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2016 Norm Norm-Vet 2016 NORM NORM-VET Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway ISSN: 1502-2307 (print) / 1890-9965 (electronic) Any use of data from NORM/NORM-VET 2016 should include specific reference to this report. Suggested citation: NORM/NORM-VET 2016. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Tromsø / Oslo 2017. ISSN:1502-2307 (print) / 1890-9965 (electronic). This report is available at www.vetinst.no and www.antibiotikaresistens.no 1 CONTENTS NORM / NORM-VET 2016 CONTRIBUTORS AND PARTICIPANTS Editors: Gunnar Skov Simonsen NORM, Univ. Hosp. North Norway Anne Margrete Urdahl NORM-VET, Norwegian Veterinary Institute Authors: Per Espen Akselsen Antibiotic usage in humans [email protected] KAS, Haukeland Univ. Hosp. Cecilie Torp Andersen Candida spp. [email protected] Oslo Univ. Hosp. Elisabeth Astrup MRSA in humans [email protected] Norw. Inst. of Pub. Health Hege Salvesen Blix Antibiotic usage in humans [email protected] Norw. Inst. of Pub. Health Dominique Caugant Meningococci [email protected] Norw. Inst. of Pub. Health Petter Elstrøm MRSA in humans [email protected] Norw. Inst. of Pub. Health Hege Enger MRSA in humans [email protected] St. Olav Univ. Hosp. Frode Width Gran MRSA in humans [email protected] St. Olav Univ. Hosp. Kari Grave Antibiotic usage in animals [email protected] Norw. Vet. Inst. Kari Olli Helgesen Antibiotic usage in animals [email protected] Norw. Vet. Inst Gro Johannessen Bacteria from animals and food [email protected] Norw. Vet. Inst. Aleksandra Jakovljev Group B streptococci [email protected] St. Olav Univ. Hosp. Morten Lindbæk Antibiotic usage in humans [email protected] ASP, Univ. of Oslo Bjørn Tore Lunestad Bacteria from bivalve molluscs [email protected] NIFES Mohammed Umaer Naseer Enteropathogenic bacteria in humans [email protected] Norw. Inst. of Pub. Health Marion Neteland Antibiotic usage in humans [email protected] KAS, Haukeland Univ. Hosp. Madelaine Norström Bacteria from animals [email protected] Norw. Vet. Inst. Karin Rønning Tuberculosis [email protected] Norw. Inst. of Pub. Health Gunnar Skov Simonsen Bacteria from humans [email protected] NORM, Univ. Hosp. North Norw. Jannice Schau Slettemeås Bacteria from animals [email protected] Norw. Vet. Inst. Cecilie Svanevik Bacteria from bivalve molluscs [email protected] NIFES Dagfinn Skaare Haemophilus influenzae [email protected] Vestfold Hospital, Tønsberg Martin Steinbakk Bacteria from humans [email protected] Norw. Inst. of Pub. Health Anne Margrete Urdahl Bacteria from animals [email protected] NORM-VET, Norw. Vet. Inst. Didrik Vestrheim Pneumococci [email protected] Norw. Inst. of Pub. Health Institutions participating in NORM-VET: National Institute of Nutrition and Seafood Research Bjørn Tore Lunestad / Cecilie Svanevik Norwegian Food Safety Authority Kjersti Nilsen Barkbu / Kjell Hauge / Solfrid Åmdal Norwegian Veterinary Institute Aina Steihaug Barstad / Agathe Vikre Danielsen / Kari Grave / Kari Olli Helgesen / Gro Johannessen / Knut Madslien / Solveig Sølverød Mo / Madelaine Norström / Jannice Schau Slettemeås / Anne Margrete Urdahl Institutions participating in NORM: Akershus University Hospital, Lørenskog, Department of Microbiology Bjørn Odd Johnsen / Marit Vattøy Fürst Medisinsk Laboratorium Trond Egil Ranheim / Nina Beate Johansen Førde Hospital, Department of Microbiology Reidar Hjetland / Astrid Vedde Haugesund Hospital, Department of Microbiology Liv Jorunn Sønsteby / Pirrko-Liisa Kellokumpu Haukeland Univ. Hospital, Bergen, Dep. of Microbiology Paul Christoffer Lindemann / Torunn Sneide Haukeland Innlandet Hospital, Lillehammer, Department of Microbiology Rolf Arne Sandnes / Kari Ødegaard Levanger Hospital, Department of Microbiology Angela Kümmel / Berit Harbak Molde Hospital, Department of Microbiology Einar Nilsen / Carola Christin Breivik Norstedt Norwegian Institute of Public Health, Ref. Lab. for Enteropathogenic Bacteria Astrid Louise Wester / Ina Haagensen Norwegian Institute of Public Health, Ref. Lab. for H. influenzae Martin Steinbakk / Gunnhild Rødal Norwegian Institute of Public Health, Ref. Lab. for M. tuberculosis Anne Torunn Mengshoel / Annika Reichman Norwegian Institute of Public Health, Ref. Lab. for N. gonorrhoeae Martin Steinbakk / Gina Ilaug Guldahl Norwegian Institute of Public Health, Ref. Lab. for N. meningitidis Dominique Caugant / Lene Haakensen Norwegian Institute of Public Health, Ref. Lab. for S. pneumoniae Didrik Vestrheim / Anne Ramstad Alme Norwegian Institute of Public Health, Ref. Lab. for S. pyogenes Martin Steinbakk / Anne Ramstad Alme Nordland Hospital, Bodø, Department of Microbiology Sandra Åsheim / Tonje Holan