Antibiotic-resistant foodborne bacteria remain widespread in Europe despite pockets of progress

Antimicrobial resistance is not an abstract future threat - it is a present-day clinical reality in European food safety. Ciprofloxacin, a fluoroquinolone antibiotic used to treat severe human infections including those caused by Campylobacter and Salmonella, has become so broadly ineffective against Campylobacter that European health authorities have formally removed it from the list of recommended first-line treatments for human Campylobacter infections. That decision reflects years of surveillance data showing resistance rising to the point where the drug cannot be relied upon.

The latest joint report from the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) covers antimicrobial resistance (AMR) data from 2023 to 2024, submitted by 27 EU member states, the United Kingdom (Northern Ireland), and five non-EU countries. The data cover bacteria from humans, food-producing animals, and meat, providing a One Health perspective on how resistance moves between animal and human populations.

Where resistance stands today

The ciprofloxacin picture is particularly stark. Resistance in Campylobacter from both humans and food-producing animals is now so widespread across Europe that the antibiotic is no longer recommended for treating human infections. Restrictions have been placed on its use in animals to preserve what effectiveness remains in human medicine - a harm reduction measure rather than a solution. Ciprofloxacin resistance in Salmonella has also increased in recent years in human infections, even as resistance in food-producing animals has been consistently high.

Beyond ciprofloxacin, high proportions of both Salmonella and Campylobacter from humans and food-producing animals show resistance to ampicillin, tetracyclines, and sulfonamides - antimicrobials used across veterinary and human medicine. These broad resistance patterns reflect decades of antimicrobial use in both sectors and are unlikely to reverse quickly even with improved stewardship.

The emerging carbapenem concern

The most pressing new signal in the 2023-2024 data is the detection of carbapenemase-producing Escherichia coli in food-producing animals and meat in several countries. Carbapenems are last-resort antimicrobials - the drugs used when virtually everything else has failed in critically ill human patients. They are not authorized for use in food-producing animals. Yet the bacteria producing enzymes that degrade carbapenems are appearing in livestock and meat.

The number of reported detections is increasing. The sources - whether the bacteria originate from environmental contamination, feed, water, or other routes - need further investigation. The concern is not that people are currently becoming infected with carbapenem-resistant bacteria from food in large numbers, but that these resistance genes can spread between bacterial populations. If carbapenemase genes move from livestock E. coli into bacteria that do infect humans, treatment options could narrow severely.

Where progress is being made

The picture is not entirely negative. For Salmonella, resistance in bacteria from humans to ampicillin decreased significantly over the past 10 years in 19 countries, and resistance to tetracyclines decreased in 14 countries. In food-producing animals at EU level, resistance to tetracyclines in broilers decreased, and resistance to both ampicillin and tetracyclines decreased in turkeys.

For Campylobacter, resistance to erythromycin - a first-line treatment for Campylobacter infections in humans - has declined over the past decade in several countries, both in human cases and in some food-producing animals. Combined resistance to multiple critically important antimicrobials remains generally low in Salmonella, Campylobacter, and E. coli - meaning multi-drug resistance, though present, has not become dominant.

These improvements demonstrate that targeted stewardship efforts can produce measurable change. But the heterogeneity in outcomes across countries - some reducing resistance substantially while others see it stabilize or increase - also demonstrates that progress is not automatic and depends on sustained, coordinated action.

The One Health imperative

The core message of the report is that antimicrobial resistance in foodborne bacteria cannot be addressed by focusing on humans alone or animals alone. Because these bacteria circulate across animal, food, and human populations through food chains, environmental pathways, and direct contact, effective action requires simultaneous attention to antimicrobial use in veterinary medicine, farming practices, food processing, human clinical medicine, and environmental contamination.

Resistance patterns vary widely between countries, bacteria, and antimicrobials, reflecting differences in how antimicrobials are used and in farming, animal health, and infection prevention practices. No single policy will be sufficient everywhere. The surveillance data provided by this joint report are essential for identifying where the most urgent interventions are needed and whether efforts already underway are producing results.