2002 SVARM 2002 Swedish Veterinary Antimicrobial Resistance Monitoring NATIONAL VETERINARY IN STI TU TE UPP SA LA, SWEDEN SVARM 2002 1 INDEX Preface ............................... 4 Summary ........................... 5 Sammanfattning ............. 7 Use of antimicrobials ... 9 Resistance in zoonotic bacteria .......... 13 Resistance in indicator bacteria ......... 17 spp Resistance in animal pathogens ........................ 27 Pig Cattle Horse Dog Cat Appendix 1: ..................... 36 Demographic data Appendix 2: ..................... 38 Materials and methods, use of antimicrobials Appendix 3: ..................... 39 Materials and methods, resistance monitoring Appendix 4: ..................... 43 © 2003 Statens Veterinärmedicinska Anstalt, Antimicrobial agents National Veterinary Institute authorised Uppsala, Sweden Printed by Wikströms, Uppsala, Sweden Appendix 5: ..................... 44 ISSN - 1650-6332 References Procuded by the Information Department Graphic production by Gudrun Orava Photographs by Bengt Ekberg ÖMÄ ILJ RK M T TR YCKSAK 341 051 2 SVARM 2002 Swedish Veterinary Antimicrobial Resistance Monitoring Editors Björn Bengtsson, Christina Greko and Catarina Wallén Department of Antibiotics National Veterinary Institute (SVA) SE-751 89 Uppsala Sweden Authors SVARM 2002 SVARM Department of Antibiotics National Veterinary Institute Björn Bengtsson, Anders Franklin, Christina Greko, Märit Karlsson and Catarina Wallén Zoonosis Center National Veterinary Institute Ivar Vågsholm Apoteket AB Kristina Odensvik SVARM laboratory working group Department of Antibiotics National Veterinary Institute Maria Finn, Margareta Horn af Rantzien, Annica Landén, Verena Rehbinder Also available at www.sva.se Text and tables may be cited and reprinted only with reference to this report. Reprints can be ordered from Department of Antibiotics 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] SVARM 2002 3 The problem with antibiotic resistance in Swe- The ultimate goal is to preserve the effectiveness den is still limited. However during the last year of available antimicrobials for man and animals several reports have been presented revealing that and the general concept is to use antimicrobials the situation, in some countries, is alarming. In only when needed, on prescription only and that November 2001 an EU-recommendation was the choice of treatment is based on relevant infor- adopted in which every member state is asked mation. In addition further efforts must be made to put in place specifi c strategies on prudent use to prevent infectious diseases both in human and of antimicrobial agents. These strategies should in veterinary medicine. comprise measures in relation to surveillance of In this document we have combined our annual antimicrobial resistance, surveillance of antimicro- reports: SWEDRES, Swedish Antibiotic Utilisa- bial use, control and preventive measures, educa- tion and Resistance in Human Medicine and tion and training, and research. Such a system has SVARM, Swedish Veterinary Antimicrobial Resist- Pre fa ce fa Pre been in place in Sweden since 1995 through the ance Monitoring. Our hope is that the report will Swedish Strategic Programme for the Rational serve as a basis for further policy recommenda- Use of Antibiotics and Surveillance of Resistance tions and intervention strategies, and that it will (STRAMA), which is fi nancially supported by the increase our understanding of the dynamics of Swedish Government. resistance. It is today generally accepted that all use of an- timicrobials in different sectors contributes to the development of resistance. Therefore, in Sweden, human and veterinary medicine have collaborated over a number of years, not least within STRA- MA. Based on this experience we are convinced that joint efforts between human and veterinary medicine are essential in order to counteract the threat that antimicrobial resistance poses to both human and animal health. Overall, the fi gures in this report indicate that the Swedish strategy in human and veterinary medicine has been success- ful in containing resistance. 