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Norm Norm-Vet 2000 NORM NORM-VET 2000 Consumption of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway CONTRIBUTORS AND PARTICIPANTS Editors: Hilde Kruse NORM-VET, The Norwegian Zoonosis Centre Gunnar Skov Simonsen NORM, Department of Microbiology, University Hospital of Tromsø The following persons contributed to the writing of this report: Hege Salvesen Blix WHO Collaborating Centre for Drug Statistics Methodology Kari Grave VETLIS / The Norwegian School of Veterinary Science Einar Heldal The National Health Screening Service / The National Tuberculosis Register Merete Hofshagen NORM-VET, The Norwegian Zoonosis Centre Hilde Kruse NORM-VET, The Norwegian Zoonosis Centre Jørgen Lassen The National Institute of Public Health Ane Nødtvedt NORM-VET, The Norwegian Zoonosis Centre Per Sandven The National Institute of Public Health Gunnar Skov Simonsen NORM, Department of Microbiology, University Hospital of Tromsø Martin Steinbakk NORM, Department of Microbiology, University Hospital of Tromsø The following institutions participate in the NORM-VET surveillance system: The Municipal Food Control Authorities The Norwegian Food Control Authority The Norwegian Animal Health Authority The National Institute of Public Health Jørgen Lassen / Trine-Lise Stavnes The National Veterinary Institute Gudmund Holstad / Tormod Mørk / Ellen Christensen / Hanne Tharaldsen The Norwegian Zoonosis Centre Merete Hofshagen / Hilde Kruse / Ane Nødtvedt The following institutions participate in the NORM surveillance system: Laboratory of Enteric Pathogens, The National Institute of Public Health Jørgen Lassen / Trine-Lise Stavnes Department of Microbiology, Ullevål University Hospital Turid Mannsåker / Thea Bergheim Department of Immunology and Microbiology, Haukeland University Hospital Asbjørn Digranes / Berit Riksheim Department of Microbiology, University Hospital of Trondheim Per Leiv Svarva / Randi Valsø Lyng Department of Microbiology, University Hospital of Tromsø Gunnar Skov Simonsen / Merethe Elise Olsen Department of Microbiology, Central Hospital of Oppland Rolf Arne Sandnes / Ingunn Haavemoen Telelab A/S, Skien Yngvar Tveten / Anne Ragnhild Oseid Department of Microbiology, Akershus Central Hospital Martin Steinbakk / Liselotte Buarø Department of Microbiology, Central Hospital of Rogaland Elisebet Haarr / Tone Roa Department of Microbiology, Central Hospital of Nordland Liisa Mortensen / Karstein Korsvik The following persons are members of the NORM-VET steering group: Gunnar Hagen The Norwegian Animal Health Authority Nina Krefting Aas The Norwegian Food Control Authority Ellen Mari Grande The National Agricultural Inspection Service Kåre Fossum The National Veterinary Institute Hilde Kruse The Norwegian Zoonosis Centre The following persons were members of the NORM reference group in 2000: E. Arne Høiby The National Institute of Public Health Reidar Hjetland Department of Microbiology, Central Hospital of Sogn og Fjordane Eirik Holten Department of Microbiology, Central Hospital of Akershus Asbjørn Digranes Department of Immunology and Microbiology, Haukeland University Hospital Inger Sofie Samdal Vik Department of Microbiology, County Hospital of Møre og Romsdal, Molde ISSN: 1502-2307 Any use of data from NORM/NORM-VET 2000 should include specific reference to this report. 2 CONTENTS I. Sammendrag (norsk) ……………………………………………………………………………. 4 II. Summary (English)……………………………………………………………………………… 7 III. Introduction …………………………………………………………………………………….. 10 IV. Demographic data…………………………………………………………….…………………. 11 V. Consumption of antimicrobial agents A. Animal consumption………………………………………………………………………… 12 B. Human consumption ………………..……………………………………………………….. 15 VI. Occurrence of antimicrobial resistance A. Feed / animals / food Bacteria from feed Escherichia coli………………………………….………… 18 Bacteria from animals Staphylococcus spp. ……………………..………………... 19 Bacteria from food Escherichia coli …..……………………………………….. 25 Enterococcus spp.………………………………………….. 26 Coagulase positive Staphylococcus spp.…………….…….. 28 B. Zoonotic and other food-borne microorganisms Salmonella …..…………………………………………….. 29 Shigella spp..………………………………………………. 36 Yersinia enterocolitica…………………………………….. 37 Campylobacter spp.….…………………………………….. 38 C. Human clinical isolates Blood culture Escherichia coli …………………………………….……… 42 Klebsiella spp. ……………………………………………... 43 Enterococcus spp. ………………………………….………. 45 Streptococcus pneumoniae ………………………………… 46 Staphylococcus aureus ……….…………………….……… 48 Respiratory tract Haemophilus influenzae …………………………………… 49 Streptococcus pneumoniae ………………………………… 51 Urinary tract Escherichia coli …………………………………………… 52 Klebsiella spp. ………………………….…………………. 54 Enterococcus spp. ………………………………………… 55 Tuberculosis Mycobacterium tuberculosis ……………………………… 57 Appendix 1 Collection of data on animal consumption of antimicrobial agents……………………. 