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Multivariate analyses demonstrated that 3rd- and 4thgeneration cephalosporin and fluoroquinolone resistance
in E. coli from humans was associated with corresponding
AMC in humans, whereas resistance to fluoroquinolones
in Salmonella spp. and Campylobacter spp. from humans
was related to consumption of fluoroquinolones in animals.
Overall, the JIACRA results suggest that from a One Health
perspective, there is potential in both the human and animal
sectors to further develop prudent use of all antimicrobial
classes and thereby reduce AMR.
The AMR data collected may also be helpful when investigating the effectiveness of management measures taken or
the general impact of an AMR national/local action plan and
efforts towards the reduction of AMC and AMR in both animals and humans. To help and simplify the interpretation of
the results from the AMR monitoring, available data might be
selected or combined in indicators, which can give a general
idea of the progress of the epidemiological situation. Recently,
EFSA, ECDC and EMA jointly developed indicators that can
be used to monitor the progress of Member States towards
the reduction of AMC and AMR in both humans and foodproducing animals, based on the AMR and antimicrobial sale
data already collected by Member States and analyzed by
the three EU agencies (34). Examples of proposed indicators
to assess AMR in human medicine include the proportion of
Staphylococcus aureus that are resistant to meticillin (MRSA)
and the proportion of E. coli that are resistant to 3rd-generation
cephalosporins. These two pathogens are of major public health
importance. For veterinary medicine, an example indicator is
the proportion of commensal E. coli from food-producing
animals that are completely susceptible to all antimicrobials
tested in the harmonized panel prescribed by legislation. In
terms of AMC, some of the suggested indicators are the total
consumption of antimicrobials in humans (limited to antibacterials for systemic use) and the overall sales of veterinary antimicrobials. Notwithstanding the need to analyze the underlying
data to fully understand the epidemiological situation in the
different countries and animal species, and the limitations
that such high-level indicators may have in representing the
real situation, these are expected to constitute a useful tool
for risk managers to monitor the progress made by Member
States in these fields.
SCIENTIFIC ADVICE TO THE RISK MANAGER
Scientific advice and AMR risk assessments
EFSA is providing regulators with scientific and technical
advice on AMR, as a basis of informing related riskmanagement decisions. Over recent years, EFSA has been
consulted by the European Commission on a number of
topics and has also taken the initiative to investigate AMRrelated emerging risks and topics of particular concern
for public health and food safety. For example, scientific
opinions were adopted by the EFSA Panel on Biological
Hazards (BIOHAZ Panel) on MRSA (13), ESBL-/AmpC-

Food Protection Trends January/February

producing and carbapenemase-producing bacteria in foodproducing animals and food (22, 23).
MRSA first emerged in hospital environments in
the 1970s, and since then its diffusion worldwide has
increased, so that it has become a serious health problem
in hospitals. More recently, MRSA was isolated from
people in the general community who had no epidemiological connections to hospitals. In addition, strains of
MRSA associated with animals have been also identified,
from both food-producing animals and pets. In 2009,
EFSA assessed the public health significance of MRSA
in animals and foods (13). The EFSA BIOHAZ Panel
concluded that livestock-associated MRSA represented
only a small proportion of all reported MRSA infections
in the EU, with significant differences between Member
States. The assessment reviewed control options that
could be considered to minimize the risk of transfer of
food-associated and animal-associated MRSA to humans,
and concluded that since the most important routes
of transmission to humans are through direct contact
with live animals and their environments, the most
effective control options would be pre-harvest measures,
including good husbandry practices, HACCP, good
hygienic and manufacturing practices (GHP, GMP), and
possible restrictions of the movements of livestock. It also
recommended the application of basic hygienic measures
before and after contact with horses and companion animals.
In the 2000s, beta-lactamases also emerged in Gramnegative bacteria, including ESBL and AmpC, which
confer resistance to a variety of beta-lactam antimicrobials,
including penicillins, cephalosporins and monobactams.
More recently, carbapenemases have also emerged,
conferring resistance to carbapenems, which are generally
used to treat serious infections caused by multidrugresistant Gram-negative bacteria. Two EFSA opinions
assessed public health risks related to ESBL-, AmpC- and
carbapenemase-producing bacteria in food-producing
animals and food, and related control options (22, 23).
The opinions highlighted that despite the fact that few
studies present clear evidence of direct transmission of
these bacteria from food-producing animals or food to
humans, the existence of common clones provide indirect
evidence of this transmission. Various control options
were identified, but in both opinions, because of a lack of
comparative efficacy and efficiency of individual measures,
their prioritization was deemed to be very difficult. The
assessment of the impact of control measures aimed
at controlling carbapenemase-producing bacteria was
particularly difficult, because of the very low expected
prevalence of those bacteria in the food chain. The EFSA
BIOHAZ Panel indicated that decreased frequency of use
of antimicrobials in animal production in the EU is of high
priority for the control of the emergence and spread of
resistance and co-resistance phenomena, and indicated that

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