The COVID-19 pandemic has had a clear impact on human health: there has been a marked decline in consumption in urban areas, and hospital activity has shifted in response to the care of COVID-19 patients. In animal health, the objectives of the Ecoantibio plans have been met. These significant advances require continued efforts, both individually and collectively.

Antimicrobial Resistance in Human Medicine: The Impact of the COVID-19 Pandemic

In 2020, the COVID-19 pandemic and the measures required to control it (lockdowns, preventive measures) altered the behavior of the French population, with a beneficial effect observed on other infections. The pandemic also led to a decrease in medical consultations and antibiotic prescriptions: the drop in consumption is very significant in urban areas, though less pronounced in healthcare facilities. Consumption varies by drug, and bacterial resistance to antibiotics is evolving in contrasting ways. Despite this progress, France remains one of the top antibiotic-consuming countries in Europe, ranking 26th out of 29. Sustaining a reduction in antibiotic consumption remains a priority, and maintaining the adoption of infection prevention practices at both the individual and community levels could contribute to this goal.

Antibiotic consumption in the community: a decline of unprecedented magnitude

The annual monitoring system established by Santé publique France shows a very significant decline in antibiotic prescriptions and consumption in the outpatient sector, where 92% of antibiotics are dispensed. In 2020, 44.4 million prescriptions were dispensed in outpatient settings. This represents an 18% drop compared to 2019.

This unprecedented reduction in antibiotic consumption affects all age groups regardless of gender. However, it is more pronounced among children under 4 years of age and less so among people over 64 years of age.

Specific trends in antibiotic resistance in healthcare facilities

In healthcare facilities, antibiotic consumption per 1,000 hospital days increased by 2.1% in 2020, rising from 300 to 306 DDD/1,000 HD, despite an 8% decrease in healthcare facility activity due to the health crisis. The increase in the consumption of certain classes of antibiotics—such as macrolides (+35%) or carbapenems (+17%)—may be linked to the care of COVID-19 patients.

Similarly, in nursing homes for dependent elderly individuals (Ehpad) affiliated with a healthcare facility, the increase in the use of certain classes of antibiotics—despite an overall decline in 2020—could be explained by the medical care of COVID-19 patients.

The trend in bacterial antibiotic resistance is more mixed, with a stabilization in the number of cases of methicillin-resistant Staphylococcus aureus (from 18 in 2019 to 17 cases per 100,000 hospital days in 2020) and an increase in the number of cases of extended-spectrum beta-lactamase (55 per 100,000 hospital days in 2019 versus 58 in 2020) or carbapenemases (1.1 cases in 2019 and 1.3 cases in 2020 per 100,000 hospital days).

Ultimately, the COVID-19 pandemic has highlighted that our behaviors can have a rapid impact on certain indicators of antibiotic resistance. Enhanced hand hygiene and other preventive measures, by limiting the spread of winter illnesses and reducing opportunities for prescribing, may have contributed to controlling antibiotic resistance. Nevertheless, a balance must be found between strict adherence to these measures, lifestyles, and social interactions. Consumption levels remain high, and it is therefore important to promote the proper use of antibiotics to avoid unnecessary prescriptions. The coming years will reveal whether these preventive practices persist over the long term among the population and whether the observations from 2020 continue.

Antibiotic Resistance in Veterinary Medicine: A Continuous Decline in Antibiotic Use

Since 2011 and the implementation of the first ECOANTIBIO plan, the use of antibiotics in veterinary medicine has steadily declined. The latest European Surveillance of Veterinary Antibiotic Consumption (ESVAC) report, published in 2020 by the European Medicines Agency (EMA), shows that France’s efforts rank it third in Europe in terms of the percentage reduction in antibiotic use in veterinary medicine between 2011 and 2018 (the period covered by the report). In fact, sales of veterinary antibiotics in France have fallen by 54.8% since 2011, according to the latest ANSES report. Animal exposure to antibiotics, as reflected by the ALEA indicator—which provides a more accurate picture of antibiotic use—has decreased by 45.4% since 2011 across all sectors.

To better target the fight against antibiotic resistance, critically important antibiotics (CIAs)—which are used to treat serious human infections and those caused by bacteria of non-human origin that can be transmitted to humans—are receiving special attention.

Colistin has been included in the exposure reduction targets of the ECOANTIBIO 2 Plan due to concerning data on resistance to this compound. A target to reduce exposure to colistin by 50% over five years has been set for the cattle, swine, and poultry sectors compared to 2014–2015. The reduction in exposure to AICs was approximately 90% between 2013 and 2020 and 74.6% for colistin between 2011 and 2020 across all sectors.

Regarding the ECOANTIBIO 2 plan, the reduction in colistin exposure in the cattle, swine, and poultry sectors compared to 2014–2015 is already 66%, meaning the plan’s reduction target has been met.

These efforts were made possible by the strong involvement of livestock producers and veterinarians. This commitment must continue in the future to sustain the positive results in reducing antibiotic use in the veterinary sector and to ensure the continued prudent and responsible use of antibiotics in veterinary medicine.