2015 SWEDRES|SVARM Consumption of antibiotics and occurrence of antibiotic resistance in Sweden 2 SWEDRES |SVARM 2015 A report on Swedish Antibiotic Utilisation and Resistance ISSN 1650-6332 in Human Medicine (Swedres) and Swedish Veterinary ISBN 978-91-7603-546-7 (pdf) Antibiotic Resistance Monitoring (Svarm) ISBN 978-91-7603-547-4 (print) Article no. at Folkhälsomyndigheten 15099 Published by: Public Health Agency of Sweden and National Veterinary This title and previous Swedres and Svarm reports are Institute available for downloading at www.folkhalsomyndigheten.se/publicerat-material/ or www.sva.se. Editors: Jenny Hellman and Olov Aspevall, The title can also be ordered from the webshop at: Public Health Agency of Sweden www.folkhalsomyndigheten.se/publicerat-material/ or Björn Bengtsson and Märit Pringle, Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute National Veterinary Institute, SE-751 89 Uppsala, Sweden Phone: +46 (0) 18 67 40 00 Fax: +46 (0) 18 30 91 62 Addresses: E-mail: [email protected] Public Health Agency of Sweden SE-171 82 Solna, 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 and tables may be cited and reprinted only with reference to this report. Images, photographs and illustrations are protected by copyright. Suggested citation: Swedres-Svarm 2015. Consumption of antibiotics and occurrence of antibiotic resistance in Sweden. Solna/Uppsala Scan the QR code to open Swedres-Svarm 2015 as a pdf in ISSN 1650-6332 your mobile device, for reading and sharing. Download a free QR code reader in the App Store for Apple Print & Layout: Åtta.45 Tryckeri devices or in Google Play for Android, for example Quick Scan QR Code Reader (iPhone) or QR Droid Code Scanner (Android). Cover by Ingvar Westerdahl/Thomas Isaksson SWEDRES |SVARM 2015 3 Preface This 2015 Swedish report from the monitoring of anti- Also, increased knowledge of antibiotics, resistance and coun- biotic resistance and antibiotic consumption in human and termeasures in society, governance, supporting structures veterinary medicine, Swedres-Svarm, is an integrated report and systems, and international collaboration are stressed. A from the Public Health Agency of Sweden and the National national coordinating mechanism for governmental author- Veterinary Institute with data from humans, animals, and ities will be important in implementing this strategy. This food. The data from public health, human and veterinary group is led by the Public Health Agency of Sweden in medicine have been jointly published in Swedres-Svarm since collaboration with the Swedish Board of Agriculture, and is 2002, and data from the sectors have been fully integrated comprised of representatives from 23 governmental authori- under common sections in the report since 2012. ties and organizations. The importance of a ‘One Health’ approach is being Although the current situation in Sweden, in both the acknowledged internationally, and awareness of the urgency public health and veterinary sectors, is favorable from a global of jointly dealing with antibiotic resistance and health care- perspective, this year’s report shows trends of concern in human associated infections is increasing. medicine both for methicillin-resistant Staphylococcus aureus A good example of international collaboration is the devel- (MRSA) and for carbapenem-resistant Enterobacteriaceae. In opment of the Global Antimicrobial Resistance Surveillance part, these trends can be explained by the increased number of System (GLASS) by the World Health Organization with refugees who arrived in Sweden last year. Of more concern, support from Sweden. Early implementation of the system though, is the increasing risk in general of introduction and has recently started in several countries worldwide, including spread of carbapenem- resistant or extended spectrum beta- Sweden. In addition, the Unit for Antibiotics and Infection lactamase (ESBL) producing Enterobacteriaceae, in high- Control at the Public Health Agency of Sweden has recently risk health care departments, such as neonatal intensive care. been designated as a WHO Collaborating Centre for anti- Efforts to prevent or reduce the consequences of these risks microbial resistance containment with the assignment to need to be prioritized. further support development and implementation of GLASS In the veterinary sector, MRSA is rare in both farm and and support capacity building in the WHO Member States. companion animals, and carbapenem-resistant Enterobac- A new national strategy for Sweden regarding antibiotic teriaceae has not been reported. resistance was approved by the government in April this Finally, we would like to