58 Appendix 2 Collection of data on human consumption of antimicrobial agents……………………. 59 Appendix 3 Sampling, microbiological methods and data handling in NORM-VET………………… 60 Appendix 4 Sampling, microbiological methods and data handling of zoonotic infections…………. 62 Appendix 5 Sampling, microbiological methods and data handling in NORM………………………. 64 Appendix 6 Table of breakpoints ..…………………………………………………………………… 65 3 I. SAMMENDRAG Forbruket av antibiotika til dyr i Norge ligger på et sammenlignet med stafylokokker fra øvrige moderat nivå sammenlignet med mange andre hudinfeksjoner, mens det motsatte var tilfellet når det industrialiserte land, og forbruksmønsteret er i hovedsak gjaldt pencillinresistens. gunstig. Det totale salget av veterinære antibakterielle Til sammen 36% av E. coli fra kyllingkjøtt ble midler godkjent for terapeutisk bruk til dyr i Norge var klassifisert som resistente mot ett eller flere av de 5750 kg i 2000, noe som utgjør en 39% reduksjon siden antibiotika som inngikk i undersøkelsen; 16% mot ett, 1995. Andelen penicilliner av det totale forbruket økte 11% mot to og 9% mot tre eller flere. Resistens mot fra 36% i 1995 til 44% i 2000. I samme periode sank sulfonamider ble hyppigst observert, etterfulgt av aminoglykosidenes andel av det totale forbruket fra 27% resistens mot henholdsvis streptomycin, tetracyklin, til 20%. I 2000 utgjorde penicilliner den største andelen ampicillin, trimetoprim og nalidixinsyre. Til sammen 64 av forbruket (44%), fulgt av sulfa (27%), % av enterokokkene fra kyllingkjøtt ble klassifisert som aminoglykosider (20%), tetracykliner (3%), trimetoprim resistente mot ett eller flere av de antibiotika som og derivater (3%), og andre antibakterielle midler (4%). inngikk. Samlet sett var 38% av isolatene resistente mot Det totale salget av veterinære antibakterielle midler kun ett antibiotikum, 22% mot to, og 4% mot fire eller godkjent for terapeutisk bruk til oppdrettsfisk i Norge flere antibiotika. Resistens mot bacitracin ble hyppigst utgjorde 685 kg i 2000, og kinoloner representerte 76% observert, etterfulgt av resistens overfor tetracyklin, av dette forbruket. I løpet av de siste 13 årene har erytromycin, spiramycin, vankomycin og streptomycin forbruket av antibakterielle midler i oppdrettsnæringen (høygradig). Det er noe terapeutisk bruk av tetracyklin i blitt redusert med 99% samtidig som produksjonen av norsk kyllingproduksjon. oppdrettsfisk er mangedoblet. Denne reduksjonen Til sammen 25 % av E. coli fra svinekjøtt ble klassifisert tilskrives først og fremst innføring av effektive vaksiner, som resistente mot ett eller flere av de antibiotika som men bedrede miljøforhold i oppdrettsnæringen har også inngikk i undersøkelsen; 5% mot ett, 7% mot to og 12% hatt betydning. mot tre eller flere. Resistens mot streptomycin ble Antibakterielle vekstfremmere benyttes ikke lenger i hyppigst observert, etterfulgt av resistens mot husdyrproduksjonen i Norge. Avoparcin ble forbudt i sulfonamider, tetracyklin, trimetoprim og ampicillin. 1995 og virginiamycin i 1998. Bacitracin er ikke forbudt, Disse antibiotika brukes ofte terapeutisk i norsk men benyttes ikke lenger som fôrtilsetningsstoff. Årlig svineproduksjonen. Det ble også observert noe resistens forbruk av koksidiostatika har vært på samme nivå de mot kloramfenikol, kanamycin og gentamicin. Til siste seks årene, selv om forbruksmønsteret har endret sammen 36% av enterokokkene fra svinekjøtt ble seg. Narasin har dominert bruken siden 1996, mens klassifisert som resistente mot ett eller flere av de bruken av andre ionofore koksidiostatika har sunket. antibiotika som inngikk. Sett under ett var 24% av Den relativt gunstige situasjonen med hensyn til bruk av isolatene resistente mot kun ett antibiotikum, 9% mot to antibiotika i norsk landbruk gjenspeiler seg i en moderat og 2% mot tre eller flere antibiotika. Resistens mot forekomst av antibiotikaresistens blant bakterier isolert tetracyklin ble hyppigst observert, etterfulgt av resistens fra norske husdyr og animalske produkter. mot bacitracin, trimetoprim, streptomycin (høygradig), Noe resistens ble avdekket ved undersøkelse av erytromycin, spiramycin, kloramfenikol og gentamicin. Escherichia coli fra hundefôr. Resistens mot henholdsvis Resultatene fra resistensundersøkelsene av streptomycin, tetracyklin, sulfonamider og ampicillin ble indikatorbakterier fra norsk kylling- og svinekjøtt var i hyppigst observert. Det ble ikke påvist nedsatt følsomhet overensstemmelse med resultatene fra tilsvarende overfor kinoloner. undersøkelser i Norge i 1998. Dataene viser at fekale Forekomsten av resistens blant Staphylococcus aureus indikatorbakterier i norsk svine- og kyllingkjøtt kan være fra så vel klinisk som subklinisk
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