Downloaded from orbit.dtu.dk on: Oct 09, 2021 DANMAP 2016 - Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark Borck Høg, Birgitte; Korsgaard, Helle Bisgaard; Wolff Sönksen, Ute; Bager, Flemming; Bortolaia, Valeria; Ellis-Iversen, Johanne; Hendriksen, Rene S.; Borck Høg, Birgitte; Jensen, Lars Bogø; Korsgaard, Helle Bisgaard Total number of authors: 27 Publication date: 2017 Document Version Publisher's PDF, also known as Version of record Link back to DTU Orbit Citation (APA): Borck Høg, B. (Ed.), Korsgaard, H. B. (Ed.), Wolff Sönksen, U. (Ed.), Bager, F., Bortolaia, V., Ellis-Iversen, J., Hendriksen, R. S., Borck Høg, B., Jensen, L. B., Korsgaard, H. B., Pedersen, K., Dalby, T., Træholt Franck, K., Hammerum, A. M., Hasman, H., Hoffmann, S., Gaardbo Kuhn, K., Rhod Larsen, A., Larsen, J., ... Vorobieva, V. (2017). DANMAP 2016 - Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. Statens Serum Institut, National Veterinary Institute, Technical University of Denmark National Food Institute, Technical University of Denmark. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. Users may download and print one copy of any publication from the public portal for the purpose of private study or research. You may not further distribute the material or use it for any profit-making activity or commercial gain You may freely distribute the URL identifying the publication in the public portal If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. DANMAP 2016 DANMAP 2016 - Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark Statens Serum Institut National Veterinary Institute, Technical University of Denmark National Food Institute, Technical University of Denmark DANMAP 2016 Editors: Birgitte Borck Høg ([email protected]) Helle Korsgaard ([email protected]) National Food Institute, Technical University of Denmark Kemitorvet, Building 202, DK-2800 Kgs. Lyngby Ute Wolff Sönksen ([email protected]) Microbiology and Infection Control, Statens Serum Institut Artillerivej 5, DK-2300 Copenhagen Authors: National Food Institute Flemming Bager, Valeria Bortolaia, Johanne Ellis-Iversen, Rene S. Hendriksen, Birgitte Borck Høg, Lars Bogø Jensen, Helle Korsgaard National Veterinary Institute Karl Pedersen Statens Serum Institut Tine Dalby, Kristina Træholt Franck, Anette M. Hammerum, Henrik Hasman, Steen Hoffmann, Katrin Gaardbo Kuhn, Anders Rhod Larsen, Jesper Larsen, Eva Møller Nielsen, Stefan Schytte Olsen, Andreas Petersen, Louise Roer, Sissel Skovgaard, Ute Wolff Sönksen, Mia Torpdahl, Veronika Vorobieva DANMAP Steering Committee: National Food Institute Flemming Bager National Veterinary Institute Karl Pedersen Statens Serum Institut Ute Wolff Sönksen, Anders Rhod Larsen Layout: Jens Nørgaard and Charlotte Brunholt Jensen, STEP Photos: Colourbox and iStock Printing: STEP DANMAP 2016 - October 2017 – ISSN 1600-2032 Text and tables may be cited and reprinted only with reference to this report: DANMAP 2016 Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. ISSN 1600-2032 The report is available from www.danmap.org This report is issued by DANMAP - The Danish Integrated Antimicrobial Resistance Monitoring and Research Programme. It presents the results of monitoring the antimicrobial use and antimicrobial resistance in food animals, food and humans in 2016. The report is produced in collaboration between the National Food Institute, Technical University of Denmark and Statens Serum Institut. The DANMAP programme is funded jointly by the Ministry of Health, the Ministry of Environment and Food and the Ministry of Higher Education and Science. DANMAP 2016 DANMAP 2016 - Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark TABLE OF CONTENTS Table of contents 1. Editorial 7 2. Acknowledgements 8 3. Introduction to DANMAP 9 3.1 About DANMAP 10 3.2 General information 11 4. Antimicrobial consumption in animals 15 Highlights 16 4.1 Introduction 16 4.2 Total antimicrobial consumption 19 4.3 Antimicrobial consumption by animal species 21 Textbox 4.1 New model for the yellow card initiative 27 Textbox 4.2 Use of colistin in animals and humans – a Danish perspective 28 Textbox 4.3 Correlation between quality of mink feed and prescription of antimicrobials for mink 30 Textbox 4.4 Stronger focus on preventing illegal import of antimicrobials 31 Textbox 4.5 Antimicrobial use in dogs and cats in Denmark – 2012-2016 32 5. Antimicrobial consumption in humans 35 Highlights 36 5.1 