2007 NORM NORM-VET Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway ISSN: 1502-2307 Any use of data from NORM/NORM-VET 2007 should include specific reference to this report. Suggested citation: NORM/NORM-VET 2007. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Tromsø / Oslo 2008. ISSN:1502-2307. This report is available at www.vetinst.no and www.antibiotikaresistens.no 1 NORM / NORM-VET 2007 CONTRIBUTORS AND PARTICIPANTS Editors: Madelaine Norström NORM-VET, Nat. Vet. Inst. Gunnar Skov Simonsen NORM, Univ. Hosp. of North Norway / Norw. Inst. of Pub. Health Authors: Hege Salvesen Blix Usage in humans [email protected] Norw. Inst. of Pub. Health Susanne Dudman Human clinical isolates [email protected] Norw. Inst. of Pub. Health Kari Grave Usage in animals [email protected] Nat. Vet. Inst./ Norw. School of Vet. Sc. Olav Hungnes Human clinical isolates [email protected] Norw. Inst. of Pub. Health Jørgen Lassen Enteropathogenic bacteria [email protected] Norw. Inst. of Pub. Health Turid Mannsåker Human clinical isolates [email protected] Norw. Inst. of Pub. Health Ingvild Nordøy Human clinical isolates [email protected] Rikshospitalet Univ. Hosp. Madelaine Norström Animal indicator bacteria and enteropathogenic bacteria [email protected] NORM-VET, Nat. Vet. Inst. Gunnar Skov Simonsen Human clinical isolates [email protected] NORM, Univ. Hosp. of North Norway Dagfinn Skaare Human clinical isolates [email protected] Telelab A/S Trine-Lise Stavnes Enteropathogenic bacteria [email protected] Norw. Inst. of Pub. Health Marianne Sunde Animal indicator bacteria [email protected] Nat. Vet. Inst. Institutions participating in NORM-VET: Norwegian Food Safety Authority National Veterinary Institute, Norwegian Zoonosis Centre Madelaine Norström / Merete Hofshagen National Veterinary Institute, Section of Bacteriology Marianne Sunde / Hanne Tharaldsen Norwegian Institute of Public Health Jørgen Lassen / Trine-Lise Stavnes Institutions participating in NORM: Aker University Hospital, Oslo, Department of Bacteriology Gorm Hansen / Bitten Rasmussen Akershus University Hospital, Oslo, Department of Microbiology Martin Steinbakk / Marit Einvik Capio laboratoriemedisin, Oslo, Department of Microbiology Nina Clausen Buskerud Hospital, Drammen, Department of Microbiology Helvi Holm Samdal / Ellen Grimstad Haugesund Hospital, Department of Microbiology Liv Jorunn Sønsteby / Pirrko-Liisa Kellokumpu Nordland Hospital, Bodø, Department of Microbiology Liisa Mortensen / Siw Meløysund Levanger Hospital, Department of Microbiology Angela Kümmel/ Eldbjørg Berg Innlandet Hospital, Lillehammer, Department of Microbiology Viggo Hasseltvedt / Kari Ødegaard Østfold Hospital, Fredrikstad, Department of Microbiology Eivind Ragnhildstveit / Anne Cathrine Hollekim Vestfold Hospital, Tønsberg, Department of Microbiology Lumnije Dedi / Astrid Lia Molde Hospital, Department of Microbiology Einar Vik / Heidi Tomren Ålesund Hospital, Department of Microbiology Reidar Hide / Luisa Johansen Førde, Department of Microbiology Reidar Hjetland / Astrid Vedde Haukeland Univ. Hospital, Bergen, Dep. of Immunology and Microbiology Dag Harald Skutlaberg / Torunn Sneide Haukeland Asker & Bærum Hospital, Bærum, Department of Microbiology Bjørn Odd Johnsen / Merriam Sundberg National Cancer Hospital, Oslo, Laboratory of Microbiology Truls Leegaard / Merete R. Ueland National Reference Laboratory for Enteropathogenic Bacteria, Oslo Jørgen Lassen / Trine-Lise Stavnes Rikshospitalet University Hospital, Oslo, Institute of Medical Microbiology Fredrik Müller / Magli Bøvre Stavanger University Hospital, Department of Microbiology Elisebet Haarr / Anita Løvås Brekken St. Olav University Hospital, Trondheim, Department of Microbiology Raisa Hannula / Marianne Dorothea Wiig Sørlandet Hospital, Kristiansand, Department of Microbiology Ståle Tofteland / Torill S. Larsen Telelab A/S, Skien Yngvar Tveten / Monica Kollstrøm Ullevål University Hospital, Oslo, Department of Microbiology Gaute Syversen / Thea Bergheim University Hospital of North Norway, Tromsø, Department of Microbiology Gunnar Skov Simonsen / Siv-Heidi Barkhald NORM reference group in 2007: Olav Natås Stavanger University Hospital, Stavanger Eldbjørg Berg Levanger Hospital, Levanger E. Arne Høiby Norwegian Institute of Public Health, Oslo Peter Gaustad Rikshospitalet University Hospital, Oslo Dag Berild Aker University Hospital, Oslo Ståle Tofteland Sørlandet Hospital, Kristiansand Mark Fagan Froland Community Health Center, Froland The NORM and NORM-VET programmes are part of the Norwegian Government’s Action Plan against Antimicrobial Resistance issued in 2000. 2 NORM / NORM-VET 2007 CONTENTS CONTENTS I. Introduction ………………………………………………………………………………………............. 