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Antibiotic consumption and prevention of antibiotic resistance in France in 2021: the place are we?

Every year, on the occasion of European Antibiotic Awareness Day, on 18 November, actors involved in the prevention of bacterial resistance to antibiotics (or antimicrobial resistance) publish a report on antibiotic consumption and antibiotic resistance in human and animal health . in the environment in France.

This review puts into perspective the consumption of antibiotics in human and animal health and their evolution. Thus, we simultaneously observe a steady decline in human health prescriptions and a reduction in animal exposure to antibiotics. In human health as in animal health, consumption indicators of critical antibiotics are declining.

Regarding the resistance of bacteria to antibiotics, the common indicator of resistance of Escherichia coli strains to cephalosporins is decreasing, in human health, in the city, in institutions for the elderly dependent and in health institutions as well as in animal health .

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 resistance to antibiotics in human health further strengthens actions for the appropriate use of antibiotics, prevention and control of infections. It defines priority human health indicators and target values ​​to be achieved by 2025.
Over the years, successes have been noted, most pronounced in animal health, but they must be preserved. Actions are also being developed in the field of environment.

A map of all antimicrobial resistance surveillance systems, analysis of obstacles and motivations for establishing these collaborations and their evaluation have made it possible to identify areas for improvement in an integrated surveillance perspective. “One Health”. Thus, a dozen recommendations made by ANSES and Public Health in France have been released and will be published in 2023.

Two summaries have also been published today on antibiotic consumption and bacterial resistance in healthcare facilities (Mission Spares), as well as in community care and aged care facilities (Mission Primo). These results complement the latest data on the consumption of antibiotics in the city sector during the period 2011-2021.

To download:

Antibiotic consumption and bacterial antibiotic resistance in France: key points 2021

  • In human health, 93% of antibiotics were dispensed in community medicine and 7% in health facilities; among those dispensed in the city, about 15% come from a hospital prescription.
  • In 2021, antibiotic consumption in the city sector registered 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 infections usual winter and medical consultations.
  • France remains among the European countries that consume the most antibiotics (fourth country as of 2018) according to ESAC-Net monitoring data. It is therefore essential to continue to promote and strengthen actions in favor of the appropriate use of antibiotics among all stakeholders: citizens, patients, human and animal health professionals and decision makers.
  • Bacterial resistance in Enterobacteriaceae, especially in Escherichia coli, appears to be decreasing in 2021 in relation to resistance to third-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 decline in 2020, antibiotic prescriptions in community medicine are on the rise

Despite a 10-year steady decline in the consumption of antibiotics in the city, France remains the fourth largest consuming country in Europe after Greece, Romania and Bulgaria.

After an accelerated decline in prescriptions and consumption in 2020, accompanied by measures to manage the COVID-19 epidemic (injections, adoption of barrier gestures, decline in medical consultations), 2021 was accompanied by a resumption of common infections of winter, medical consultations. and antibiotic prescriptions, especially in the last trimester.

About 80% of antibiotic prescriptions are 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, but the most significant change in antibiotic prescriptions and consumption is seen in children aged 0 to 4 years: they have increased to return to almost the same level as in 2019, before the covid19 Pandemic.

Fig – Prescriptions for antibiotics by age group and for the whole population. France, human health, 2011-2021

Fig - Prescriptions for antibiotics by age group and for the whole population.  France, human health, 2011-2021

But antibiotic consumption continues to decline in 2021 for nursing home residents without an in-house pharmacy

For the first time, data on residents in nursing homes without in-house pharmacy (PUI) who are subject to individual reimbursement from Health Insurance (consumption and length of stay) have been released. They made it possible to produce specific indicators for residents in nursing homes without PUI (84% in 2015) for the period 2015-2021.

Between 2015 and 2021, antibiotic consumption in EHPADs without PUI is on a downward trend 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 that the protection of residents was not relaxed until May and then August 2021, and all preventive gestures continued to be respected, especially the wearing of masks indoors.

Antibiotic consumption in healthcare facilities: an increase in broad-spectrum antibiotics

In health care institutions (HS), where almost 20% of antibiotics are prescribed, the consumption of antibiotics (expressed in DDD) measured by the SPARES mission, is lower than in 2020, especially with lower consumption of macrolides and fluoroquinolones. However, consumption of other antibiotics considered broad-spectrum by the European Center for Disease Prevention and Control (ECDC) – e.g. third-generation cephalosporins, carbapenems and antibiotics active against methicillin-resistant staphylococci) – has progressed.

Antibiotic-resistant Enterobacteriaceae infections: continued vigilance

Regarding enterobacteria found in urinary tract infections, urban patients, and 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 third-generation cephalosporins has been decreasing since 2015, but resistance to fluoroquinolones has increased since 2019). In 2021, they continue to evolve according to these trends.

Among residents in nursing homes

For strains of E. coli isolated from urine samples from nursing home residents, resistance is generally higher than for patients living at home. Resistance to third-generation cephalosporins has fluctuated since 2011. In 2021 it is decreasing compared to 2020 and 2019, but it is higher than in 2011. Resistance to fluoroquinolones has been decreasing more or less since 2013, 2013.

In health facilities

In 2021, antibiotic resistance measured by the SPARES mission, especially in Enterobacteriaceae, returned to a level similar to 2019. However, the number of external reports of infections/colonizations with emerging highly resistant bacteria (BHRe) remains below what it was in 2019. , raising fears of under-reporting and a decline in screening in the context of a pandemic, with the risk of the low-noise spread of these bacteria in hospitals.

promise

This year, French Public Health becomes a member of Promise. The 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 that allows academic networks/teams to share best practices and their expertise and coordinate their actions.

Preventing bacterial resistance to antibiotics: tools and equipment made available to the general public and health professionals

In human health, a variety of tools are available to human health professionals for infection prevention and appropriate antibiotic use. As part of the 2022-2025 national strategy for the prevention of infections and resistance to antibiotics, French Public Health, in collaboration with Health Insurance, have launched the campaign “Antibiotics, being treated well is first of all their good use. Its objective: to remind you that antibiotics are only effective against bacterial infections and that they should only be taken on medical advice.

In animal health, preventive 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 creation of the Inserm-led Promise meta-network 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 aids such as “Antibioclic”, “Antibiogarde”, “ePopi”.

The thematic module “Antibio’Malin” aims to provide information and practical advice to everyone about infections, appropriate use of antibiotics and antibiotic resistance. It is available on the Santé.fr web platform.

The e-Bug educational project provides fun and free tools to facilitate learning about microorganisms, the transmission, prevention and treatment of infections and antibiotic resistance for students through high school.

Downloadable prevention posters are also available to order.

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 facilities are available through our Géodes platform. They make it possible to monitor and better understand the evolution of antibiotic resistance indicators in France thanks to interactive visualization and by territory.

Access our indicators

  • Diseases:
  • Determinants:

See also

Find out more about antibiotic resistance in France

Learn more about antibiotic resistance in Europe and around the world

Links to websites of organizations and institutions involved in fighting and preventing antibiotic resistance in Europe and around the world.

  • BE-JAMRAI
  • European Antibiotic Awareness Day (European Center for Disease Prevention and Control)
  • Global Antimicrobial Stewardship Alert Week (World Health Organization):

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