When Alexander Fleming first discovered Penicillin, he might have never expected how dependent we would become on antibiotics and how important they are for humanity, from curing our infections to safeguarding the plants and animals we eat. Resistance arises when bacteria develop mechanisms to survive exposure to antimicrobial drugs, making infections harder or impossible to treat. Antimicrobial-resistant bacterial infections are a serious health problem in Europe, causing over 35,000 deaths annually [1].
Before modern medicine [2], infections from minor cuts could lead to bloodstream infections or death, but antimicrobials have helped both humans and animals live longer and healthier lives. The emergence of antimicrobial resistance pressures our healthcare systems and food systems due to reduced therapeutic options for preventing, controlling, and treating infectious diseases. By reversing decades of scientific and medical progress, antimicrobial resistance has become one of the greatest global health challenges of our time [3].
A One Health approach recognises that the health of humans, animals, and the wider environment are inherently linked and interdependent. A pressing question is: How consumption of antibiotics in food-producing animals affect resistance in bacteria from humans? How resistance in animals affect resistance in humans? The EU’s JIACRA report [4] is considered a great hallmark in putting the One Health approach into practice. The JIACRA report shows the relationship between the consumption of antimicrobials by humans and animals and the occurrence of antimicrobial resistance. The main findings of the report are that the sectors are indeed interconnected. Figure 1 shows that there is a complex bidirectional relationship between consumption and resistance in both humans and animals.
Figure 1. Antimicrobial consumption and resistance in humans and animals
The JIACRA report examined whether using fluoroquinolones and other quinolones in food-producing animals is linked to antibiotic resistance in bacteria that infect humans. Fluoroquinolones and other quinolones are broad-spectrum antibiotics used to treat bacterial infections in both humans and animals. For instance, it compared resistance in invasive C. jejuni from humans with the amount of these antibiotics used in animals (per kilogram of estimated biomass) in each country for 2019–2021. A significant positive link was found between the use of fluoroquinolones in animals and resistance in C. jejuni from humans during those years. However, the strength of this link varied depending on the type of antibiotic, the bacteria, and the sector. For example, no link was found between the use of third- and fourth-generation cephalosporins in animals and resistance to third-generation cephalosporins in human infections.
To address this, countries are starting to adopt integrated surveillance systems. In 2023, the Council Recommendations on stepping up EU actions to combat antimicrobial resistance in a One Health approach called for further emphasis on One Health surveillance. Nevertheless, relationships between animals and humans are complex, and there is still a lot to understand on how resistance from humans travels to animals, or how consumption in humans might drive consumption in animals. Moreover, much remains unknown about how resistant bacteria may be present in the environment (water, soil, air) and how they interact with humans and animals [5].
Contributor: Carlos Torrado
Suggested further reading:
Delpy, L., Astbury, C. C., Aenishaenslin, C., Ruckert, A., Penney, T. L., Wiktorowicz, M., & Bordier, M. (2024). Integrated surveillance systems for antibiotic resistance in a One Health context: a scoping review. BMC Public Health, 24(1), 1717.
Muloi, D., Ward, M. J., Pedersen, A. B., Fevre, E. M., Woolhouse, M. E., & van Bunnik, B. A. (2018). Are food animals responsible for transfer of antimicrobial-resistant Escherichia coli or their resistance determinants to human populations? A systematic review. Foodborne pathogens and disease, 15(8), 467-474
United Nations (2016). Political Declaration of the High-Level Meeting of the General Assembly on Antimicrobial Resistance: draft resolution / submitted by the President of the General Assembly. Available at: Link
WHO (2022). One health joint plan of action (2022‒2026): working together for the health of humans, animals, plants and the environment. Available at: Link
[1] ECDC (2022). Health burden of infections with antibiotic-resistant bacteria in the EU-EEA. Link
[2] National Academies of Sciences, Engineering, and Medicine. 2022. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine. Washington, DC: The National Academies Press. https://doi.org/10.17226/26350
[3] WHO (2019). Ten threats to global health in 2019. Link
[4] EMA/ECDC/EFSA fourth joint report on the integrated analysis of the antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA (JIACRA IV). Link
[5] UNEP (2023). Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance. Link