2012 SWEDRES|SVARM Swedish Antibiotic Utilisation and Resistance in Human Medicine Swedish Veterinary Antimicrobial Resistance Monitoring 2 SWEDRES |SVARM 2012 A Report on Swedish Antibiotic Utilisation and Resistance in Human Medicine (SWEDRES) and Swedish Veterinary Antimicrobial Resistance Monitoring (SVARM) Published by: Swedish Institute for Communicable Disease Control and National Veterinary Institute Editors: Jenny Hellman and Barbro Olsson-Liljequist, Swedish Institute for Communicable Disease Control Björn Bengtsson and Christina Greko, National Veterinary Institute Addresses: The Swedish Institute for Communicable Disease Control SE-171 82 Solna, Sweden Phone: +46 (0) 8 457 23 00 Fax: +46 (0) 8 328330 E-mail: [email protected] www.smi.se The 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 Article number 2013-101-1 ISSN 1650-6332 This title and previous SWEDRES and SVARM reports are available for downloading at www.smi.se/publikationer or www.sva.se This title can be ordered from: Smittskyddsinstitutets beställningsservice c/o Strömberg, 120 88 Stockholm Fax: +46 (0) 8 – 779 96 67 E-mail: [email protected] Department of Animal Health and Antimicrobial Strategies, 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] Text and tables may be cited and reprinted only with refer- ence to this report. Images, photographs and illustrations are protected by copyright. Suggested citation: SWEDRES-SVARM 2012. Use of antimicrobials and occur- rence of antimicrobial resistance in Sweden. Solna/Uppsala ISSN 1650-6332 Print & Layout: DanagårdLiTHO AB Omslag: Ingvar Westerdahl/Thomas Isaksson SWEDRES |SVARM 2012 3 Content 1. Preface ........................................................................................................................................................... 5 2. Contributors and participants ....................................................................................................................... 7 3. Sammanfattning/Summary ........................................................................................................................... 9 Sammanfattning ............................................................................................................................................. 9 Summary ...................................................................................................................................................... 12 4. Guidance for readers ................................................................................................................................... 15 5. Use of antimicrobials ................................................................................................................................... 19 Use of antimicrobials in humans ................................................................................................................. 19 Use of antifungals ........................................................................................................................................ 35 Use of antimicrobials for animals ................................................................................................................ 37 Comparison of antimicrobial use in human and veterinary medicine ....................................................... 41 6. Occurrence of antimicrobial resistance ...................................................................................................... 43 Antimicrobial resistance as notifiable diseases ............................................................................................ 43 ESBL-producing Enterobacteriaceae ..................................................................................................... 43 Methicillin resistant Staphylococcus aureus (MRSA) ................................................................................. 48 Methicillin resistant Staphylococcus pseudintermedius (MRSP).................................................................. 53 Vancomycin resistant Enterococcus faecalis and Enterococcus faecium (VRE) ............................................. 53 Streptococcus pneumoniae with reduced susceptibility to penicillin (PNSP) ............................................. 55 Resistance in zoonotic pathogens ................................................................................................................ 55 Salmonella ................................................................................................................................................. 55 Campylobacter ............................................................................................................................................ 60 Resistance in clinical isolates from humans ................................................................................................ 61 Isolates from blood cultures reported to ECDC/EARS-Net ................................................................. 61 Resistance in other bacterial species from blood cultures ...................................................................... 63 The annual resistance surveillance and quality control programme (ResNet) ...................................... 63 Clostridium difficile .................................................................................................................................... 67 Neisseria gonorrhoeae ................................................................................................................................. 68 Neisseria meningitidis ................................................................................................................................ 68 Mycobacterium tuberculosis ......................................................................................................................... 68 Resistance in clinical isolates from animals ................................................................................................. 69 Resistance in indicator bacteria from animals ............................................................................................ 81 7. Appendices ................................................................................................................................................... 89 Appendix 1: Demographics and denominator data .................................................................................... 89 Appendix 2: Materials and methods, use of antimicrobials ....................................................................... 93 Appendix 3: Materials and methods, resistance in bacteria from humans ................................................. 96 Appendix 4: Materials and methods, resistance in bacteria from animals .................................................. 98 Appendix 5: SVARM 2000-2012 .............................................................................................................. 103 Appendix 6: References ............................................................................................................................. 105 Interventions addressed the overuse of antibiotics in outpatient care in Kalmar County ......................... 28 Diagnose linked prescribing data from primary care ................................................................................. 30 Enterobacteriaceae with carbapenemases (ESBLCARBA ), the most recent threat ................................. 45 No indication of spread of Escherichia coli carrying blaCMY-2 from broilers to human clinical settings ....... 47 Antimicrobial susceptibility of Brachyspira hyodysenteriae isolated from pigs between 1990 and 2010 ...... 73 SVARMpat ................................................................................................................................................... 74 Farming practices in Sweden related to feeding milk and colostrum from cows treated with anti- microbials to dairy calves ............................................................................................................................. 80 4 SWEDRES |SVARM 2012 SWEDRES |SVARM 2012 5 1. Preface The 2012 Swedish report from the monitoring of antimi- With increased globalization, including travel and worldwide crobial resistance and antimicrobial usage in human and veter- food and animal trade, the challenge grows. As can be seen in inary medicine, SWEDRES-SVARM, is the first fully inte- this year’s report both MRSA and Enterobacteriaceae produc- grated report from the Swedish Institute for Communicable ing ESBLs are increasing in human infections. There are no Disease Control (SMI) and the National Veterinary Institute indications that the observed increase is linked to Swedish (SVA) on antimicrobial resistance and use of antimicrobials, animals, but there is a risk for direct transmission of bacteria with data from humans, animals and food where applicable; of these particular types of resistance between humans and efforts have been made to discuss zoonotic aspects. animals and through the food chain. Consequently, intersec- Antibiotic resistance is one of the 21st century’s greatest torial collaboration between human and veterinary medicine challenges to human and animal health. Use and misuse of is one of the important measures needed when trying to coun- antimicrobials for humans and animals have