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Swedres 2010 a Report on Swedish Antibiotic Utilisation and Resistance

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Swedres 2010 a Report on Swedish Antibiotic Utilisation and Resistance SWEDRES|2010 A Report on Swedish Antibiotic Utilisation and Resistance in Human Medicine 2 SWEDRES| 2010 Content 1. Preface ..........................................................................................3 44444444444444444444444444444444444444444444444444444 44444444444444444444444444444444444444444444444444444Contributors ....................................................................................4 55555555555555555555555555555555555555555555555555555 555555555555555555555555555555555555555555555555555552.1. Summary ...................................................................................5 88888888888888888888888888888888888888888888888888888 2.2. Sammanfattning ........................................................................8 Swedish Institute for Communicable Disease 88888888888888888888888888888888888888888888888888888 100000000000000000000000000000000000000000000000000 Control, SMI, is a government agency with 3.000000000000000000000000000000000000000000000000000 Use of antimicrobials .................................................................10 the mission to monitor the epidemiology of 3.1.1000000000000000000000000000000000000000000000000 Use of antibiotics ................................................................10 communicable diseases among Swedish citi- 0000000000000000000000000000000000000000000000000 3.2.33333333333333333333333333333333333333333333333333 Use of antifungals ...............................................................20 zens and promote control and prevention of 22222222222222222222222222222222222222222222222222233333333333333333333333333333333333333333333333333 these diseases. 4.222222222222222222222222222222222222222222222222222 Antimicrobial resistance ............................................................22 Staphylococcus2222222222222222222222222222222222222222222222222 aureus including MRSA .......................................22 Publishers: 2222222222222222222222222222222222222222222222222 Streptococcus6666666666666666666666666666666666666666666666666 pneumoniae .............................................................26 Swedish Institute for Communicable 6666666666666666666666666666666666666666666666666 6888888888888888888888888888888888888888888888888and ..............................28 Disease Control. Enterococcus8888888888888888888888888888888888888888888888888 faecalis Enterococcus faecium 6000000000000000000000000000000000000000000000000 ..................................................................30 Streptococcus0000000000000000000000000000000000000000000000000 pyogenes Editors: Streptococcus600000000000000000000000000000000000000000000000 agalactiae ................................................................30 000000000000000000000000000000000000000000000000 Jenny Hellman, Christer Norman, Barbro Haemophilus600000000000000000000000000000000000000000000000 influenzae ...............................................................30 Olsson-Liljequist, Swedish Institute for 000000000000000000000000000000000000000000000000 Extended600000000000000000000000000000000000000000000000000 spectrum beta-lactamase-producing Communicable Disease Control. 000000000000000000000000000000000000000000000000000 Enterobacteriaceae6000000000000000000000000000000000000000000000000000 (ESBL) ..........................................................31 6000000000000000000000000000000000000000000000000 Address: Escherichia0000000000000000000000000000000000000000000000000 coli ............................................................................32 SE 171 82 Solna, Sweden 6000000000000000000000000000000000000000000000000 Klebsiella0000000000000000000000000000000000000000000000000 pneumoniae ..................................................................33 Phone: +46 8 457 23 00 6000000000000000000000000000000000000000000000000 Pseudomonas0000000000000000000000000000000000000000000000000 aeruginosa ..............................................................34 Fax: +46 8 30 06 26 Clostridium6000000000000000000000000000000000000000000000000 difficile .....................................................................34 E-mail: [email protected] 0000000000000000000000000000000000000000000000000 Helicobacter6000000000000000000000000000000000000000000000000 pylori .......................................................................35 www.smi.se 0000000000000000000000000000000000000000000000000 Salmonella6555555555555555555555555555555555555555555555555 and Shigella spp ........................................................35 555555555555555555555555555555555555555555555555 SWEDRES