Background

Inappropriate antimicrobial consumption (AMC) drives the emergence of antimicrobial resistance (AMR), necessitating a unified “One Health” approach to combat this global threat. Shared metrics enhance intersectoral comparisons and coordination.  This study compares AMC in the Belgian human (hospital and community) and veterinary sectors, using a common metric (mg/estimated kg biomass).

Methodology

The JIACRA methodology[1] adapted to the Belgian context and including more recent data (2012-2021) was used. Belgian human AMC for systemic antimicrobials (ATC group J01) stratified by sector (community or hospital) were retrieved from the TESSy database, hosted by European Centre for Disease Prevention and Control. The data were[2] converted to the mass of active compound and aggregated by antimicrobial class. Annual human biomass in Belgium was estimated from Eurostat population demography data alongside estimates of body mass by gender and age[3]. Data on antimicrobial sales in animals expressed in mg/kg biomass from the BelVet-SAC reports were utilized[4]. Pearson and Spearman correlation tests were performed to assess the correlation between AMC and time.

Results

Significant reductions in total AMC (mg/kg estimated biomass) were observed over time in both humans and animals. Notably, in Belgium, consistently higher average human consumption than animal consumption diverged from European trends. Belgian hospitals contributed significantly to human AMC (20.9% in 2021) compared to the European average (10%). Stagnation in hospital AMC and considerable reductions in community AMC, led to a year-on-year increase in the relative contribution of hospitals to total human consumption (15.3% 2012, to 20.9% in 2021). By examining consumption by antimicrobial class, higher overall population-corrected consumption in humans was noted for penicillins, cephalosporins (all generations) and quinolones while other antimicrobial classes showed higher consumption in animals.

Conclusion

This One-Health approach to measure AMC highlight the need to strengthen antimicrobial stewardship interventions, especially in Belgian hospitals