Usage of Antibiotics and Occurrence of Antibiotic Resistance in Bacteria from Humans and Animals in Switzerland Joint report 2013 ARCH-Vet anresis.ch Publishing details © Federal Office of Public Health FOPH Published by: Federal Office of Public Health FOPH Publication date: November 2015 Editors: Federal Office of Public Health FOPH, Division Communicable Diseases. Elisabetta Peduzzi, Judith Klomp, Virginie Masserey Design and layout: diff. Marke & Kommunikation GmbH, Bern FOPH publication number: 2015-OEG-17 Source: SFBL, Distribution of Publications, CH-3003 Bern www.bundespublikationen.admin.ch Order number: 316.402.eng Internet: www.bag.admin.ch/star www.blv.admin.ch/gesundheit_tiere/04661/04666 Table of contents 1 Foreword 4 Vorwort 5 Avant-propos 6 Prefazione 7 2 Summary 10 Zusammenfassung 12 Synthèse 14 Sintesi 17 3 Introduction 20 3.1 Antibiotic resistance 20 3.2 About anresis.ch 20 3.3 About ARCH-Vet 21 3.4 Guidance for readers 21 4 Abbreviations 24 5 Antibacterial consumption in human medicine 26 5.1 Hospital care 26 5.2 Outpatient care 31 5.3 Discussion 32 6 Antibacterial sales in veterinary medicines 36 6.1 Total antibacterial sales for use in animals 36 6.2 Antibacterial sales – pets 37 6.3 Antibacterial sales – food producing animals 38 6.4 Discussion 40 7 Resistance in bacteria from human clinical isolates 42 7.1 Escherichia coli 42 7.2 Klebsiella pneumoniae 44 7.3 Pseudomonas aeruginosa 48 7.4 Acinetobacter spp. 49 7.5 Streptococcus pneumoniae 52 7.6 Enterococci 54 7.7 Staphylococcus aureus 55 Table of contents 1 8 Resistance in zoonotic bacteria 58 8.1 Salmonella spp. 58 8.2 Campylobacter spp. 61 9 Resistance in indicator bacteria in animals 68 9.1 Enterococci 68 9.2 Escherichia coli 72 9.3 ESBL / pAmpC-producing Escherichia coli 76 9.4 Methicillin resistant Sta phy lococcus aureus (MRSA) 81 10 Resistance in diagnostic submissions from animals 86 10.1 Staphylococcus spp. 86 11 Materials and methods 92 11.1 Data on Antibacterial consumption in human medicine 92 11.2 Data on antibacterial sales in veterinary medicine 92 11.3 Bacterial isolates from humans (clinical probes) 93 11.4 Bacterial isolates from animals (for monitoring: clinical and not clinical probes) 93 11.5 Susceptibility testing, breakpoints, processing antibiotic resistance data from human isolates 94 11.6 Susceptibility testing, cut-off, processing anti biotic resistance data from animal isolates 95 Annex I 100 Defined daily dose (DDD) of antibiotics for patient treatment Annex II 104 Distribution of minimal inhibitory concentrations (MICs) in bacterial isolates from animals Annex III 114 Tables of multi-resistance patterns in bacterial isolates from animals Annex IV 128 anresis.ch participants and steering committee Index 131 Figures, tables and textboxes 2 Table of contents 1 Foreword Antibacterial consumption in human medicine 3 1 Foreword Antibiotic resistance is an emerging global public health a system to enable the continuous monitoring of resistance threat. The use of antibiotics contributes to the selection of in farm animals, meat and dairy products in Switzerland. Ad- resistant bacteria leading to treatment failure of bacterial dis- ditionally it compiles data on sales of antimicrobial agents for eases in humans and animals. Resistant bacteria can spread veterinary medicine. Since 2009 data on sales of veterinary between humans in the community and healthcare. On the antimicrobials and results of the monitoring of resistance in other hand, resistant bacteria from animals and the environ- farm animals are published yearly in the ARCH-Vet report. ment can be transmitted to humans either through direct The present report, which is the first joint report from anre- contact or through ingestion of contaminated food or other sis.ch and ARCH-Vet, presents Swiss data for 2013. In addi- contaminated vehicles. Increasing global trade and travel tion to resistance data it includes data on the consumption favor additionally the spread of antimicrobial resistance be- of antibiotics in humans and sales of antimicrobials in veter- tween countries and continents. Regarding the complexity inary medicine. It is the basis for the detection, interpreta- of the epidemiology of antimicrobial resistance, it is impor- tion and evaluation of trends regarding usage of antibiotics tant to monitor trends in antibiotic resistance in a holistic and occurrence of resistance. Although the data for human approach (“One Health approach”) including data on usage and veterinary medicine are presented in one report, it is and resistance in human and veterinary medicine as well as important to be aware that differences between the moni- in food production. toring systems for collection, interpretation and reporting In response to the growing concern about