4 SVARM 2002 This third report from SVARM concurs with the to different production types. Recently, the Board two previous reports and other Swedish studies in of Agriculture was appointed as the competent this fi eld and indicates that the situation regard- governmental authority in this fi eld, and is to pro- ing antimicrobial resistance in bacteria of animal vide such data from 2006. Ideally, it should also origin is stable. Resistance does occur but in an be possible to link data on use to animal health international perspective the levels are low. To records. Such systems would be most valuable to sustain the favourable situation, it is important to analyse trends in use and resistance, to identify uphold the tradition of prudent use of antimicro- possible risk factors and to assess the degree of bials in animals and a good animal health status. compliance with policy recommendations. The information gathered in programmes like SVARM, monitoring both antimicrobial con- Resistance in zoonotic bacteria sumption and occurrence of resistance, should Antimicrobial resistance in Salmonella from Swed- further the understanding of the epidemiology of ish animals is rare and the situation has been stable antimicrobial resistance. From the data gathered since the late 70s, when monitoring of resistance in SVARM after three years, certain issues that began. The overall prevalence of resistance in each Summary deserve further study have been identifi ed. One year’s material is greatly infl uenced by the occur- such issue is co-selection of resistance whereby use rence of multiresistant isolates of S. Typhimurium, of one antimicrobial selects for resistance not only i.e. resistant to at least three antimicrobials. As to itself but also to other drugs. Thus, co-selection these phagetypes (DT104, DT193 and DT120) might explain occurrence of resistance to drugs are rare among food-producing animals, probably not currently used, or the persistence of resistance a result of the strategies in the Swedish Salmonella for long periods after the use was discontinued. control programme, the overall prevalence of resistance is low. Nor is there any indication of Consumption of antimicrobials spread of such clones among the notifi ed incidents Antimicrobials for use in animals in Sweden are in wild animals and pets. only available on veterinary prescription and Levels of antimicrobial resistance among guidelines emphasising judicious use have been Campylobacter jejuni from broiler chickens issued. Use for growth promotion was banned sampled at slaughter were low and of the same in 1986. In year 2002, a total of 17.3 tons of magnitude as year 2001. No isolate was resistant antimicrobials were used for animals in Sweden. to more than one antimicrobial tested. This fi gure is of a similar magnitude as those for 2000 and 2001. The major part (85%) was used Resistance in indicator bacteria for treatment of individual animals. Over the last In SVARM, the antimicrobial susceptibility fi ve years, the overall sales of tetracyclines have among Escherichia coli and Enterococcus spp. decreased markedly. An increase in sales of fl uoro- isolated from healthy animals sampled at slaughter quinolones intended for treatment of individual serve as indicator of the selective pressure exerted animals (injectables and tablets) was recorded by antimicrobials used in specifi c animal popula- over the last three years. The possible implica- tions. Although unlikely to cause disease, these tions of this for resistance in bacteria from animals bacteria can constitute a reservoir of transferable are, however, diffi cult to assess as these drugs are resistance genes that can spread to bacteria with authorised for use in several animal species, both potential to cause disease in animals and humans. food producing animals and pets. This year, data on indicator bacteria isolated from A sudden increase in sales of pleuromutilins was broiler chickens is reported. noted between 2001 and 2002. These drugs are Overall, the fi gures for 2002 are low in an used for treatment of swine dysentery and other international perspective and with few exceptions enteric conditions associated with Brachyspira similar to levels for year 2000 and 2001. Resist- spp. Resistance to pleuromutilins in Brachyspira ance to some antimicrobials can be explained spp. has been reported from other countries. As by use of the substance in chicken production, the therapeutic arsenal available for treatment of whereas resistance to substances not used might these conditions is limited, emergence and spread be a consequence of co-selection. Thus, use of of resistance to pleuromutilins in Brachyspira spp. one antimicrobial might select for resistance also could have serious consequences for animal health. to other, unrelated, substances. In the combined Therefore, it seems advisable to monitor both data for years 2000, 2001 and 2002 there are use of these drugs and susceptibility of relevant indications of linked resistance in E. coli as well as pathogens closely. To minimise the selective pres- in enterococci, which implies that co-selection of sure, routine use for prevention of disease should resistance, might occur. be avoided as far as possible. The proportion of vancomycin resistant entero- Clearly, current systems for animal drug statis- cocci (VRE) in the gastrointestinal tract of broiler tics