Background: The JPIAMR ARCH and COMBACTE-MAGNET  EPI-Net networks have joined efforts to formulate a set of target  actions to link the surveillance of antimicrobial usage (AMU) and  antimicrobial resistance (AMR) with antimicrobial stewardship (AMS)  activities in four different settings. This White Paper focuses on the  veterinary setting and embraces the One Health approach.

Methods: A  review of the literature was carried out addressing research questions  in three areas: AMS leadership and accountability; AMU surveillance and  AMS; and AMR surveillance and AMS. Consensus on target actions was  reached through a RAND-modified Delphi process involving over 40 experts  in infectious diseases, clinical microbiology, AMS, veterinary medicine  and public health, from 18 countries.

Results/discussion: Forty-six  target actions were developed and qualified as essential or desirable.  Essential actions included the setup of AMS teams in all veterinary  settings, building government-supported AMS programmes and following  specific requirements on the production, collection and communication of  AMU and AMR data. Activities of AMS teams should be tailored to the  local situation and capacities, and be linked to local or national  surveillance systems and infection control programmes. Several research  priorities were also identified, such as the need to develop more  clinical breakpoints in veterinary medicine.

Conclusions: This  White Paper offers a practical tool to veterinary practitioners and  policy makers to improve AMS in the One Health approach, thanks to  surveillance data generated in the veterinary setting. This work may  also be useful to medical doctors wishing to better understand the  specificities of the veterinary setting and facilitate cross-sectoral  collaborations.