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2004 NORM NORM-VET Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway ISSN: 1502-2307 Any use of data from NORM/NORM-VET 2004 should include specific reference to this report. Suggested citation: NORM/NORM-VET 2004. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Tromsø / Oslo 2005. ISSN:1502-2307. This report is available at www.vetinst.no and www.antibiotikaresistens.no 1 NORM / NORM-VET 2004 CONTRIBUTORS AND PARTICIPANTS Editors: Hilde Kruse NORM-VET, National Veterinary Institute Gunnar Skov Simonsen NORM, Dept. of Microbiology, University Hospital of North Norway and Norw. Inst. of Public Health Authors: Hege Salvesen Blix Norwegian Institute of Public Health Kari Grave VETLIS / Norwegian School of Veterinary Science Merete Hofshagen NORM-VET, National Veterinary Institute Bjørn Iversen Norwegian Institute of Public Health Hilde Kløvstad Norwegian Institute of Public Health Hilde Kruse NORM-VET, National Veterinary Institute Jørgen Lassen Norwegian Institute of Public Health Turid Mannsåker Norwegian Institute of Public Health Madelaine Norström NORM-VET, National Veterinary Institute Gunnar Skov Simonsen NORM, Dept. of Microbiology, University Hospital of North Norway and Norw. Inst. of Public Health Martin Steinbakk NORM, Dept. of Microbiology, University Hospital of North Norway and Akershus Univ. Hospital Marianne Sunde National Veterinary Institute Institutions participating in NORM-VET: Norwegian Food Safety Authority National Veterinary Institute, Norwegian Zoonosis Centre Madelaine Norström / Hilde Kruse / Merete Hofshagen National Veterinary Institute, Section of Bacteriology Hanne Tharaldsen / Marianne Sunde Norwegian Institute of Public Health Jørgen Lassen / Trine-Lise Stavnes Institutions participating in NORM: Aker University Hospital, Department of Bacteriology Signe H. Ringertz / Bitten Rasmussen Akershus University Hospital, Department of Microbiology Martin Steinbakk / Siri Haug Bærum Hospital, Central Laboratory, Section of Microbiology Pål A. Jenum / Merriam Sundberg Central Hospital of Buskerud, Department of Microbiology Hjørdis Iveland / Ellen Grimstad Central Hospital of Nordland, Department of Microbiology Liisa Mortensen / Hege Elisabeth Larsen Central Hospital of Nord-Trøndelag, Levanger, Department of Microbiology Arne Mehl / Anne-Kristine Lorås Central Hospital of Oppland, Lillehammer, Department of Microbiology Einar Aandahl / Viggo Hasseltvedt / Kari Ødegaard Central Hospital of Hedmark, Elverum, Laboratory of Microbiology Linda Schildman / Lene Bjøntegård Central Hospital of Østfold, Department of Microbiology Eivind Ragnhildstveit / Anne Cathrine Hollekim Stavanger University Hospital, Department of Microbiology Elisebet Haarr / Tone Roa Central Hospital of Sogn og Fjordane, Department of Microbiology Reidar Hjetland / Astrid Vedde Central Hospital of Vest-Agder, Department of Microbiology Sølvi Noraas / Torill S. Larsen Central Hospital of Vestfold, Department of Microbiology Rolf Schøyen / Astrid Lia Central Hospital of Hordaland, Haugesund, Department of Microbiology Liv J. Sønsteby / Pirrko-Liisa Kellokumpu County Hospital of Møre og Romsdal, Molde, Department of Microbiology Einar Vik / Jytte Scheby County Hospital of Møre og Romsdal, Ålesund, Department of Microbiology Reidar Hide / Anna Haugen Haukeland Univ. Hospital, Department of Immunology and Microbiology Asbjørn Digranes / Torunn Sneide Haukeland National Hospital, University of Oslo, Institute of Medical Microbiology Fredrik Müller / Magli Bøvre National Cancer Hospital, Laboratory of Microbiology Jørgen Lassen / Inchis Engelstad / Merete R. Ueland Norwegian Institute of Public Health, Laboratory of Enteric Pathogens Jørgen Lassen / Trine-Lise Stavnes Telelab A/S, Skien Yngvar Tveten / Monica Kollstrøm Ullevål University Hospital, Department of Microbiology Gaute Syversen / Thea Bergheim University Hospital of North Norway, Department of Microbiology Gunnar Skov Simonsen / Siv-Heidi Barkhald University Hospital of Trondheim, Department of Microbiology Trond Jacobsen / Sissel Kristiansen Stubø Laboratory of Clinical Medicine, Oslo Heidi Svanevik / Wibeke Aasnæs NORM reference group in 2004: Inger Sofie Samdal Vik Norwegian Institute of Public Health Fredrik Müller National Hospital, University of Oslo, Institute of Medical Microbiology Astrid Lia Central Hospital of Vestfold, Department of Microbiology Olav Natås Central Hospital of Rogaland, Department of Microbiology Arne Broch Brantsæter Norwegian Institute of Public Health Elisabeth von der Lippe Ullevål University Hospital, Department of Infectious Diseases Mark Fagan Froland Community Health Center The NORM and NORM-VET programmes are part of the Norwegian Government’s Action Plan against Antimicrobial Resistance issued in 2000. 