Dik Mevius - RIVM...\ 愀尩 Occurrence of ESC producing E. coli in pigs at slaughter over time....
Transcript of Dik Mevius - RIVM...\ 愀尩 Occurrence of ESC producing E. coli in pigs at slaughter over time....
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Kunnen we de verspreiding van ESBLs voorkomen? In mens en dier!
Dik Mevius
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Evolutie van ESBLs bepaald door selectie!!
Penicillin
Ampi/Amox
3rd/4th-gen Cefalosporines
TEM-1 ESBL Carb.
Carbepenems
OXA-48 NDM-1
Bla-z
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Canton & Coque
The CTX-M ß-lactamase pandemic
Current Opinion in Microbiology Volume 9, Issue 5 2006 466 - 475
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Sinds 2000: CTX-M pandemie
Canton & Coque`, 2006
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ESBLs zijn overdraagbaar
ESBLs liggen vaak op plasmiden
Horizontale overdracht mogelijk binnen bacteriesoorten (E. coli -> E. coli) maar ook tussen bacteriesoorten (E. coli -> Salmonella of Klebsiella)
Geen grenzen aan mogelijkheden van verspreiding
Voedselveiligheids probleem!!
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Extended‐spectrum β‐lactamase‐producing and AmpC‐producing Escherichia coli from livestock and companion animals, and their putative impact on public health: a global perspective
Clinical Microbiology and Infection Volume 18, Issue 7, pages 646-655, 23 APR 2012 DOI: 10.1111/j.1469-0691.2012.03850.x http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2012.03850.x/full#f2
Ewers et al. 2012
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Meer dan 300 ESBL-producerende E. coli isolaten uit UK, DE en NL vergeleken
Bronnen waren: mens, dier en vlees
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Figure 1. Isolates were grouped into 114 clusters at the 40% similarity level.
Wu G, Day MJ, Mafura MT, Nunez-Garcia J, et al. (2013) Comparative Analysis of ESBL-Positive Escherichia coli Isolates from Animals and Humans from the UK, The Netherlands and Germany. PLoS ONE 8(9): e75392. doi:10.1371/journal.pone.0075392 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0075392
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Conclusie
ESBLs is een One-Health probleem Probleem bij de mens wordt
gedomineerd door mens – mens transmissie van succesvolle “mensen-ESBLs”
Bijdrage vanuit dieren door overdracht van ESBL-genen en plasmiden
Ewers et al. 2012
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Interventiemogelijkheden
Prikkel wegnemen Gebruik 3e/4e generatie cefalosporinen Overig antibioticumgebruik verminderen ivm co-selectie
Infectiecontrolemaatregelen en hygiene om verspreiding te voorkomen
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Effect van stoppen met gebruik van 3e-gen cefalosporinen
Ceftiofur gebruik in broederijen gestopt
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(a) Occurrence of ESC producing E. coli in pigs at slaughter over time.
Agersø Y , and Aarestrup F M J. Antimicrob. Chemother. 2013;68:569-572
© The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected]
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Effect vermindering overig antibioticumgebruik op darm E. coli
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ESBLs in kipfilets
84 – 100% pluimveevlees bevat ESBLs
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ESBL-attributie PPS (Topsectorenbeleid)
Samenwerking tussen DLO (CVI) UU (UMCU, IRAS, I&I, Informatica) GD RIVM PVE/PPE VionFood Group, van Drie Group
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Doelstellingen project
1.Vaststellen kwantitatieve bijdragen van dierlijke reservoirs van Extended Spectrum beta-lactamase producerende bacteriën (ESBLs) aan humane ESBL-geassocieerde cases
2.Bepalen transmissieroutes
• Direct contact, consumptie, milieuroutes, buitenland
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Reservoirs en ketens
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Overdracht van ESBL’s van dieren naar mensen
Nigel French, pers. comm.
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Risicofactoren ESBL infecties ● Invasieve infecties
– Recent gebruik antibiotica (m.n. fluoroquinolonen en cephalosporinen) – Onderliggende ziekte / hoge leeftijd – Eerdere ziekenhuisopname – Invasieve handelingen – Geboorte buiten Europa
● Urineweginfecties – Recent gebruik antibiotica (m.n. fluoroquinolonen en cephalosporinen) – Onderliggende ziekte (m.n. chronische urineweginfecties) – Verblijf in een verpleeghuis
● Kolonisatie (algemene bevolking) – Geboorte buiten Europa / reizen – Contacten binnen het huishouden – Contact met (landbouw)huisdieren (maar lagere prevalentie in
pluimveerijke gebieden)
A substantial number of community cases did not live in an RCH nor had
been recently hospitalised, suggesting the independent generation of ESBL-
producing enterobacteria in the broader community (Moor et al., 2008)
In 10 outbreaks, two or more diners shared the same ESBL-PB, and in four of them, the strain was shared with the
food handlers (Lavilla et al., 2008)
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Perceptie
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Producten ESBL-attributie Kwantitatieve gegevens over het voorkomen en de karakteristieken van ESBLs in dierlijke productieketens, het milieu, dierlijke producten en de mens
Diepgaand onderzoek naar genetische associaties
Wiskundige modellen over de attributie van ESBLs bij mensen aan verschillende reservoirs (dieren en mensen) en de bijdrage van verschillende ketens aan de blootstelling van de mens
Kwantitatieve inschatting van effect van reducties van ESBLs in dierreservoirs en in de ketens op voorkomen van ESBLs bij de mens
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Pedigree N = 5 (UK) GGPS N = 50 (UK)
Hatcheries = 1
GPS Rearing N = ± 17 GPS Production N = ± 40
PS-H N = ± 3
PS Rearing N = ± 98 PS production N = 242
Broiler-H N = ± 16
Broiler farms N = ± 735
Vleeskuiken productie pyramide (Dierikx et al 2013)
UK/US CMY-2
ESBLs
CTX-M-1, CMY-2, SHV-12, TEM-52, CTX-M-2, .....
Combinatie van verticale transmissie, recirculatie en introductie
Intro
duct
ie u
it be
smet
milie
u
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Mogelijkheden om in te grijpen
Optimale hygiene Broederij Vleeskuikensbedrijf
• Beide zwaar besmet met ESBLs
Competitive Exclusion (Aviguard, Broilact) Voorkomen van kolonisatie
bij jonge dieren Sterk gereduceerd
antibioticumgebruik
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Conclusie
Het voorkomen van ESBLs bij mensen en dieren is een gezamenlijk probleem
Controle is alleen mogelijk door een gezamenlijke aanpak
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Carbepenemases in dieren. Zijn we voorbereid?