Campylobacter6666666666666666666666666666666666666666666666666 spp ......................................................................36 Article number 2011-1-1 6666666666666666666666666666666666666666666666666 Neisseria6666666666666666666666666666666666666666666666666 gonorrhoeae ..................................................................36 ISBN 978-91-86723-09-5, 6666666666666666666666666666666666666666666666666 6777777777777777777777777777777777777777777777777Neisseria meningitidis ..................................................................37 can be ordered from: 7777777777777777777777777777777777777777777777777 Smittskyddsinstitutets beställningsservice 6777777777777777777777777777777777777777777777777Mycobacterium tuberculosis ..........................................................37 7777777777777777777777777777777777777777777777777 c/o Strömberg, 120 88 Stockholm. 8888888888888888888888888888888888888888888888888888 Appendix8888888888888888888888888888888888888888888888888888 1. Abbreviations .............................................................39 Or from our webstore: 400000000000000000000000000000000000000000000000000 www.smittskyddsinstitutet.se/publikationer Appendix000000000000000000000000000000000000000000000000000 2. Demographics and denominator data .......................40 E-mail: [email protected] 422222222222222222222222222222222222222222222222222 Appendix222222222222222222222222222222222222222222222222222 3. Surveillance of antibiotic consumption .....................42 Fax: 08-779 96 67 444444444444444444444444444444444444444444444444444 This title is also available for downloading from Appendix444444444444444444444444444444444444444444444444444 4. Antibiotic susceptibility testing .................................43 www.smittskyddsinstitutet.se/publikationer 4444444444444444444444444444444444444444444444444444 Appendix4444444444444444444444444444444444444444444444444444 5. National surveillance of antibiotic resistance ............44 The website of the Swedish Institute for 4666666666666666666666666666666666666666666666666666 Infectious Disease Control. Appendix6666666666666666666666666666666666666666666666666666 6. Recent publications (2008-2010) ...............................46 Print: Edita Västra Aros AB SWEDRES| 2010 3 1. Preface WELCOME to the tenth Swedish report combining results from trend noted since 2007. It is therefore apparent that healthcare the monitoring of antimicrobial resistance and antimicrobial related infection control measures will not be sufficient to stop usage in human and veterinary medicine: SWEDRES and the increase of MRSA. In order to stop community associated SVARM, respectively. These two reports are printed jointly to dissemination we need, in addition to the prudent use of anti- increase the awareness of trends in incidence of antimicrobial biotics, to implement new and challenging strategies. use and antimicrobial resistance in the respective areas. The During 2010 the decrease in antibiotic sales continued problem of antibiotic resistance is multisectorial but needs albeit at a lower rate than was seen in 2009. Unexplained large to be viewed upon as one where the dissemination of bacte- differences between counties exist which need to be addressed. ria between humans, animals and the environment must be Furthermore the report shows that the differences are espe- considered when preventive measures are discussed. cially prominent among children and for the group of antibi- In humans ESBL-producing Enterobacteriaceae are by far otics prescribed for respiratory tract infections. the largest growing resistance problem with approximately To encourage, strengthen and intensify the work with 5000 new cases reported during 2010. Earlier studies have prudent antibiotic use, the Swedish government has in 2010 shown that hospital associated transmission and international allocated stimulatory conditional funding to be received by travel are two modes of spread of these bacteria. Even more county councils decreasing outpatient antibiotic use by increas- worrisome than the 5000 new ESBL-cases are the 18 iden- ing adherence to treatment guidelines. tified cases of carbapenemase producing Enterobacteriaceae As antibiotic resistant strains become more common the in Sweden, as of to date, caused by the genes NDM-1, KPC more important it will be to avoid selection of these strains or VIM. This new threat of multiresistant and in many by unnecessary antibiotic use. What we can and must do is to cases totally resistant bacteria have in countries like Greece continue the important strive to keep the selective antibiotic and India caused large hospital and community associated pressure as low as possible and to promote infection control. outbreaks. The cases seen in Sweden are all but one directly Through comprehensive and well communicated resistance linked to import from
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