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Swedres/Svarm 2017 2017 SWEDRES|SVARM Consumption of antibiotics and occurrence of antibiotic resistance in Sweden 2 SWEDRES |SVARM 2017 A report on Swedish Antibiotic Utilisation and Resistance in Human Medicine (Swedres) and Swedish Veterinary Antibiotic Resistance Monitoring (Svarm) Published by: Public Health Agency of Sweden and National Veterinary Institute Editors: Erika Olsson and Olov Aspevall, Public Health Agency of Sweden Oskar Nilsson and Märit Pringle, National Veterinary Institute Addresses: The Public Health Agency of Sweden SE-171 82 Solna, Sweden Phone: +46 (0) 10 205 20 00 Fax: +46 (0) 8 32 83 30 E-mail: [email protected] www.folkhalsomyndigheten.se National Veterinary Institute SE-751 89 Uppsala, Sweden Phone: +46 (0) 18 67 40 00 Fax: +46 (0) 18 30 91 62 E-mail: [email protected] www.sva.se Text and tables may be cited and reprinted only with reference to this report. Images, photographs and illustrations are protected by copyright. Suggested citation: Swedres-Svarm 2017. Consumption of antibiotics and occur- rence of resistance in Sweden. Solna/Uppsala ISSN1650-6332 ISSN 1650-6332 Article no. 18003 This title and previous Swedres and Svarm reports are available for downloading at www.folkhalsomyndigheten.se/ Scan the QR code to open Swedres-Svarm 2017 as a pdf in publicerat-material/ or at www.sva.se your mobile device, for reading and sharing. Download a free QR code reader in the App Store for Apple Layout: Dsign Grafisk Form, Helen Eriksson AB devices or in Google Play for Android, for example Quick Scan QR Code Reader (iPhone) or QR Droid Code Scanner Print: Taberg Media Group, Taberg 2018 (Android). Cover by Ingvar Westerdahl/Thomas Isaksson SWEDRES |SVARM 2017 3 Preface Since the mid-1940s, antibiotics have been a highly valu- the European Commission, concludes that a number of aspects able in effectively treating serious infections in humans and of the measures put in place in Sweden could serve as an illus- animals. However, the effectiveness of antibiotics is threat- tration of potential good practices to other Member States. ened by increasing levels of resistance to more and more anti- Surveillance of antibiotic resistance and antibiotic use and biotics. The spread of resistance is fuelled by high selective cooperation between sectors in a One Health perspective are pressure from imprudent use in humans and animals, from crucial in the work to counteract the spread of antibiotic resist- environmental pollution with antibiotics, e.g. from produc- ance. This report is the result of collaboration between the tion facilities, and from use for growth promotion purposes National Veterinary Institute and the Public Health Agency in animal husbandry. In addition, healthcare-associated infec- of Sweden to present and analyse Swedish data on antibiotic tions promote the spread of resistant bacteria in hospitals. All resistance and the use of antibiotics in animals and humans. of these issues must be addressed globally in order to improve Last year the Public Health Agency of Sweden focused on the current situation. improving surveillance through cooperation with regional Fortunately, the urgency to stop the development of antibi- clinical microbiological laboratories and healthcare – connect- otic resistance has been recognised internationally, and several ing laboratories and automatically collecting data on resistance initiatives are being taken. These include recent action plans and issuing warnings when serious resistance is discovered. and strategies from the United Nations, the World Health Related to this is an initiative led by the National Veterinary Organization, the World Organization of Animal Health, and Institute to develop a network of Swedish veterinary laborato- the EU Commission as well as the on-going implementation ries to increase the quality of diagnostic susceptibility testing. of the Global AMR Surveillance system. Another aim of this initiative is to include data from more Sweden has put into place national, inter-sectorial strate- laboratories in the surveillance. gies and action plans for addressing antibiotic resistance. The While the situation in Sweden regarding antibiotic resist- Swedish action plan to counteract antibiotic resistance was ance is favourable compared to other countries, resistance in revised in 2017, and follow-ups and revisions will be made bacteria from humans have gradually increased since surveil- annually. lance started. In addition, several regional and a few national In the autumn of 2017, the European commission (DG hospital outbreaks are reported every year. This emphasises SANTE F) undertook a fact-finding mission to gather infor- the need for continued efforts in all preventive areas and for mation from competent authorities and other stakeholders collaboration