5 II. Sammendrag (norsk) ……………………………………………………………………………….......... 6 III. Summary (English)…………………………………………………………………………………......... 9 IV. Population statistics.…………………………………………………………………………………....... 13 V. Usage of antimicrobial agents Usage in animals…………………………………………………………………………………..... 15 Usage in humans.………………………………………………………………………………….... 19 VI. Occurrence of antimicrobial resistance Indicator bacteria from animals and food Escherichia coli from turkeys, swine and sheep .................................................. 29 Enterococcus spp. from turkey and swine..……………......................................... 32 Zoonotic and non-zoonotic enteropathogenic bacteria Salmonella spp. ……………………….........................……………….................. 37 Campylobacter spp. …………………………………. ........................................... 43 Yersinia enterocolitica ..……….........................…………………….................... 48 Shigella spp. .………………….............……….........................…….................... 49 Human clinical isolates Distribution of bacterial species in blood cultures .................................................. 51 Escherichia coli in blood cultures ………………….............................................. 53 Escherichia coli in urine ……………………………............................................. 55 Klebsiella spp. in blood cultures…………………….............................................. 56 Haemophilus influenzae in respiratory tract specimens............................................ 61 Staphylococcus aureus in blood cultures …………................................................ 64 Staphylococcus aureus in wound specimens ........................................................... 65 Enterococcus spp. in blood cultures ….…………….............................................. 71 Streptococcus pneumoniae in blood cultures ………................................................ 73 Streptococcus pneumoniae in respiratory tract specimens .................................... 75 Mycobacterium tuberculosis …….……………...................................................... 77 Candida spp. in blood cultures ............................................................................... 78 Influenza virus in respiratory tract specimens ......................................................... 80 New guidelines for use of antibiotics in Norwegian primary health care, by K. E. Eliassen ......... 26 Changing habits of antibiotic prescription in general practice. The Rx-PAD study, by S. Gjelstad 27 gyrA and parC mutations and associated quinolone resistance in Vibrio anguillarum serotype O2b isolated from Norwegian farmed Atlantic cod (Gadus morhua), by D. J. Colquhoun ........... 35 Metallo-beta-lactamases (MBLs) and Klebsiella pneumoniae carbapenemases (KPCs); two new mobile beta-lactamases emerging in Gram-negative bacteria – A problem in Norway or just a curiosity?, by Ø. Samuelsen ........................................................................................................... 59 MRSA infections in Norway, by P. Elstrøm ............................………………………………....... 67 MRSA strain typing methods in the context of epidemiological analysis, by T. Jacobsen, L. Marstein, A. K. Kilnes, J. Fossum, J. E. Afset and K. Bergh..................................................... 68 3 CONTENTS NORM / NORM-VET 2007 Appendix 1 Collection of data on usage of antimicrobial agents in animals ..……………….……….............. 81 Appendix 2 Collection of data on usage of antimicrobial agents in humans …………………………............. 82 Appendix 3 Sampling, microbiological methods and data processing in NORM-VET ..…………….............. 83 Appendix 4 Sampling, microbiological methods and data processing of zoonotic and non-zoonotic enteropathogenic bacteria in NORM and NORM-VET ..…………………………………........... 84 Appendix 5 Sampling, microbiological methods and data processing in NORM ......…………………........... 85 Appendix 6 Breakpoints NORM-VET...…….…………………………………………..………………........... 86 Appendix 7 Breakpoints NORM .....…………………………………………………………….….…............. 87 4 NORM / NORM-VET 2007 INTRODUCTION I. INTRODUCTION Antimicrobial resistance is an emerging problem antimicrobial resistance. The NORM and NORM-VET worldwide. It reduces the effectiveness of antimicrobial programmes were consequently established in order to treatment of infectious diseases in humans and animals provide and present microbiologically and thereby leading to increased morbidity and mortality, as epidemiologically valid data on the occurrence and well as higher costs. It is well established that there is a distribution of antimicrobial resistance over time. The strong association between the usage of antimicrobial