The BELMAP report provides a One Health overview of antimicrobial consumption (AMC) and resistance (AMR) in Belgium across human, animal, and environmental sectors to inform strategies and foster collaboration. Data are synthesized from national surveillance systems and research projects.

Methods

Human (community, hospitals) AMC analyses use reimbursement data, while veterinary AMC uses sales and use data. Human AMR data comes from national and European surveillances (NSIH-AMR, EARS-BE) focusing on invasive pathogens, supplemented by National Reference Centres (NRCs) for specific pathogens, including primary care and non-invasive samples. Veterinary AMR covers indicator and zoonotic bacteria, and pathogens from diseased animals. Environmental monitoring includes residues and resistant organisms like Aspergillus fumigatus. The report compilation involves over 50 data providers, ensuring continued contextualisation of data and avoiding common pitfalls of secondary data use such as overconfidence.

Results

In 2023, an equal volume of 103 tonnes of active antimicrobial substances were consumed in the human and veterinary sectors. Veterinary AMC saw a cumulative 62.4% reduction between 2011 and 2023, exceeding national and European targets. Human community AMC was stable in 2023 vs 2022 (+0.7%) and decreased 14.4% since 2014, but remains far from national targets. Hospital consumption decreased by 8.9% between 2014 and 2023, but its relative contribution to total human consumption increased to 18.3% in 2023. Surface water monitoring of watch list antimicrobial residues observed two cases above the predicted no effect concentration in 2022 and 2023.

Including AMR data from NRCs and veterinary pathogens highlights less-reported, concerning trends. The highest resistance rates in human pathogens are observed in bacterial sexually transmitted diseases. Neisseria gonorrhoeae incidence nearly doubled since 2019, with significant increases in ciprofloxacin (63.6% in 2023) and azithromycin (0.2% in 2013 to 36.1% in 2023) resistance. Extensively Drug-Resistant (XDR) Shigella sonnei accounted for 47.5% of isolates in 2023, while increases in resistance in Mycoplasma genitalium saw 40.5% of isolates resistant to both first and second-line treatments in 2023. In sick animals, out of 13 host-pathogen combinations reported, only three  do not show high (50-70%) resistance to at least one of the first line treatments.

In conclusion, One Health surveillance increases awareness, collaboration, and knowledge-sharing, supporting a “Big-Picture” approach to AMR.