2O15 NORM NORM-VET Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway DESIGN, FORSIDE: IDA SKAAR IDA FORSIDE: DESIGN, – SVANEGODKJENT TRYKKSAK – 241 762 241 – TRYKKSAK SVANEGODKJENT – ISSN: 1502-2307 (print) / 1890-9965 (electronic) AS MEDIA LUNDBLAD 2015 NORM NORM-VET Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway ISSN: 1502-2307 (print) / 1890-9965 (electronic) Any use of data from NORM/NORM-VET 2015 should include specific reference to this report. Suggested citation: NORM/NORM-VET 2015. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Tromsø / Oslo 2016. ISSN:1502-2307 (print) / 1890-9965 (electronic). This report is available at www.vetinst.no and www.antibiotikaresistens.no 1 NORM / NORM-VET 2015 CONTRIBUTORS AND PARTICIPANTS Editors: Gunnar Skov Simonsen NORM, Univ. Hosp. North Norway Anne Margrete Urdahl NORM-VET, Norwegian Veterinary Institute Authors: Per Espen Akselsen Antibiotic usage in humans [email protected] KAS, Haukeland Univ. Hosp. Cecilie Torp Andersen Candida spp. [email protected] Oslo Univ. Hosp. Elisabeth Astrup MRSA in humans [email protected] Norw. Inst. of Pub. Health Hege Salvesen Blix Antibiotic usage in humans [email protected] Norw. Inst. of Pub. Health Dominique Caugant Meningococci [email protected] Norw. Inst. of Pub. Health Kari Grave Antibiotic usage in animals [email protected] Norw. Vet. Inst. Nils Olav Hermansen Enteropathogenic baceria in humans [email protected] Norw. Inst. of Pub. Health Gro Johannessen Bacteria from animals and food [email protected] Norw. Vet. Inst. Kjersti Wik Larssen MRSA in humans [email protected] St. Olav Univ. Hosp. Morten Lindbæk Antibiotic usage in humans [email protected] ASP, Univ. of Oslo Marion Neteland Antibiotic usage in humans [email protected] KAS, Haukeland Univ. Hosp. Madelaine Norström Bacteria from animals [email protected] Norw. Vet. Inst. Andreas Radtke Group B streptococci [email protected] St. Olav Univ. Hosp. Karin Rønning Tuberculosis [email protected] Norw. Inst. of Pub. Health Jannice Schau Slettemeås Bacteria from animals [email protected] Norw. Vet. Inst. Gunnar Skov Simonsen Bacteria from humans [email protected] NORM, Univ. Hosp. North Norw. Dagfinn Skaare Haemophilus influenzae [email protected] Vestfold Hospital, Tønsberg Martin Steinbakk Group A streptococci [email protected] Norw. Inst. of Pub. Health Anne Margrete Urdahl Bacteria from animals [email protected] NORM-VET, Norw. Vet. Inst. Didrik Vestrheim Pneumococci [email protected] Norw. Inst. of Pub. Health Frode Width-Gran MRSA in humans [email protected] St. Olav Univ. Hosp. Institutions participating in NORM-VET: Norwegian Food Safety Authority Kjell Hauge Norwegian Veterinary Institute Aina Steihaug Barstad / Kari Grave / Merete Hofshagen / Gro Johannessen / Madelaine Norström / Jannice Schau Slettemeås / Anne Margrete Urdahl Institutions participating in NORM: Akershus University Hospital, Lørenskog, Department of Microbiology Trond Egil Ranheim / Torill Sofie Larsen Fürst Medisinsk Laboratorium Trygve Tjade / Nina Beate Johansen Førde Hospital, Department of Microbiology Reidar Hjetland / Astrid Vedde Haugesund Hospital, Department of Microbiology Liv Jorunn Sønsteby / Pirrko-Liisa Kellokumpu Haukeland Univ. Hospital, Bergen, Dep. of Microbiology Dag Harald Skutlaberg / Torunn Sneide Haukeland Innlandet Hospital, Lillehammer, Department of Microbiology Rolf Arne Sandnes / Kari Ødegaard Levanger Hospital, Department of Microbiology Angela Kümmel / Berit Harbak Molde Hospital, Department of Microbiology Einar Nilsen / Lisa Valle Norwegian Institute of Public Health, Ref. Lab. for Enteropathogenic Bacteria Nils Olav Hermansen / Ina Haagensen Norwegian Institute of Public Health, Ref. Lab. for H. influenzae Martin Steinbakk / Gunnhild Rødal Norwegian Institute of Public Health, Ref. Lab. for M. tuberculosis Anne Torunn Mengshoel / Kari Nilsen Norwegian Institute of Public Health, Ref. Lab. for N. meningitidis Dominique Caugant / Inger Marie Saga Norwegian Institute of Public Health, Ref. Lab. for S. pneumoniae Didrik Vestrheim / Anne Ramstad Alme Norwegian Institute of Public Health, Ref. Lab. for S. pyogenes Martin Steinbakk / Anne Ramstad Alme Nordland Hospital, Bodø, Department of Microbiology Sandra Åsheim / Hege Elisabeth Larsen Oslo University Hospital, Radiumhospitalet, Laboratory of Microbiology Gorm Hansen / Sunniva Fagerås Røst Oslo University Hospital, Rikshospitalet, Institute of Medical Microbiology Gorm Hansen / Belinda Langnes Lindstad Oslo University Hospital, Rikshospitalet, Ref. Lab. for Mycology Cecilie Torp Andersen / Lonny Margrethe Kløvfjell Oslo University Hospital, Ullevål, Department of