Eight years of sales surveillance of antimicrobials for veterinary use in Germany—What are the perceptions?

Abstract

A surveillance system for sales volumes of antimicrobial agents for veterinary use was established in Germany in 2011. Since then, pharmaceutical companies and wholesalers have been legally obliged to report annual volumes of veterinary antimicrobial products sold to veterinary practices or clinics located in Germany. The evaluation of sales volumes for eight consecutive years resulted in a considerable total decrease by 58% from 1706 tons to 722 tons. During the investigation period, two legally binding measures to control the risk of antimicrobial resistance resulting from the veterinary use of antimicrobials were introduced, a) the German treatment frequencies benchmarking in 2014 and b) the obligation to conduct susceptibility testing for the use of cephalosporins of the 3 rd and 4 th generation and of fluoroquinolones in 2018. Both had a marked impact on sales volumes. Nonetheless, the category of Critically Important Antimicrobials as defined by the World Health Organization kept accounting for the highest share on sales volumes in Germany in 2018 with 403 tons, despite an overall reduction by 53%. Sales surveillance is considered essential for data retrieval on a global scale and inter-country comparison. However, the usability of a surveillance system based on sales data for risk management of antimicrobial resistance has limitations. The German system does not include off-label use of antimicrobial products authorized for human medicine and does not allow for identification of areas of high risk according to animal species, farm and production types and indications for treatment. For further reduction and enhanced promotion of a prudent use of antimicrobials, targeted measures would be required that could only be deducted from use data collected at farm or veterinary practice level. A surveillance system based on use data is currently lacking in Germany but will be established according to Regulation (EU) 2019/6 on veterinary medicinal products.

Phenotypical antimicrobial resistance data of clinical and non-clinical Escherichia coli from poultry in Germany between 2014 and 2017

“…The relationship between AMR and AMU has been described in livestock [ 25 , 49 , 50 ]. During the last years, Germany has reduced antimicrobial consumption in food-producing animals considerably [ 51 ]. In 2014 the sales figure for antimicrobials were 149.3 mg/Population Correction Unit (PCU)), while in 2017 this figure was reduced to 89 mg/PCU [ 4 ].…”

“…Likewise, in Germany, the level of AMR in commensal E. coli from livestock was effectively reduced [5,6]. Usage data collected at farm or veterinary level are required to better address the AMR assessment in livestock [51].…”

Comparison of Phenotypical Antimicrobial Resistance between Clinical and Non-Clinical E. coli Isolates from Broilers, Turkeys and Calves in Four European Countries

“…In Norway, antimicrobial use was extremely low [ 20 ]. Usage data on farm level could provide a higher level of detail than sales data, addressing the association between AMU and AMR per animal and drug category more precisely [ 16 , 22 , 23 ]. Some countries have started collecting AMU at farm level [ 16 ].…”

The First Report of mcr-1-Carrying Escherichia coli Originating from Animals in Serbia

“…In France, for instance, the prevalence of mcr-1 -carrying E. coli reported between 2011 and 2014 was significantly higher in turkeys (5.9%) than in broilers (1.6–1.8%) and in pigs (<1%) [ 40 ]. Germany, one of the largest consumers of colistin in veterinary medicine in the EU, but also the largest pig producer in Europe, the prevalence of mcr -carrying E. coli seemed to be higher in turkeys than in pigs [ 39 , 41 ]. According to Irrgang et al [ 38 ], the detected prevalence of mcr-1 -carrying E. coli originating from turkeys in Germany was 10.2% in 2010, 17.9% in 2011, 11.7% in 2012 and 10.4% in 2014.…”