In 2023, following a call for proposals, a new five-year term was established. There are still five national missions, but their scope has been expanded to include the appropriate use of antibiotics. These missions are delegated to nine CPIA and four associated CRATB following a call for applications.

The national missions are:

• First: “Surveillance and prevention of healthcare-associated infections and antibiotic resistance (including the appropriate use of antibiotics) in outpatient care and the medical-social sector,” led by the CPias Pays-de-Loire in partnership with the CPias Auvergne-Rhône-Alpes, the CRAtb Pays-de-Loire, and the CRAtb Normandie;

• Second: “Surveillance and prevention of antibiotic resistance (including the appropriate use of antibiotics) in healthcare facilities,” led by CPias Grand Est in partnership with CPias Nouvelle-Aquitaine, CRAtb Provence-Alpes-Côte d’Azur, and CRAtb Grand-Est;

• Spiadi: “Surveillance and prevention of infections associated with invasive devices,” led by the CPias Centre-Val de Loire;

• Spicmi: “Surveillance and prevention of infection risks associated with surgical and interventional medical procedures,” led by CPias Île-de-France in partnership with CPias Pays-de-Loire;

• Matis: “Support for initiatives to prevent healthcare-associated infections and antibiotic resistance (including the appropriate use of antibiotics): assessment, training, communication, and documentation,” led by the CPias Nouvelle-Aquitaine in partnership with the CPias Îles de Guadeloupe.

The scientific deliberations of CominaPIA (National Committee for the Prevention of Healthcare-Associated Infections and Antibiotic Resistance) took into account the missions of the CPias, the CRAtb, and Santé publique France. They were based on an assessment of the current situation and the results of a prior consultation with stakeholders. The committee also incorporated the objectives of the interministerial “Antimicrobial Resistance” roadmap and European programs coordinated by the ECDC. This committee is responsible for the annual evaluation of the implementation of these missions.

• Visit the preventioninfection.fr website of the Network for Infection Prevention, Antimicrobial Resistance, and the Appropriate Use of Antibiotics (RéPIA), which brings together national initiatives

• Learn more about healthcare-associated infections

Monitoring of Antibiotic Resistance and Antibiotic Use in Healthcare Facilities

• The national Spares initiative is led by CPias Grand Est in partnership with CPias Nouvelle-Aquitaine, CRAtb Provence-Alpes-Côte d’Azur, and CRAtb Grand-Est.

Regarding the surveillance of antibiotic use and bacterial resistance in healthcare facilities, it relies on a common data-recording tool based on specialized software, requiring minimal pre-processing of the data: the ConsoRes tool. All participating healthcare facilities may join.

This new organization replaces the ATB-Raisin and BMR-Raisin networks, which provided surveillance data on antibiotic use and bacterial resistance in healthcare facilities until 2018:

• The BMR-Raisin surveillance program, which was coordinated by CClin Paris Nord until 2017, targeted methicillin-resistant S. aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-producing Enterobacteriaceae) isolated from diagnostic specimens collected from hospitalized patients.

• The ATB-Raisin surveillance program, coordinated by the CClin Nouvelle Aquitaine until 2017, had been collecting data since 2006 on antibiotic consumption in outpatient settings within participating healthcare facilities, both overall and by sector of activity (excluding retrocession, home hospitalization, and weekday hospitalization). It thus complemented French data derived from the analysis of antibiotic sales reports submitted to the ANSM by pharmaceutical distributors and those generated by the health insurance system through monitoring the number of antibiotic prescriptions issued under the Public Health Objectives-Based Remuneration (ROSP) program.

Regarding prevention, it carries out various initiatives and audits, particularly in connection with the national MATIS mission.

In 2023, it will incorporate the CRAtb Provence-Alpes-Côte d’Azur and CRAtb Grand-Est to carry out missions promoting the proper use of antibiotics, which have been included in the call for proposals for the 2023–2028 period.

Surveillance of Antibiotic Resistance and Antibiotic Use in Community Settings and Long-Term Care Facilities

• The national initiative “Surveillance of Antibiotic Resistance and Healthcare-Associated Infections in Community Settings and Long-Term Care Facilities” (Primo), led by the CPias Pays-de-Loire in partnership with the CPias Auvergne-Rhône-Alpes, the CRAtb Pays-de-Loire, and the CRAtb Normandie.

Regarding antibiotic resistance, the Primo national initiative has been coordinating surveillance since 2018 based on participating community clinical laboratories. This surveillance covers strains isolated from patients living at home and from residents in nursing homes. It uses the e-Medqual ville tool, and all participating community laboratories can take part. The surveillance focuses on resistance data for Escherichia coli, Staphylococcus aureus, as well as Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae, and Klebsiella oxytoca.

Prior to the launch of this initiative in 2018, there was no structured national surveillance for antibiotic resistance in the private sector and long-term care facilities. Regional networks of private laboratories, such as the Medqual, Aquitaine, Epiville France, Oscar, and AforcopiBio networks, or the one established by Santé publique France – Hauts-de-France, produced regional data.

In addition, data from clinical laboratories are collected by the National Reference Centers (CNR), but their data are often aggregated with those from healthcare facilities.

Regarding the prevention of antibiotic resistance, the Primo mission has coordinated the monitoring of hydroalcoholic product use in nursing homes since 2018.

In 2023, it will incorporate the CRAtb Pays-de-Loire and CRAtb Normandie to carry out missions promoting the proper use of antibiotics, which have been included in the call for proposals for the 2023–2028 period.

• Monitoring of Antibiotic Use in the Community and Long-Term Care Facilities

In addition to the analyses of antibiotic sales data conducted by the French National Agency for Medicines and Health Products Safety (ANSM), Santé publique France monitors antibiotic consumption in the outpatient sector at the national level, providing regional indicators.

Measured using health insurance reimbursement data, antibiotic consumption and prescriptions in the outpatient sector are among the health determinants presented on Santé publique France’s interactive GEODES portal. The indicator used for consumption is the number of Defined Daily Doses (DDD) per 1,000 inhabitants per day. In this regard, it should be noted that the DDD is the standard dosage set by the WHO for an adult. This indicator, which is also calculated for each major class of antibiotics, is broken down by eight age groups by region, by department, and, since 2022, by EPCI. For prescriptions, the indicator is now calculated per 1,000 inhabitants per year.