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Swedres-Svarm 2005 SVARM Swedish Veterinary Antimicrobial Resistance Monitoring Preface .............................................................................................4 Summary ..........................................................................................6 Sammanfattning................................................................................7 Use of antimicrobials (SVARM 2005) .................................................8 Resistance in zoonotic bacteria ......................................................13 Salmonella ..........................................................................................................13 Campylobacter ...................................................................................................16 Resistance in indicator bacteria ......................................................18 Escherichia coli ...................................................................................................18 Enterococcus .....................................................................................................22 Resistance in animal pathogens ......................................................32 Pig ......................................................................................................................32 Cattle ..................................................................................................................33 Horse ..................................................................................................................36 Dog .....................................................................................................................37 Cat ......................................................................................................................39 Appendix 1: Demographic data .......................................................42 Appendix 2: Materials and methods, use of antimicrobials ..............44 Appendix 3: Materials and methods, resistance monitoring ............45 Appendix 4: Antimicrobial agents licensed ......................................49 Appendix 5: References ..................................................................50 © Statens Veterinärmedicinska Anstalt, National Veterinary Institute Uppsala, Sweden Printed by Edita Västra Aros, Västerås, Sweden ISSN Produced by SVA Graphic production by Björn Lundquist AB, Malmö, Sweden Photographs by Bengt Ekberg, SVA SVARM 2005 Swedish Veterinary Antimicrobial Resistance Monitoring Editors Björn Bengtsson, Christina Greko and Ulrika Grönlund-Andersson Department of Antibiotics, National Veterinary Institute (SVA) SE-751 89 Uppsala Sweden Authors Björn Bengtsson, Anders Franklin, Christina Greko and Ulrika Grönlund-Andersson Department of Antibiotics, SVA Kristina Odensvik Apoteket AB (National Corporation of Swedish Pharmacies) SVARM laboratory working group Maria Finn, Margareta Horn af Rantzien, Annica Landén, Verena Rehbinder and Susanna Thyselius Department of Antibiotics, SVA SVARM advisory committee Björn Bengtsson, Anders Franklin, Christina Greko and Ulrika Grönlund-Andersson, Department of Antibiotics, SVA Viveka Båverud, Department of Bacteriology, SVA Desirée Jansson, Department of Pigs, Poultry and Ruminants, SVA Ivar Vågsholm, Zoonosis Center, SVA Kristina Odensvik, Apoteket AB Text and tables may be cited and reprinted only with reference to this report Suggested citation: SVARM 2005, Swedish Veterinary Antimicrobial Resistance Monitoring. The National Veterinary Institute (SVA), Uppsala, Sweden, 2006. www. sva.se, ISSN 1650-6332. This report is available at www.sva.se Reprints can be ordered from Department of Antibiotics 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] S VA R M 2 0 0 5 3 Preface WELCOME to the fourth Swedish report combining results animal pathogens is thereby available for practitioners, facili- from the monitoring of antimicrobial resistance and anti- tating the therapeutic choice in the clinical setting. Moreover, microbial usage in both veterinary and human medicine: high-quality data allows appropriate analysis of trends in SVARM and SWEDRES. It is today generally accepted that resistance and of underlying causes for such trends and will all use of antimicrobials in different sectors contributes to be a most important complement to the data from indicator the development of resistance. This joint report will facilitate and zoonotic bacteria. SVARMpat is run in collaboration comparisons of resistance levels and incidence of use in the between the National Veterinary Institute (SVA) and the two areas. Swedish Animal Health Service (SvDHV) and is financed by In 2005, surveillance of antimicrobial resistance in animal the Swedish Board of Agriculture. pathogens in Sweden has been significantly broadened with According to the Zoonosis Directive that was adopted in the initiation of SVARMpat. The objective of SVARMpat is the EU in 2003, surveillance of antimicrobial resistance shall to improve the monitoring of pathogens in farm animals by not only comprise zoonotic organisms such as Salmonella active, targeted sampling and collection of high-quality data and Campylobacter but should also include indicator bacteria on antimicrobial resistance. Results will be reported yearly in such as Escherichia coli and enterococci from food animals the SVARM report. Updated knowledge on susceptibility of and food. The indicator bacteria constitute a reservoir of 4 S VA R M 2 0 0 5 resistance genes that may be transferred to pathogenic bacte- on unfavourable development of resistance indicate that the ria in animals and man. SVARM will in the near future also antimicrobial arsenal available is becoming more and more include zoonotic and indicator bacteria isolated from food limited. Further efforts must be made to prevent infectious of animal origin, according to a decision by the Swedish diseases both in human and in veterinary medicine by other Parliament in 2006. The programme will be initiated and means. organised in collaboration between SVA and the National Our hope is that this report will serve as a basis for policy Food Administration. recommendations and intervention strategies, and that it will Data in this report indicate, as also the data presented increase our understanding of the dynamics of resistance. The previously, that the Swedish strategies in human and veteri- ultimate goal is to preserve the effectiveness of available anti- nary medicine have been successful in containing resistance. microbials for man and animals. The general concept is to use antimicrobials only when needed, on prescription by a professional only, and that the choice of treatment is based on relevant information. Notwithstanding, some of the presented results in both veterinary and human fields are cause for concern. Examples S VA R M 2 0 0 5 5 Summary THE SIXTH REPOrt from SVARM shows that the situation Indicator bacteria, i.e. Escherichia coli and Enterococcus spp. regarding antimicrobial resistance in bacteria of animal origin from healthy animals, are monitored since resistance in the is stable. Resistance does occur but viewed from an interna- normal gut flora reflects the antimicrobial selective pressure in tional perspective the prevalence is low. Likewise, data in the an animal population. If harmonised methodology is used, data corresponding report covering human medicine, SWEDRES can be compared over time and on an international level. This (http://www.strama.org or http://www.smittskyddsinstitutet. year, indicator bacteria from healthy slaughter pigs were moni- se) indicate a favourable situation. tored. Levels of resistance are low in an international perspec- The total amount of antimicrobials used for animals tive and have been stable since monitoring began year 2000. has declined since the mid 90s but the figures are roughly Resistance mostly occurs to substances used in pig production. unchanged from year 2003. The sales of pleuromutilins for in- Hence, resistance to ampicillin, streptomycin, sulphonamides, feed or in-water medication of pigs has decreased by 39% over tetracycline or trimethoprim in E. coli and resistance to tetracy- the last five years. The decrease is probably explained by efforts cline or macrolides in enterococci are the most common traits. to contain swine dysentery. The use of macrolides has also In E. coli, resistance to third generation cephalosporins was not decreased by 31%, but the use of tetracyclines for in-feed or in- observed and quinolone resistance was rare. Vancomycin resist- water medication, adjusted for the lower dose of doxycycline ant enterococci were not isolated from pigs. In both E. coli and has increased by 21% since year 2000. These changes probably Enterococcus, there are indications of linked resistance genes. reflect a change in prescription pattern for treatment of respira- Resistance to some antimicrobials might therefore be a conse- tory infections in pigs. quence of co-selection whereby use of one antimicrobial selects The use of antimicrobials for dogs in year 2005 was esti- for resistance also to other substances. mated to 318 prescriptions/1000 dogs. Almost half (48%) Vancomycinresistant enterococci (VRE) were isolated on of the prescriptions were for cephalosporins or amoxicillin media supplemented with vancomycin, from 41 of 99 samples combined with clavulanic acid, and 14% were for fluoroqui- from chickens using. Since the start of monitoring year 2000, nolones. The
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