2 NORM / NORM-VET 2004 CONTENTS CONTENTS I. Introduction ………………………………………………………………………………………… 5 II. Sammendrag (norsk) ……………………………………………………………………………….. 6 III. Summary (English)………………………………………………………………………………….. 9 IV. Population statistics…………………………………………………………….……………...…….. 12 V. Usage of antimicrobial agents A. Usage in animals…………………………………………………………………………………. 13 B. Usage in humans.………………………………………………………………………………… 17 VI. Occurrence of antimicrobial resistance A. Animal clinical isolates Staphylococcus intermedius from dogs…................... 25 Escherichia coli from swine and poultry………....…. 27 B. Indicator bacteria from animals and food Escherichia coli from dogs.................………………. 29 Escherichia coli from swine and broilers...…………. 30 Enterococcus spp. from dogs.................…………….. 33 Enterococcus spp. from swine and broilers...……….. 34 C. Zoonotic and non-zoonotic enteropathogenic bacteria Salmonella spp. ……………………………………… 39 Campylobacter spp. …………………………………. 44 Yersinia enterocolitica………………………………. 48 Shigella spp. .………………….............…………….. 49 D. Bacteria from human clinical specimens Blood culture Distribution of bacterial species in blood cultures....... 51 Escherichia coli..……………………………………. 55 Klebsiella spp. ………………………………………. 58 Detection of ESBL in E. coli and Klebsiella spp......... 60 Enterococcus spp. ……………….…….……………. 64 Streptococcus pneumonia……………………………. 67 Staphylococcus aureus. ……………….…………….. 69 Respiratory tract Haemophilus influenzae…………………………....... 72 Respiratory tract and wounds Streptococcus pyogenes..………………………...….. 74 Wounds Staphylococcus aureus….…………………………… 76 Urinary tract Escherichia coli.…………………………………….. 78 Tuberculosis Mycobacterium tuberculosis.….……….……………. 79 Norwegian information campaign on appropriate antibiotic use by Hilde Kløvstad ......................... 16 Usage of antibacterials in Norwegian hospitals by Hege Salvesen Blix...... …………..................... 22 The genetic background for streptomycin resistance in Escherichia coli influences the distribution of MICs by Marianne Sunde and Madelaine Norström…………………………… 32 Antimicrobial resistance in Campylobacter jejuni from humans and broilers in Norway by Madelaine Norström, Jørgen Lassen and Hilde Kruse.....................................…………………. 47 European initiatives for surveillance of antimicrobial use and resistance – ESAC and EARSS by Hege Salvesen Blix and Gunnar Skov Simonsen……………………………………………….. 57 MRSA infections in Norway by Bjørn G. Iversen…………………………………………………. 71 3 CONTENTS NORM / NORM-VET 2004 Appendix 1 Collection of data on usage of antimicrobial agents in animals………………….……….. 80 Appendix 2 Collection of data on human usage of antimicrobial agents………………………………. 81 Appendix 3 Sampling, microbiological methods and data processing in NORM-VET………………... 82 Appendix 4 Sampling, microbiological methods and data processing of zoonotic and non-zoonotic enteropathogenic bacteria in NORM and NORM-VET…………………………………… 84 Appendix 5 Sampling, microbiological methods and data processing in NORM……………………… 85 Appendix 6 Breakpoints NORM-VET..…….…………………………………………..……………… 86 Appendix 7 Breakpoints NORM.......…………………………………………………………….….…. 87 4 NORM / NORM-VET 2004 INTRODUCTION I. INTRODUCTION Antimicrobial resistance is an emerging problem as a fundamental component of the strategy for worldwide. It reduces the effectiveness of antimicrobial containment of antimicrobial resistance. The NORM and treatment of infectious diseases in humans and animals NORM-VET programmes were consequently established thereby leading to increased morbidity and mortality, as in order to provide and present microbiologically and well as higher costs. It is well established that there is a epidemiologically valid data on the occurrence and strong association between the usage of antimicrobial distribution of antimicrobial resistance over time. The agents and the occurrence of resistance. The selective national action plan formally expired by the end of 2004. pressure exerted by antimicrobial usage is a key issue in However, a conference organized in September 2004 by the epidemiology of resistance. Moreover, resistance can the Norwegian Institute of Public Health and supported by be disseminated through the spread of resistant pathogenic the Norwegian government issued a report which will bacteria themselves or by horizontal transfer of resistance form the basis for containment of antimicrobial resistance genes from one type of bacteria to another. Such transfer in the years to come. The need for surveillance of both is not limited to closely related bacteria; it can also take resistance and drug usage was again emphasized. place between bacteria of different evolutionary origins and/or ecological sources. Thus,
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