Microbiology Gaute Syversen / Thea Bergheim Oslo University Hospital, Ullevål, Ref. Lab. for N. gonorrhoeae Gaute Syversen / Thea Bergheim Stavanger University Hospital, Department of Microbiology Heidi Syre / Anita Løvås Brekken St. Olav University Hospital, Trondheim, Department of Microbiology Kjersti Wik Larssen / Toril Nordtømme St. Olav University Hospital, Trondheim, Ref. Lab. for MRSA Kjersti Wik Larssen / Sissel Karin Eriksen St. Olav University Hospital, Trondheim, Ref. Lab. for S. agalactiae Andreas Radtke / Randi Valsø Lyng Sørlandet Hospital, Kristiansand, Department of Microbiology Ståle Tofteland / Lise Hulløen-Orø Unilabs Telelab A/S, Skien Krisztina Papp / Anne Ragnhild Oseid University Hospital of North Norway, Tromsø, Department of Microbiology Gunnar Skov Simonsen / Ellen Haldis Josefsen University Hospital of North Norway, Nat. Adv. Unit on Detection of AMR Ørjan Samuelsen / Bjørg C. Haldorsen Vestfold Hospital, Tønsberg, Department of Microbiology Dagfinn Skaare / Astrid Lia Vestre Viken - Bærum Hospital, Department of Medical Microbiology Annette Onken / Merriam Sundberg Vestre Viken - Drammen Hospital, Department of Medical Microbiology Einar Tollaksen Weme / Hanne Fanuelsen Østfold Hospital, Fredrikstad, Department of Microbiology Sara Debes / Anne Cathrine Hollekim Ålesund Hospital, Department of Microbiology Einar Nilsen / Monica Sjåstad NORM reference group in 2015: Martin Steinbakk Norw. Inst. Pub. Health Dag Harald Skutlaberg Haukeland Univ. Hosp. Anita Kanestrøm Østfold Hosp. Trust Aasmund Fostervold Norw. Soc. Med. Microbiol. Thea Bergheim Norw. Soc. Engineers and Technologists Jon Birger Haug Norw. Soc. Inf. Dis. Knut Eirik Eliassen Norw. Coll. Gen. Pract. 2 NORM / NORM-VET 2015 CONTENTS CONTENTS Introduction ……………………………………………………………………………………….............. 5 Sammendrag ..........……………………………………………………………………………….............. 6 Summary …………………………………………………………………………………………............ 9 Population statistics.…………………………………………………………………………………...... 13 Usage of antimicrobial agents Usage in animals Therapeutic usage of veterinary antimicrobial agents ………………………………………… 15 Antimicrobial and coccidiostat feed additives ……………………………………….… ……. 22 Usage in humans Overall antibiotic sales ……………………………………………………………………….. 25 Antibiotic usage in primary care ……………………………………………………………… 31 Antibiotic usage in hospitals …………………………………………………………………. 37 National Action Plan against Antibiotic Resistance in Healthcare .………………………….. 39 Antimycotic usage in Norway ……………………………………………………………….. 43 Occurrence of antimicrobial resistance Indicator bacteria from animals and food Escherichia coli from cattle and swine ..............................................…................................. .. 45 Cephalosporin resistant Escherichia coli from cattle, beef, swine and pork ……………..….... 48 Quinolone resistant Escherichia coli from cattle, cattle, beef, swine and pork ….................. 49 Carbapenemase producing Escherichia coli from cattle, beef, swine and pork …………….. 50 Escherichia coli from vegetables …………………….……………………………………….. 51 Methicillin resistant Staphylococcus aureus in cattle …. ……………………..………………. 53 Zoonotic and non-zoonotic enteropathogenic bacteria Salmonella spp. ……………………….........................………………..................................... 57 Campylobacter spp. …………………………………. .............................................................. 65 Yersinia enterocolitica .. ……….........................……………………....................................... 68 Shigella spp. .………………….............……….........................…….................................. 70 Human clinical isolates Distribution of bacterial species in blood cultures .................................................................... 73 Escherichia coli in blood cultures ………………….............................................................. 75 Escherichia coli in urine ……………………………................................................................ 77 Klebsiella spp. in blood cultures .………………….................................................................... 79 Klebsiella spp. in urine ………………………………………………………………………. 81 Pseudomonas aeruginosa in blood culture …………………………………………………… 83 Haemophilus influenzae in blood cultures and cerebrospinal fluids …………………………. 86 Neisseria meningitidis in blood cultures and cerebrospinal fluids …………………………… 87 Neisseria gonorrhoeae ……………………………………………………………………….. 88 Staphylococcus aureus in blood cultures …………............................................................... 89 Staphylococcus aureus in wound specimens ............................................................................. 90 Methicillin