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Swedres-Svarm 2014 2014 SWEDRES|SVARM Consumption of antibiotics and occurrence of antibiotic resistance in Sweden 2 SWEDRES |SVARM 2014 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: Jenny Hellman and Olov Aspevall, Public Health Agency of Sweden Björn Bengtsson and Märit Pringle, National Veterinary Institute Addresses: 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 ISSN 1650-6332 ISBN 978-91-7603-360-9 (pdf) ISBN 978-91-7603-361-6 (print) Article no. at Folkhälsomyndigheten 14027 This title and previous Swedres and Svarm reports are available for downloading at www.folkhalsomyndigheten.se/publicerat-material/ or www.sva.se. The title can also be ordered from the webshop at: www.folkhalsomyndigheten.se/publicerat-material/ or Department of Animal Health and Antimicrobial Strategies, 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] 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 2014. Consumption of antibiotics and occurrence of antibiotic resistance in Sweden. Solna/Uppsala ISSN 1650-6332 Print & Layout: Edita Västra Aros AB Cover by Ingvar Westerdahl/Thomas Isaksson SWEDRES |SVARM 2014 3 Preface The 2014 Swedish report from the monitoring of anti- Public Health Agency of Sweden and the Swedish Ministry biotic resistance and antibiotic consumption in human and of Health and Social Affairs. veterinary medicine, Swedres-Svarm, is an integrated report This year’s report shows that Sweden is still in a very favour- from the Public Health Agency of Sweden and the National able situation and that the levels of resistance continue to be Veterinary Institute that includes data from humans, animals low. In some areas of the veterinary sector, we have even seen and food. The report is a result of the successful collabora- some improvements relative to previous years. Thankfully, the tion between the relevant sectors in Sweden. screening of all breeding herds once again showed that MRSA Through a ‘One Health’ approach, we stand a better has not spread among breeding pigs in Sweden. chance to respond to the challenges of antibiotic resistance We can conclude that in a global perspective Sweden is and the way we use, and sadly, misuse, antibiotics. Veterinary better off compared to most countries, but we are far from and human medicine must act and work in a synchronised being spared the problems associated with antibiotic resist- manner, and this is the reason why a large number of Swedish ance. Consequently, further efforts are needed to counter the governmental authorities have been working together to selection and spread of resistance, and one key component in prepare a joint action plan against antibiotic resistance in that work is high-quality information about the current situ- 2014. In parallel with that work, a joint communication ation in the country. strategy has been adopted that will ensure greater impacts This December it will be 70 years since Sir Alexander for whatever actions are taken. During the last year, several Fleming held his now famous Nobel Laureate lecture in initiatives have been taken that cross traditional political and Stockholm. Even then he warned the audience about the national boundaries and involve many of our experts. Of perils of misusing antibiotics and what would happen if we particular importance in a Swedish context was a high-level chose not to use them wisely. His warnings still hold true, meeting focusing on a global programme for surveillance of and hopefully there is still time to act upon them in truly antibiotic resistance that was co-hosted by the WHO, the global manner. Johan Carlson Jens Mattsson Director General Director General Public Health Agency of Sweden National Veterinary Institute 4 SWEDRES |SVARM 2014 Contributors and participants Authors Swedres Other contributors in Svarm Public Health Agency of Sweden National Veterinary Institute Olov Aspevall, Bo Aronsson, Petra Edquist, Malin Grape, Kerstin Ekström, Maria Finn, Mattias Myrenås and Sara Hæggman, Mats Hedlin, Jenny Hellman, Jerker Eva Säker Jonsson, Sonja Löfmark, Eva Morfeldt, Barbro Mäkitalo, Christer Norman, Magdalena Prioux, Karin Sjöström, Farm & Animal Health Gunilla Skoog, Anders Ternhag, Tomas Söderblom and Maria Lindberg Thomas Åkerlund Swedish Board of Agriculture Medical Products Agency Kinfe Girma Hans Olaisson Department of Infectious Diseases, Danderyds Acknowledgements Hospital, Stockholm The analyse of the antibiotic consumption was made in Jesper Ericsson close collaboration with the external group of antibiotic sales data of the Public Health Agency of Sweden: Ingrid Department of Clinical Microbiology, Brännström, Jonatan Dahlqvist, Mats Erntell, Annika Karolinska University Hospital, Solna Hahlin, Mikael Hoffmann and Anastasia Nyman. Christian Giske Data on antibiotic use in relation to number of admissions National Reference laboratory for Antibiotic and number of patient days in somatic hospital care during Resistance, Växjö Hospital 2010-2014 were kindly provided by pharmacists in local Gunnar Kahlmeter Strama-groups. National Reference Laboratory for Pathogenic Strama collaboration group of the Public Health Agency Neisseria, Örebro University Hospital of Sweden formerly the Strama advisory board. Hans Fredlund, Susanne Jacobsson and Magnus Unemo The national surveillance of antibiotic resistance would Department of Communicable Disease Control, not have been possible without the contribution of data The County Council, Region of Halland and active support of all the Swedish clinical microbiology Mats Erntell laboratories. Strama group, Kalmar County Complementary epidemiological information on clinical Per-Åke Jarnheimer Olsson notifications has been performed by the local County Departments for Communicable Disease Control. Authors Svarm Data on antimicrobials for animals sold with special license National Veterinary Institute were kindly provided by pharmaceutical companies. Björn Bengtsson, Karin Bergström, Stefan Börjesson, Anna Duse, Helle Ericsson Unnerstad, Christina Greko, Annica Kerstin Ortman and Hanna Arosenius at Eurofins Food & Landén, Oskar Nilsson, Märit Pringle and Julia Österberg. Agro, Skara for kindly provided SVA with clinical isolates and susceptibility results from clinical submissions from animals. Other contributors in Swedres National Board of Health and Welfare Andrej Leimanis SWEDRES |SVARM 2014 5 Content Preface ...................................................................................3 Zoonotic pathogens ..........................................................63 Contributors and participants ...............................................4 Salmonella .......................................................................63 Sammanfattning/Summary ...................................................7 Campylobacter .................................................................67 Guidance for readers ...........................................................13 Clinical isolates from humans ...........................................68 Isolates from blood cultures reported to Consumption of antimicrobials ........................................17 ECDC/EARS-Net ........................................................68 Total consumption of antibiotics in humans ....................17 Resistance in other bacterial species from blood cultures...........................................................................70 Antibiotics in outpatient care ............................................18 The annual resistance surveillance and quality Gender differences ........................................................19 control programme (ResNet) ........................................71 Antibiotics commonly used to treat respiratory Clostridium difficile ..........................................................73 tract infections, urinary tract infections and skin and soft tissue infections ...............................................19 Neisseria gonorrhoeae .......................................................75 Antibiotic consumption in children ..............................23 Neisseria meningitidis ......................................................75 County data ...................................................................25 Mycobacterium tuberculosis ...............................................76 Antibiotics in dentistry ..................................................27 Clinical isolates from animals ...........................................77 In focus National campaign for improved Pigs.................................................................................77 patient safety ..................................................................28 Cattle .............................................................................79 Antibiotics in hospital care ...............................................31 Sheep..............................................................................82
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