among all sectors in society. The situation in the in Sweden on the implementation of measures for tackling veterinary sector is also generally favourable, with low occur- the issues of antibiotic resistance relating to use of veterinary rence of most types of resistances, and bacteria causing clinical medicines, and to identify good practices or difficulties expe- disease in animals are mostly susceptible to the antibiotics that rienced. The report from the mission, published on the web of are relevant for treatment. Solna and Uppsala 2018-05-22 Johan Carlson Jens Mattsson Director General Director General The Public Health Agency of Sweden National Veterinary Institute 4 SWEDRES |SVARM 2017 Contributors and participants Editors Other contributors in Svarm Olov Aspevall and Erika Olsson, National Veterinary Institute Public Health Agency of Sweden Boel Harbom, Mattias Myrenås and Eva Säker Oskar Nilsson and Märit Pringle, National Veterinary Institute, Sweden Farm & Animal Health Maria Lindberg Project Manager Hanna Billström, Public Health Agency of Sweden Acknowledgements The analysis of data was made in collaboration with: Authors Swedres Ingrid Brännström, Charlotta Edlund, Christer Norman, Public Health Agency of Sweden Mats Erntell, Annika Hahlin, Mikael Hoffmann, Gunnar Olov Aspevall, Hanna Billström, Alma Brolund, Kahlmeter, Johan Struwe and Christina Åhrén. Petra Edquist, Nasanin Hashemi, Sara Hæggman, Jenny Hellman, Jerker Jonsson, Eva Morfeldt, Barbro Mäkitalo, Data on antibiotic use in relation to number of admissions Erika Olsson, Karin Sjöström, Anders Ternhag, Tomas and number of patient days in somatic hospital care during Söderblom, Vendela Wiener and Thomas Åkerlund 2013-2017 were kindly provided by pharmacists in local Strama-groups. Medical Products Agency Sahra Barzi The national surveillance of antibiotic resistance would not have been possible without the contribution of data and Department of Clinical Microbiology, active support of all the Swedish clinical microbiology Karolinska University Hospital, Solna laboratories. Christian Giske Complementary epidemiological information on clinical National Reference laboratory for Antibiotic notifications has been performed by the local County Resistance, Växjö Hospital Departments for Communicable Disease Control. Gunnar Kahlmeter Thank you to Kerstin Ortman and Hanna Arosenius at National Reference Laboratory for Pathogenic Animalycen, Skara for kindly providing SVA with clinical Neisseria, Örebro University Hospital isolates and susceptibility results from clinical submissions Hans Fredlund, Susanne Jacobsson and Magnus Unemo from animals. Authors Svarm Thank you also to environmental departments in several National Veterinary Institute municipalities for collecting samples of fresh meat from Björn Bengtsson, Karin Bergström, Stefan Börjesson, Anna retail for ESBL-screening. Duse, Helle Ericsson Unnerstad, Christina Greko, Annica Landén, Oskar Nilsson and Märit Pringle SWEDRES |SVARM 2017 5 Content Preface �����������������������������������������������������������������������������������3 In Focus Next generation sequencing (NGS) reveals Contributors and participants �����������������������������������������������4 different population-structures of Escherichia coli Sammanfattning/Summary ���������������������������������������������������7 carrying blaCMY-2 and E. coli carrying blaCTX-M-1 in Guidance for readers �����������������������������������������������������������13 the Swedish broiler production ��������������������������������������66 Methicillin-resistant Sales of antibiotics for humans ..........................................17 Staphylococcus aureus (MRSA) �������������������������������������68 Total sales of antibiotics for humans ������������������������������17 Methicillin-resistant Antibiotics in outpatient care �����������������������������������������18 Staphylococcus pseudintermedius (MRSP) ���������������������71 Gender differences �����������������������������������������������������19 Zoonotic pathogens ��������������������������������������������������������72 Antibiotics commonly used to treat Salmonella �������������������������������������������������������������������72 respiratory tract infections, urinary tract Campylobacter ��������������������������������������������������������������75 infections and skin and soft tissue infections ������������19 Clinical isolates from animals �����������������������������������������76 Antibiotic consumption in children ��������������������������24 Pigs �����������������������������������������������������������������������������76 County data ����������������������������������������������������������������25 Cattle ��������������������������������������������������������������������������80
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