Introduction 37 5.2 Total consumption (Primary Health Care and Hospital Care Sectors) 37 5.3 Primary Health Care 38 5.4 Hospital Care 47 Textbox 5.1 Reducing antibiotic consumption among children and elderly through knowledge building – interventions joining primary and secondary health care sector 53 Textbox 5.2 Incidence of multi-resistant bacteria and consumption of antimicrobial agents in Greenland 56 Textbox 5.3 Antimicrobial resistance and consumption of antimicrobials in the Faroe Islands 58 6. Resistance in zoonotic bacteria 61 Highlights 62 6.1 Introduction 62 6.2 Salmonella 63 6.3 Campylobacter 67 Textbox 6.1 Resistance in bacteria from diagnostic submissions from pigs 71 Textbox 6.2 DANMAP detecting emerging and rare resistances 73 4 DANMAP 2016 TABLE OF CONTENTS 7. Resistance in indicator bacteria 75 Highlights 76 7.1 Introduction 76 7.2 Enterococci 77 7.3 Indicator Escherichia coli 7.4 Extended spectrum beta-lactamase (ESBL)/AmpC- and carbapenemase-producing Escherichia coli 80 Textbox 7.1 Comparison of ESBL/AmpC-producing Escherichia coli isolates of animal origin ESBL/pAmpC-producing with Escherichia coli isolates obtained from human bloodstream infections 84 8. Resistance in clinical bacteria from humans 85 Highlights 86 8.1 Escherichia coli 88 8.2 Klebsiella pneumoniae 91 Textbox 8.1 Characterisation of ESBL/pAmpC- and carbapenemase producing Escherichia coli from bloodstream infections 94 8.3 Pseudomonas aeruginosa 96 8.4 Acinetobacter spp. 97 Textbox 8.2 Carbapenemase producing bacteria in Denmark 98 8.5 Enterococci 100 Textbox 8.3 Emergence of clinical ST 203-CT859 vanA Enteroccus faecium in Denmark 102 8.6 Streptococci 104 8.7 Staphylococcus aureus 106 Textbox 8.4 LA-MRSA CC398 in animals and humans 110 8.8 Neisseria gonorrhoeae 113 Textbox 8.5 Clostridium difficile surveillance 115 9. Materials and Methods 117 9.1 General information 118 9.2 Data on antimicrobial consumption 118 9.3 Collection of bacterial isolates 121 9.4 Microbiological methods 123 9.5 Susceptibility testing 123 9.6 Whole genome sequencing 124 9.7 Data handling 124 10. Terminology 127 10.1 List of abbreviations 128 10.2 Glossary 129 DANMAP 2016 5 1. 6 DANMAP 2016 1. 1. Editorial For many years Denmark has maintained a strong focus on the and a high selective pressure. This highlights the importance transmission of antimicrobial resistance from production ani- of finding places of introduction and routes of transmission mals to humans. It is well documented that a high or irrational at Danish hospitals. A working group under the Danish Health use of antimicrobials inevitably will lead to development of Authority is currently working on guidelines defining risk situ- resistance and Denmark has introduced several interventions ations, screening methods and ways of controlling spread at to reduce the antibiotic use in animals to protect public health. hospitals, it is important to remember that some farm animal The control initiatives in animals include: maintaining aware- environments also may constitute places of possible risks due ness of the use of antimicrobials in especially food animals; to locally and periodically high consumptions of antimicrobials. surveillance of antimicrobial use at farm level, with penalties DANMAP has to date not found CPO in animals or food of Dan- for farmers who have an unjustifiable high use of antimicrobi- ish origin, but the ability of AMR monitoring systems to detect als; guidelines for use of antimicrobials in pig production and rare and emerging AMR genes with a potentially very high in companion animals, and a farming sector led initiative to impact needs to be reviewed. drastically reduce the use of 3rd and 4th generation cephalo- sporins in pigs and cattle. New transmission routes present new challenges for surveil- lance and control. A novel approach is to look for genes rather The contribution from the animal reservoir to AMR in humans than resistant bacterial species as it was done in a recent varies across the globe. The Danish preventive initiatives on study, where waste from toilets of airplanes arriving in Den- controlling antimicrobial usage in animals continue, and so mark from selected destinations was analysed by metagenom- the most immediate AMR hazard to humans today does not ics techniques. This contributed to an understanding of the emerge from the Danish animal reservoir. Carbapenemase diversity and amount of genes being