Reviewing antimicrobial resistance and drug usage systems in the Human, Animal and Food Sector in six European countries.

Antimicrobial resistance (AMR) has been identified as a significant threat to public health in human and animal sector and antimicrobial use (AMU) as a main trigger of AMR.. Surveillance and monitoring systems are essential to control and assess the trends. However, the presence of different standardization systems among the countries and sectors makes comparisons problematic. A literature review was performed in 2018 using PubMed (to identify relevant peer reviewed articles) and internet (to identify national and European databases), using the following search terms: “antimicrobial resistance”, “antimicrobial use”, ”Spain”, ”Germany”, ”UK”, “United Kingdom”, “Scotland”, “Wales”, “England”, “Northern Ireland”, “Netherlands”, “France”, “Norway”, “Europe”, “food”, “human”, “animal”, “surveillance”, “system” and “monitoring”. Additionally, a questionnaire asking for detailed information on any available AMR and AMU database in each country was developed and sent to all collaborating institutes for completion. On the AMU section, the lack of standardization between countries and sectors has been encountered defining the data source (prescription/sales) and the units (Kg, mg/PCU, DDD/1000inpatients/days, DDD/1000beds/day, DDD/1000 STAR-PU among others). In addition, some limitations have been detected in the AMR section being the sample type (clinical/non-clinical), the units (MIC/SIR/IZ), the standard used (EUCAST/CLSI among others), the interpretation criteria (epidemiological or clinical) and finally the laboratory method (disk diffusion, microdilution, VITEC, among others). The One Health approach requires some harmonization among the human, animal and food systems within and between the different countries. There is a wealth of information available, but lack of harmonization limits the usability of data substantially. AMR and AMU analyses among sectors and countries should be done with caution and efforts should be undertaken to improve standardization