2016 SWEDRES|SVARM Consumption of antibiotics and occurrence of antibiotic resistance in Sweden 2 SWEDRES |SVARM 2016 A report on Swedish Antibiotic Utilisation 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: Jenny Hellman and Olov Aspevall, Public Health Agency of Sweden Björn Bengtsson and Märit Pringle, National Veterinary Institute Addresses: The 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 pro- tected by copyright. Suggested citation: Swedres-Svarm 2016. Consumption of antibiotics and occur- rence of resistance in Sweden. Solna/Uppsala ISSN1650-6332 ISSN 1650-6332 Article no. 16124 This title and previous Swedres and Svarm reports are avail- able for downloading at www.folkhalsomyndigheten.se/ Scan the QR code to open Swedres-Svarm 2016 as a pdf in publicerat-material/ or at www.sva.se your mobile device, for reading and sharing. Download a free QR code reader in the App Store for Apple Layout: ETC kommunikation devices or in Google Play for Android, for example Quick Scan QR Code Reader (iPhone) or QR Droid Code Scanner Print: Taberg Media Group, Taberg 2017 (Android). Cover by Ingvar Westerdahl/Thomas Isaksson SWEDRES |SVARM 2016 3 Preface The 2016 Swedish report from the monitoring of anti- echoed by action plans and strategies presented by the Swedish biotic resistance and antibiotic consumption in human and government with broad support in the Swedish Parliament. veterinary medicine, Swedres-Svarm, is an integrated report During 2016, the Unit for Antibiotics and Infection from the Public Health Agency of Sweden and the National Control at the Public Health Agency of Sweden was a desig- Veterinary Institute with data from humans, animals, and food. nated WHO Collaborating Centre for Antibiotic Resistance This report is a result of the successful collaboration between Containment. The activities of the Collaborating Centre the public health and veterinary sectors in Sweden. include support for country-level capacity building to promote The very word “antibiotics” is almost a contradiction. It is local and national use of surveillance data and to facili- derived from the Greek and means “against life”. However, tate participation and implementation of the Global AMR antibiotics make up a life-saving class of drugs and have shaped Surveillance System (GLASS). We also acknowledge the initi- modern human and veterinary medicine. The life that the ative by the OIE to collect data on the global use of antibiotics word refers to is the life of bacteria, and the power of these in animals. These kinds of comparisons increase transparency drugs lies in their ability to stop and eventually kill bacteria. and enable the international community to motivate more However, we are slowly losing more and more ways to keep states to join the collaboration against antibiotic resistance bacterial infections at bay due to antibiotic resistance, glob- and misuse of antibiotics. ally as well as in Sweden. It is therefore imperative that we The use of antibiotics in Swedish farm animals continues not only monitor the development of antibiotic resistance and to be at a steady, low level. The first examples in Sweden of continue to develop the tools at hand, but also to follow the tiamulin-resistant Brachyspira hyodysenteriae have been identi- actual use of antibiotics. fied in some pig production facilities. In contrast, no plas- In this joint report, we present the latest data on resistance mid-borne colistin resistance genes have been found in either and antibiotic use monitoring in Sweden. In addition to chap- fresh or archived veterinary isolates. This demonstrates the ters focusing on either human or veterinary medicine, there usefulness of regular surveillance to understand the dynamics is also an important chapter on comparative analysis. Only of resistance. To further strengthen the surveillance capac- by working together, across various disciplines, will we have a ity in Sweden, a new laboratory network was formed by the chance to face the complex challenge that antibiotic-resistant National Veterinary Institute in collaboration with major bacteria pose. In addition to this, the key to long-term success veterinary clinics. is international collaboration. The United Nations, the World Antibiotic resistance is a consequence of the use and, more Health Organization, and the World Organization of Animal importantly, the misuse of antibiotics. Only through broad Health (OIE) have all presented actions plans and strategies partnerships can we slow and hopefully prevent the rise of for the