challenge: time to react' (2009)).
What does ‘One Health’ mean?
The 'One Health' concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. Recognising that human health, animal health and ecosystem health are inextricably linked, ‘One Health’ seeks to promote, improve and defend the health and well-being of all species by enhancing cooperation and collaboration between physicians, veterinarians, other scientific health and environmental professionals and by promoting strengths in leadership and management to achieve these goals.
There is international consensus through the ‘One Health’ Initiative to which the WHO (World Health Organisation), FAO (Food and Agriculture Organisation) and the OIE (World Health Organisation for Animal Health) are signatories, that tackling the global public health threat of AMR requires action across human and animal health sectors, agriculture and the wider environment.
The multi-sector harmonisation of strategies and measures to address the challenge of AMR are necessary at a global, regional, and national level. There has been global intersectoral collaboration since 2010, with the World Organisation for Animal Health (OIE), the World Health Organisation (WHO) and the Food and Agriculture Organisation of the United Nations (FAO) establishing tripartite actions to coordinate strategies to ensure antimicrobials maintain their efficacy, and are used responsibly. These agencies are signatories to a ‘One Health’ worldwide initiative.
The European Commission has also promoted a holistic and multi-sectoral approach involving many groups such as the public health, food safety, animal health and welfare, research and innovation, bio-safety and environment sectors. The EU at both Council and Parliament levels has developed its Community Strategy against AMR having regard to the ‘One Health’ concept.
At a national level the Chief Medical Officer (CMO) and the Chief Veterinary Officer (CVO) of the Department of Health and the Department of Agriculture, Food and the Marine, respectively, established the National Interdepartmental Antimicrobial Resistance Consultative Committee in 2014 as part of the ‘One Health‘ initiative, and to advance a holistic national approach in working together to ensure that effective antibiotics remain available into the future. The Committee is co-chaired by the CMO and CVO and has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both Departments, relevant HSE agencies, EPA, HPRA, FSAI and other key stakeholder groupings in the human and animal health sectors.
Further information is available at https://health.gov.ie/national-patient-safety-office/patient-safety-surveillance/antimicrobial-resistance-amr-2/antimicrobial-resistance-amr/