Oslo University Hospital, Radiumhospitalet, Laboratory of Microbiology Gorm Hansen / Sunniva Fagerås Røst Oslo University Hospital, Rikshospitalet, Institute of Medical Microbiology Gorm Hansen / Belinda Langnes Lindstad Oslo University Hospital, Rikshospitalet, Ref. Lab. for Mycology Cecilie Torp Andersen / Lonny Margrethe Kløvfjell Oslo University Hospital, Ullevål, Department of Microbiology Gaute Syversen / Thea Bergheim Stavanger University Hospital, Department of Microbiology Monica Regine Romstad / Anita Løvås Brekken St. Olav University Hospital, Trondheim, Department of Microbiology Kjersti Wik Larssen / Alexander Husby Richardsen St. Olav University Hospital, Trondheim, Ref. Lab. for MRSA Kjersti Wik Larssen / Arsalan Moghen St. Olav University Hospital, Trondheim, Ref. Lab. for S. agalactiae Aleksandra Jakovljev / Randi Valsø Lyng Sørlandet Hospital, Kristiansand, Department of Microbiology Ståle Tofteland / Lise Hulløen-Orø Unilabs Telelab A/S, Skien Krisztina Papp / Anne Ragnhild Oseid University Hospital of North Norway, Tromsø, Department of Microbiology Gunnar Skov Simonsen / Brian Guennigsman University Hospital of North Norway, Nat. Adv. Unit on Detection of AMR Ørjan Samuelsen / Bjørg C. Haldorsen Vestfold Hospital, Tønsberg, Department of Microbiology Dagfinn Skaare / Astrid Lia Vestre Viken - Bærum Hospital, Department of Medical Microbiology Annette Onken / Merriam Sundberg Vestre Viken - Drammen Hospital, Department of Medical Microbiology Einar Tollaksen Weme / Hanne Fanuelsen Østfold Hospital, Fredrikstad, Department of Microbiology Sara Debes / Anne Cathrine Hollekim Ålesund Hospital, Department of Microbiology Einar Nilsen / Luisa Johansen NORM reference group in 2016: Martin Steinbakk Norw. Inst. Pub. Health Dag Harald Skutlaberg Haukeland Univ. Hosp. Heidi Cecilie Villmones Vestfold Hosp. Trust Aasmund Fostervold Norw. Soc. Med. Microbiol. Thea Bergheim Norw. Soc. Engineers and Technologists Jon Birger Haug Norw. Soc. Inf. Dis. Knut Eirik Eliassen Norw. Coll. Gen. Pract. 2 NORM / NORM-VET 2016 INTRODUCTION CONTENTS Introduction ……………………………………………………………………………………….............. 5 Sammendrag ..........……………………………………………………………………………….............. 7 Summary …………………………………………………………………………………………............ 11 Population statistics.…………………………………………………………………………………...... 15 Usage of antimicrobial agents Usage in animals Therapeutic usage of veterinary antimicrobial agents ………………………………………… 17 Antimicrobial and coccidiostat feed additives ……………………………………….…….. 24 Usage in humans Overall antibiotic sales ……………………………………………………………………….. 25 Antibiotic usage in primary care ……………………………………………………………… 33 Antibiotic usage in hospital care ……………………………………………………………. 38 National Action Plan against Antibiotic Resistance in Healthcare .………………………….. 41 Antimycotic usage in Norway ……………………………………………………………….. 44 Occurrence of antimicrobial resistance Indicator bacteria from animals Production animals ……………………………………………………………………………. 46 Wild animals ……………………………................................................…................................ .. 56 Indicator bacteria from food …………………………………………………..……………..….... 63 Indicator bacteria from feed ………………………………………………………………………. 74 Zoonotic and non-zoonotic enteropathogenic bacteria Salmonella spp. ……………………….........................………………..................................... 77 Campylobacter spp. …………………………………. .............................................................. 85 Yersinia enterocolitica ..……….........................……………………....................................... 88 Shigella spp. .………………….............……….........................…….................................. 90 Human clinical isolates Distribution of bacterial species in blood cultures .................................................................... 93 Escherichia coli in blood cultures and urine ………….............................................................. 95 Klebsiella spp. in blood cultures and urine .…………………......................................... ......... 101 Enterobacter spp. in blood cultures and urine ….…………………………………………… 108 Haemophilus influenzae in blood cultures and cerebrospinal fluids …………………………. 111 Neisseria meningitidis in blood cultures and cerebrospinal fluids …………………………… 112 Neisseria gonorrhoeae ……………………………………………………………………….. 113 Staphylococcus aureus in blood cultures and wound specimens................................................ 114 Methicillin resistant Staphylococcus aureus (MRSA) infections in Norway 2016 …………… 117 Enterococcus spp. in blood cultures ….……………................................................................ 119 Streptococcus pneumoniae
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