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2019 SWEDRES|SVARM Sales of antibiotics and occurrence of antibiotic resistance in Sweden 2 SWEDRES |SVARM 2019 A report on Swedish Antibiotic Sales and Resistance in Human Medicine (Swedres) and Swedish Veterinary Antibiotic Resistance Monitoring (Svarm) Published by: Public Health Agency of Sweden and National Veterinary Institute Editors: Olov Aspevall and Vendela Wiener, Public Health Agency of Sweden Oskar Nilsson and Märit Pringle, National Veterinary Institute Addresses: The Public Health Agency of Sweden Solna. SE-171 82 Solna, Sweden Östersund. Box 505, SE-831 26 Östersund, Sweden Phone: +46 (0) 10 205 20 00 Fax: +46 (0) 8 32 83 30 E-mail: [email protected] www.folkhalsomyndigheten.se National Veterinary Institute SE-751 89 Uppsala, Sweden Phone: +46 (0) 18 67 40 00 Fax: +46 (0) 18 30 91 62 E-mail: [email protected] www.sva.se Text, tables and figures may be cited and reprinted only with reference to this report. Images, photographs and illustrations are protected by copyright. Suggested citation: Swedres-Svarm 2019. Sales of antibiotics and occurrence of resistance in Sweden. Solna/Uppsala ISSN1650-6332 ISSN 1650-6332 Article no. 19088 This title and previous Swedres and Svarm reports are available for downloading at www.folkhalsomyndigheten.se/ Scan the QR code to open Swedres-Svarm 2019 as a pdf in publicerat-material/ or at www.sva.se/swedres-svarm/ your mobile device, for reading and sharing. Use the camera in you’re mobile device or download a free Layout: Dsign Grafisk Form, Helen Eriksson AB QR code reader such as i-nigma in the App Store for Apple Print: Taberg Media Group, Taberg 2020 devices or in Google Play. Cover by: Ingvar Westerdahl/Thomas Isaksson SWEDRES |SVARM 2019 3 Preface Since 2002, the Swedish public health and veterinary sector has now been made compulsory, with an ambition to subse- has collaborated to produce the Swedres-Svarm report on the quently move towards reporting of species-specific data for monitoring of antibiotic resistance and sales in human and animals. Furthermore, screening for carbapenemase-producing veterinary medicine, integrating data from humans, animals Escherichia coli in the EU-harmonised resistance monitoring and food in a joint analysis. This reflects decades of proactive programme, and a similar strengthening of monitoring activi- and interdisciplinary work to mitigate the effects of antibiotic ties for resistance in bacteria that are pathogenic to animals is resistance where Sweden has been in the lead, long before the discussed. term One Health was coined. Additionally, the Svarm report, At the international level, within the framework of Codex covering the monitoring of resistance in bacteria from animals Alimentarius, guidelines for monitoring of both usage of anti- was first issued two years earlier, and celebrates its 20th anni- biotics and antibiotic resistance levels are being developed by versary this year! FAO and OIE. This is an important contribution to the global At the time when this preface is written, we are in the midst combat against antibiotic resistance, and an incentive for the of the raging covid-19 pandemic. This crisis has exposed the international community to participate. vulnerabilities of our modern global society in an unprecedented Four years have passed since the Public Health Agency of way. Possibly this is the first time that humanity has jointly Sweden became WHO Collaborating Centre for Antibiotic shared a similar experience, and while we are still in a very Resistance Containment, facilitating participation in, and imple- intense stage we can foresee that many things will change as mentation of, the Global AMR Surveillance System (GLASS). a result. The outbreak has exposed our dependence on global From 2021, Swedish resistance data from Salmonella and Shigella supply chains and just-in-time deliveries, and how inability to will be reported to GLASS together with data from invasive- maintain them impacts almost everything in our daily lives. and urinary tract infections. During the last years, monitoring Naturally, this also covers the availability of antibiotics. In the of antibiotic resistance in humans has more and more come aftermath of the outbreak we can expect that the way society to rely on automated collection of all data from the clinical has functioned during the last three decades will be put under microbiology laboratories. This has saved work and enabled scrutiny, and that awareness will have increased of how quickly reporting of combined resistance as well as resistance in differ- disruptive events like a pandemic, could impact our ability to ent age- and gender groups. care for the sick, the elderly and also for the general public. The covid-19 outbreak has also had direct impact on this On the