thank Barbro Olsson-Liljequist, year. A ‘One Health’ approach is emphasized, as well as the who has contributed to this report since it was first published importance of strengthened surveillance, effective preventive in 2001. She has worked within this field for more than thirty measures, responsible use of antibiotics, increased knowledge years, and she will share some historical perspectives in this and development of new antibiotics, and diagnostic methods edition of Swedres-Svarm. as well as other strategies for combating antibiotic resistance. Solna and Uppsala 2016-06-14 Johan Carlson Jens Mattsson Director General Director General Public Health Agency of Sweden National Veterinary Institute 4 SWEDRES |SVARM 2015 Contributors and participants Authors SWEDRES Acknowledgements Public Health Agency of Sweden The analyses of the antibiotic consumption was made in Olov Aspevall, Hanna Billström, Britta Björkholm, close collaboration with the external group of antibiotic Ulrica Dohnhammar, Petra Edquist, Sara Hæggman, sales data of the Public Health Agency of Sweden: Jenny Hellman, Jerker Jonsson, Eva Morfeldt, Ingrid Brännström, Jonatan Dahlqvist, Mats Erntell, Barbro Mäkitalo, Christer Norman, Barbro Olsson Annika Hahlin, Mikael Hoffmann and Anastasia Nyman. Liljequist, Magdalena Prioux, Kristina Rizzardi, Karin Sjöström, Anders Ternhag, Tomas Söderblom Data on antibiotic use in relation to number of admissions and Thomas Åkerlund and number of patient days in somatic hospital care during 2010-2015 were kindly provided by pharmacists in local Medical Products Agency Strama-groups. Strama collaboration group of the Public Sahra Barzi Health Agency of Sweden. Department of Clinical Microbiology, The national surveillance of antibiotic resistance would Karolinska University Hospital, Solna not have been possible without the contribution of data Christian Giske and active support of all the Swedish clinical microbiology laboratories. National Reference Laboratory for Antibiotic Resistance, Växjö Hospital Complementary epidemiological information on clinical Gunnar Kahlmeter notifications has been performed by the local County Depart ments for Communicable Disease Control. National Reference Laboratory for Pathogenic Neisseria, Örebro University Hospital Kerstin Ortman and Hanna Arosenius at Eurofins Food & Hans Fredlund, Susanne Jacobsson and Magnus Unemo Agro, Skara who kindly provided SVA with clinical isolates and susceptibility results from clinical submissions from animals. Authors SVARM National Veterinary Institute Lotta Persson, Sofie Jonasson and Eva Fallström for kindly Björn Bengtsson, Karin Bergström, Stefan Börjesson, providing samples from wild hedgehogs. Helle Ericsson Unnerstad, Christina Greko, Annica Landén, Oskar Nilsson and Märit Pringle. The National Food Administration for collecting samples of intestinal content from healty animals at slaughter for the studies of indicator bacteria. Other contributors in SWEDRES National Board of Health and Welfare Environmental departments in several municipalites for Anastasios Pantelis collecting samples of fresh meat from retail for ESBL- screening. Other contributors in SVARM National Veterinary Institute Kerstin Ekström, Maria Finn, Mattias Myrenås and Eva Säker Farm & Animal Health Maria Lindberg Swedish Board of Agriculture Kinfe Girma SWEDRES |SVARM 2015 5 Content Preface ...................................................................................3 Vancomycin resistant Enterococcus faecalis Contributors and participants ...............................................4 and Enterococcus faecium (VRE) ......................................58 Sammanfattning/Summary ...................................................7 In focus A potential clone shift Guidance for readers ...........................................................13 of methicillin-resistant Staphylococcus pseudintermedius from ST71 to ST258 ..........................59 Consumption of antibiotics ...............................................17 Streptococcus pneumoniae with Total consumption of antibiotics in humans ....................17 reduced susceptibility to penicillin (PNSP) ..................61 Antibiotics in outpatient care ............................................18 In focus Sales of polymyxins and occurrence Gender differences ........................................................18 of the mcr-1 gene in bacteria from humans, animals and food in Sweden ..........................................62 Antibiotics commonly used to treat respiratory tract infections, urinary tract Zoonotic pathogens ..........................................................64