antibiotic resist- hamper direct comparisons of the results. Cooperation and ance, the Ministries of home and economic affairs assigned coordination between the different monitoring-networks the Federal Office of Public Health (FOPH), the Food Safety have to be strengthened and refined to improve comparabil- and Veterinary Office (FSVO), the Federal Office for Agricul- ity and fill the gaps, as it is foreseen in the national strategy ture (FOAG) and the Federal Office for the Environment on antimicrobial resistance (StAR). (FOEN) to develop and implement a national strategy to combat antibiotic resistance (“Strategie Antibiotikaresisten- The editors would like to thank all those who contributed to zen, StAR”). The approval by the Federal Council is planned data collection and the writing of this report for their excel- for the end of 2015. The strategy will encompass all the ac- lent work. tion fields of the different sectors (regulatory, prudent use, surveillance, research, control in hospitals etc.). The global goal of the strategy is to ensure the long-term efficacy of antibiotics in preserving human and animal health. It empha- sizes the importance of monitoring antimicrobial drug usage and resistance in both human and veterinary medicine. The first National Research ”Antibiotic Resistance” (NRP 49) in Switzerland was approved in 1999 and ran between 2001 and 2006. A very important achievement of this pro- gram was the establishment of a surveillance system for human medicine (anresis.ch). Since 2004, anresis.ch has been collecting routine antibiotic resistance data from hu- man microbiology laboratories. The system has been further developed and at present, it also monitors data on human antibiotic consumption (hospitals and outpatient). The NRP 49 also provided the basis for a monitoring pro- gram in veterinary medicine. In 2006, the FSVO introduced Daniel Koch Josef Schmidt Division Communicable Diseases Division Animal Health Federal Office of Public Health Federal Food Safety and Veterinary Office 4 Foreword 1 Vorwort Antibiotikaresistenzen sind ein globales Problem und bedro- bio logischen Laboratorien. Das System wurde dann weiter- hen die öffentliche Gesundheit weltweit. Die Verwendung entwickelt und überwacht nun auch die Daten zum mensch- von Antibiotika trägt zur Selektion resistenter Bakterien bei, lichen Antibiotikakonsum (Spitäler und ambulanter Bereich). was zu Behandlungsversagen bei bakteriellen Erkrankungen Das NFP 49 bildete auch die Grundlage für ein Monitoring- von Mensch und Tier führt. Resistente Bakterien können programm in der Veterinärmedizin. 2006 führte das BLV ein sich einerseits zwischen Menschen in der Bevölkerung und System ein, um in der Schweiz ein kontinuierliches Antibio- in Gesundheitseinrichtungen ausbreiten. Andererseits kön- tikaresistenzmonitoring bei Nutztieren, Fleisch und Milch- nen resistente Bakterien von Tieren und aus der Umwelt produkten zu ermöglichen. Zusätzlich trägt es Daten zum entweder durch direkten Kontakt oder durch kontaminierte Vertrieb von Antibiotika in der Veterinärmedizin zusammen. Lebensmittel oder andere Trägerstoffe auf Menschen über- Seit 2009 werden die Daten zum Vertrieb von Veterinäranti- tragen werden. Zunehmender globaler Handel und Reiseak- biotika und die Ergebnisse des Antibiotikaresistenzmonito- tivitäten fördern zusätzlich die Verbreitung von Antibiotikare- rings bei Nutztieren jährlich im ARCH-Vet Bericht veröffent- sistenzen über Länder und Kontinente hinweg. Angesichts licht. der komplexen Epidemiologie von Antibiotikaresistenzen ist Das vorliegende Dokument, bei dem es sich um den ersten es wichtig, Trends bei resistenten Bakterien nach einem gemeinsamen Bericht von anresis.ch und ARCH-Vet han- ganzheitlichen Ansatz («One Health Approach») zu überwa- delt, präsentiert Schweizer Daten für das Jahr 2013. Zusätz- chen und Daten zur Antibiotikaverwendung und Resistenz- lich zu den Resistenzdaten umfasst er Daten zum menschli- lage aus der Human- und Veterinärmedizin sowie der Le- chen Verbrauch antibiotischer Wirkstoffe und zum Vertrieb bensmittelproduktion einzubeziehen. von Antibiotika in der Veterinärmedizin. Er bildet die Grund- Als Reaktion auf die wachsende Besorgnis bezüglich Anti- lage für die Erkennung, Interpretation und Evaluation von biotikaresistenzen erteilten die Eidgenössischen Departe- Trends bezüglich Verwendung antibiotischer Wirkstoffe und mente des Innern (EDI) und für Wirtschaft, Bildung und For- Auftreten von Resistenzen. Obwohl die Daten der Human- schung (WBF) den Bundesämtern für Gesundheit (BAG), für und der Veterinärmedizin in einem Bericht erscheinen, gilt Lebensmittelsicherheit und Veterinärwesen (BLV), für Land- es zu beachten, dass die Überwachungssysteme Unter- wirtschaft (BLW) und für Umwelt (BAFU)