joint battle against antibiotic resistance. This is also ever more dangerous multi-resistant bacteria. Solna and Uppsala Johan Carlson Jens Mattsson Director General Director General Public Health Agency of Sweden National Veterinary Institute 4 SWEDRES |SVARM 2016 Contributors and participants Editors Other contributors in Svarm Olov Aspevall and Jenny Hellman, National Veterinary Institute Public Health Agency of Sweden. Boel Harbom, Mattias Myrenås and Eva Säker Björn Bengtsson and Märit Pringle, Farm & Animal Health National Veterinary Institute, Sweden. Maria Lindberg, Benedicta Molander Swedish Board of Agriculture Project Manager Kinfe Girma Peter Andréasson, Public Health Agency of Sweden Acknowledgements Authors Swedres The analysis of data was made in collaboration with: Jonatan Public Health Agency of Sweden Alvan, Ingrid Brännström, Mats Erntell, Annika Hahlin, Olov Aspevall, Hanna Billström, Petra Edquist, Malin Mikael Hoffmann, Gunnar Kahlmeter, Johan Struwe and Grape, Sara Hæggman, Jenny Hellman, Jerker Jonsson, Christina Åhrén. Sonja Löfmark, Eva Morfeldt, Barbro Mäkitalo, Christer Norman, Erika Olsson, Magdalena Prioux, Kristina Data on antibiotic use in relation to number of admissions Rizzardi, Karin Sjöström, Anders Ternhag, Tomas and number of patient days in somatic hospital care during Söderblom and Thomas Åkerlund 2012–2016 were kindly provided by pharmacists in local Strama-groups. Medical Products Agency Sahra Barzi The national surveillance of antibiotic resistance would not have been possible without the contribution of data and Strama Stockholm active support of all the Swedish clinical microbiology labo- Annika Hahlin and Emilia Titelman ratories. Department of Clinical Microbiology, Karolinska Complementary epidemiological information on clini- University Hospital, Stockholm cal notifications has been performed by the local County Christian Giske Departments for Communicable Disease Control. National Reference laboratory for Antibiotic Thank you to Kerstin Ortman and Hanna Arosenius at Resistance, Växjö Hospital Eurofins Agro, Skara for kindly providing SVA with clinical Gunnar Kahlmeter isolates and susceptibility results from clinical submissions from animals. National Reference Laboratory for Pathogenic Neisseria, Örebro University Hospital Thank you also to environmental departments in several Hans Fredlund, Susanne Jacobsson and Magnus Unemo municipalities for collecting samples of fresh meat from retail for ESBL-screening. Authors Svarm National Veterinary Institute Björn Bengtsson, Karin Bergström, Stefan Börjesson, Helle Ericsson Unnerstad, Christina Greko, Annica Landén, Oskar Nilsson and Märit Pringle SWEDRES |SVARM 2016 5 Content Preface ������������������������������������������������������������������������������������������������ 3 Zoonotic pathogens: Campylobacter and Salmonella ����������� 63 Contributors and participants �������������������������������������������������������� 4 In Focus WHO GLASS – Sammanfattning/Summary ������������������������������������������������������������� 7 Global Antimicrobial Resistance Surveillance System��������� 64 Guidance for readers ���������������������������������������������������������������������� 13 Antibiotic resistance in animals ........................................66 Consumption of antibiotics in humans ..............................17 Notifiable diseases ��������������������������������������������������������������������� 66 Total consumption of antibiotics �������������������������������������������� 17 ESBL-producing Enterobacteriaceae �������������������������������� 66 In Focus Antibiotics in outpatient care �������������������������������������������������� 18 Quantification of ESBLA and ESBLM- Gender differences �������������������������������������������������������������� 18 producing Escherichia coli in broilers�������������������������������������� 70 Antibiotics commonly used to treat Methicillin resistant S. aureus (MRSA) ���������������������������� 71 respiratory tract infections, urinary tract Methicillin-resistant infections and skin and soft tissue infections ������������������ 19 Staphylococcus pseudintermedius (MRSP) �������������������������� 71 Antibiotic consumption in children ��������������������������������� 23 Zoonotic pathogens ������������������������������������������������������������������ 74 County data �������������������������������������������������������������������������� 26 Salmonella �����������������������������������������������������������������������������