positive side, there is a rising ambition with respect report. Due to the workload on the Public Health Agency to antibiotic resistance monitoring in animals and food in the during the final stages there has been a need for compromises European Union. In December 2018, the new regulation on and prioritisation. For example, denominator data for humans veterinary medicinal products was adopted by the European will not be presented for 2019. We are all aware that 2020 will Parliament, now embracing prudent approaches such as a prohi- be a very different year, in many ways. By this time next year, bition against routine usage of antibiotics to compensate for we will have a clearer picture of how the covid-19 crisis has suboptimal management, and exclusion of antibiotics regarded impacted the use of antibiotics for treatment of animals and as last resort in humans from veterinary usage – a requirement humans. Whether the recently imposed changes in behav- which also applies to third countries exporting to the EU. Other iour and mobility, which influences our exposure to resistant improvements relate to the reporting of antibiotic sales and microbes, will have had an influence on antibiotic resistance usage data to the European Medical Products Agency, which patterns is also yet to be seen. Solna and Uppsala Johan Carlson Ann Lindberg Director General Director General The Public Health Agency of Sweden National Veterinary Institute 4 SWEDRES |SVARM 2019 Contributors and participants Editors Acknowledgements Olov Aspevall and Vendela Wiener, Contributions to Swedres Public Health Agency of Sweden The analysis of data was made in collaboration with: Oskar Nilsson and Märit Pringle, Annika Hahlin, Mikael Hoffmann, Gunnar Kahlmeter, National Veterinary Institute, Sweden Christer Norman, and Eva Pettersson. Data on the sales of antibiotics to acute care hospitals from Project Manager 2015-2019 were kindly provided by pharmacists in local Hanna Billström, Public Health Agency of Sweden Strama-groups. Authors Swedres The national surveillance of antibiotic resistance would not have been possible without the contribution of data Public Health Agency of Sweden and active support of all the Swedish clinical microbiology Saga Alvring, Olov Aspevall, Hanna Billström, laboratories. Jessica Darenberg, Ulrica Dohnhammar, Charlotta Edlund, Petra Edquist, Nazanin Hashemi, Epidemiological information on clinical notifications Jenny Hellman, Jerker Jonsson, Eva Morfeldt, checked and updated by the Regional Departments for Barbro Mäkitalo, Kristina Rizzardi, Karin Sjöström, Communicable Disease Control. Gunilla Skoog Ståhlgren, Tomas Söderblom, Vendela Wiener and Thomas Åkerlund Contributions to Svarm The environmental departments in several municipalities Medical Products Agency are acknowledged and thanked for collecting samples of Maria Larsson fresh meat from retail for ESBL-screening. National Reference laboratory for Antibiotic Resistance, Växjö Hospital Gunnar Kahlmeter National Reference Laboratory for Sexually Transmitted Infections & National Reference Laboratory for Neisseria meningitidis Magnus Unemo, Hans Fredlund and Susanne Jacobsson Clinical Microbiology, Kronoberg and Blekinge, Central Hospital Växjö Per Rydström Authors Svarm National Veterinary Institute Annette Backhans, Björn Bengtsson, Karin Bergström, Stefan Börjesson, Christina Greko, Annica Landén, Oskar Nilsson, Karl Pedersen, Märit Pringle and Marie Sjölund Swedish Board of Agriculture Kinfe Girma Other contributors in Svarm National Veterinary Institute Boel Harbom, Eva Jansson, Mattias Myrenås and Paulina Hysing Farm & Animal Health Maria Lindberg SWEDRES |SVARM 2019 5 Content Preface ...................................................................................3 Antibiotic resistance in animals ........................................68 Contributors and participants ...............................................4 Notifiable diseases ����������������������������������������������������������68 Sammanfattning/Summary ...................................................7 ESBL-producing Enterobacteriaceae .......................68 Guidance for readers ...........................................................13 In Focus Multiresistant ESBL-producing Enterobacteriaceae from horses .....................................72 Sales of antibiotics for humans ..........................................17 Methicillin-resistant Total sales of antibiotics for humans ..............................17 Staphylococcus aureus (MRSA) .....................................74 Antibiotics in outpatient care .........................................18 Methicillin-resistant Antibiotics in hospital care .............................................27 Staphylococcus pseudintermedius
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