SVARM|2010 Swedish Veterinary Antimicrobial Resistance Monitoring Content Swedish Veterinary Antimicrobial Resistance Monitoring 2010 Preface .............................................................................................3 Guidance for readers ........................................................................4 Editors Summary ..........................................................................................5 Björn Bengtsson, Helle Ericsson Unnerstad, Sammanfattning...............................................................................7 Christina Greko, Ulrika Grönlund Andersson and Annica Landén Use of antimicrobials .......................................................................9 Department of Animal Health and Zoonotic bacteria ...........................................................................14 Antimicrobial Strategies, National Veterinary Salmonella ...................................................................................14 Institute (SVA) SE-751 89 Uppsala, Sweden Campylobacter .............................................................................18 Methicillin resistant Staphylococcus aureus (MRSA) ....................19 Authors Highlight: Escherichia coli with ESBL - or transferrable Björn Bengtsson, Helle Ericsson Unnerstad, AmpC-type resistance in broilers .............................................22 Christina Greko, Ulrika Grönlund Andersson and Annica Landén Indicator bacteria ...........................................................................24 Department of Animal Health and Escherichia coli .............................................................................24 Antimicrobial Strategies, SVA Enterococcus .................................................................................28 Maria Egervärn, Hans Lindmark National Food Administration Highlight: Coagulase positive staphylococci from broiler, pig and cattle carcasses ..............................................................34 SVARM laboratory working group Animal pathogens ..........................................................................36 Stefan Börjesson, Kerstin Ekström, Maria Pig ..............................................................................................36 Finn, Margareta Horn af Rantzien, Annica Landén and Eva Säker Cattle .........................................................................................39 Department of Animal Health and Farmed fish ................................................................................40 Antimicrobial Strategies, SVA Highlight: SVARMpat ...................................................................41 Horse .........................................................................................42 Acknowledgements Several people have in various ways been Dog ............................................................................................45 involved in the work with SVARM and Cat .............................................................................................47 we express our gratitude to all who have Highlight: Methicillin resistant Staphylococcus contributed. pseudintermedius (MRSP) – an update .......................................48 Text and tables may be cited and reprinted Appendix 1: Demographic data .....................................................49 only with reference to this report Appendix 2: Materials and methods, use of antimicrobials ...........51 Suggested citation: SVARM 2010, Swedish Veterinary Antimicrobial Resistance Appendix 3: Materials and methods, resistance monitoring..........52 Monitoring. The National Veterinary Appendix 4: Cut-off values for resistance ......................................55 Institute (SVA), Uppsala, Sweden, 2011. Appendix 5: Antimicrobial agents licensed ....................................56 www.sva.se, ISSN 1650-6332. Appendix 6: References ..................................................................57 This report is available at www.sva.se Appendix 7: SVARM 2000-2010 - an overview .............................60 Reprints can be ordered from Department of Animal Health and Antimicrobial Strategies National Veterinary Institute SE-751 89 Uppsala Sweden Phone: +46 (0) 18 67 40 00 © Statens Veterinärmedicinska Anstalt, Fax: +46 (0) 18 30 91 62 National Veterinary Institute, Uppsala, Sweden e-mail: [email protected] Printed by Edita Västra Aros, Västerås, Sweden ISSN Produced by SVA Graphic production by Edita Västra Aros, Västerås, Sweden Photographs by Bengt Ekberg, SVA SVARM|2010 3 Preface WELCOME to the eleventh Swedish report combining results cine, preventive herd health is a well known concept. Herd from the monitoring of antimicrobial resistance and antimi- health programs combine knowledge from diverse fields such crobial usage in both veterinary and human medicine: SVARM as animal husbandry, composition of animal feed and disease and SWEDRES. These two reports are printed jointly to control. If properly designed, such programs can be instru- increase the awareness of trends in incidence of use and occur- mental to mitigate emergence and spread of resistance in rence of antimicrobial resistance in the respective areas. animal populations. Antimicrobial resistance is a good example of the rele- An important aspect of strategies against resistance is reli- vance of the one health concept. Fundamental is that bacteria able diagnostics, including susceptibility testing. In the clini- in animals, humans and in the environment are interlinked cal setting, diagnostics are needed to support the prudent by several direct or indirect routes. Thereby resistant bacte- and rational choice of therapy. But diagnostics is also vital for ria can spread within and between human communities, appraisal of the situation regarding resistant strains in herds animal populations and the environment. One of the routes of animals or in patients at veterinary clinics. Thus, it is only connecting intestinal bacteria of animals and humans is food. possible to manage what can be measured and only if the It is therefore our intention to further develop the studies in situation is known can effective action be taken. In a wider SVARM on resistance in bacteria from food. context, monitoring programs provide knowledge needed Not only the epidemiology of resistance is complex but for informed decisions on interventions and also measure the also the actions needed to counteract resistance comprise a effects of interventions. It is our hope and belief that the data multitude of aspects. Paramount is reduction of the selec- presented in SVARM will be useful for appraisal of the situa- tion pressure exerted by use of antimicrobials. This is best tion on a national level and in a wider context also adds a piece achieved by reducing the need for antimicrobials by preven- to the global puzzle on antimicrobial resistance. tion of diseases in animals and humans. In veterinary medi- 4 SVARM|2010 Guidance for readers Cut-off values for resistance Multiresistance In SVARM, isolates of indicator bacteria and zoonotic bacte- The term “multiresistance” is used in SVARM with a mean- ria are classified as susceptible or resistant by epidemiological ing as proposed by Schwarz et al. (2010). Briefly, isolates with cut-off values (ECOFF) issued by EUCAST and available on phenotypically identified acquired resistance to three or more line at www.eucast.org. Also animal pathogens are classified by antimicrobial classes are deemed multiresistant. This implies ECOFFs when such values are available. Cut-off values used for example that resistance to ciprofloxacin, enrofloxacin are given in Appendix 4. and nalidixic acid represents resistance to one class of antimi- ECOFFs classify isolates with acquired reduced susceptibil- crobials. ity as non-wild type, in SVARM called “resistant”. This clas- sification is relevant for monitoring purposes, but it should be Antimicrobial abbreviations understood that this does not always implies clinical resistance. Since the first report from SVARM, some cut-off values for Am ampicillin Fu fusidic acid resistance have been changed. To facilitate comparisons when Ba bacitracin Gm gentamicin retrospect data are presented in SVARM 2010, levels of resist- Ce ceftiofur Km kanamycin ance have been recalculated using current cut-off values if not Ci ciprofloxacin Na narasin otherwise stated. Cl clindamycin Nal nalidixic acid Cm chloramphenicol Ox oxacillin Indicator bacteria Col colistin Sm streptomycin In SVARM, Escherichia coli, Enterococcus faecalis and Enterococcus Ct cephalothin Su sulphonamide serve as indicators for presence of antimicrobial resist- faecium Ctx cefotaxime Tc tetracycline ance in the enteric flora of healthy animals and in the flora Ef enrofloxacin Tp trimethoprim contaminating retail meat. The prevalence of acquired resist- Em erythromycin Va vancomycin. ance in such commensal bacteria indicates the magnitude of Fox cefoxitin Vi virginiamycin the selective pressure from use of antimicrobials in an animal population. Most bacteria of the enteric flora are unlikely to Ff florfenicol cause disease, but they can be reservoirs for resistance genes that can spread to bacteria that cause infections in animals or humans. Prevalence of resistance in bacteria contaminating Other abbreviations meat indicates the magnitude of the potential risk of human exposure to such reservoirs in food producing animals. ESBL extended spectrum beta-lactamases EUCAST European Committe on Antimicrobial Susceptibility Testing