The European Union Summary Report on antimicrobial ... · Data on humans are collected through The...
Transcript of The European Union Summary Report on antimicrobial ... · Data on humans are collected through The...
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The European Union Summary Reporton antimicrobial resistance
in zoonotic and indicator bacteriafrom humans, animals and food for 2009
P.A. BeloeilUnit on Zoonoses Data CollectionWorkshop of EU RL AMR, Copenhagen, 4 April 2011
Collection of data on zoonoses, zoonotic agents, AMR and food-borne outbreaks in the EU
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ZCC(VLA)
Data on humans are collected through The European Surveillance System (TESSy)maintained by ECDC
Human AMR data available in 2009Methods (1)
• Clinical isolates of salmonellosis and campylobacteriosis
• Only S/I/R interpretation of ASTs
• Large panel of antimicrobials tested and reported
• Guidelines for AST method and interpretation differedo Mixture of disc diffusion, E-test and dilution
o Different thresholds used for interpretation
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Antimicrobial susceptibility testing guidelinesSalmonella
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Country No. reportedantimicrobials Guidelines
Austria 11 CLSI M100 breakpoints
Denmark 11 EUCAST epidemiological cut-offs (ECOFFS)
Estonia 11 CLSI
Germany 8 National + CLSI for NAL
Ireland 11 CLSI
Italy 11 CLSI
Latvia 6 CLSI
Lithuania 11 CLSI
Luxembourg 11 CLSI
Malta 4 Modified CLSI
Netherlands 8 EUCAST ECOFFS with EFSA modification for STR, CLSI for SSS
Romania 11 CLSI
Slovakia 8 CLSI
Slovenia 11 CLSI
Spain 11 CLSI
UK 11 National
Iceland 5 CLSI
Antimicrobial susceptibility testing guidelinesCampylobacter
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Country No. reportedantimicrobials Guidelines
Austria 4 National
Estonia 4 SRGA-M + CLSI M45-A
Italy 6 CLSI adapted to all antimicrobials
Lithuania 5 BSAC
Luxembourg 3 CA-SFM
Malta 2 CA-SFM
Netherlands 3 Not specified
Slovakia 3 CLSI
Slovenia 7 CA-SFM + CLSI
Spain 7 CA-SFM + CLSI
UK 7 BSAC + modified CLSI
Iceland 2 CLSI?
Human AMR data available in 2009Methods (2)
• Salmonella spp., S. Enteritidis and S. Typhimurium
o Results presented as % resistant isolates for each antimicrobial
o Three-year trends visualised for cefotaxime and ciprofloxacin
• Campylobacter, C. jejuni and C. coli
o Results presented as % resistant isolates for each antimicrobial
o Three-year trends visualised for ciprofloxacin and erythromycin
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Human AMR data available in 2009Results
• Salmonella
o 16 MSs and 1 non-MS reported AST data in Salmonella
o Numer of isolates representing 24% of reported salmonellosis cases in EU/EEA in 2009
High resistance for ampicillin, tetracyclines and sulphonamides, especially for S. Typhimurium (around 50%)
Low resistance (0-4%) for cefotaxime and ciprofloxacine, with the exception of countries using epidemiological cut-off values
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Cefotaxime resistance in S. Enteritidis from human samples, 2007-2009
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Countries that reported 0% resistance throughout this period are not shown: Germany and Luxembourg.
Countries that useEUCAST ECOFF (>0.5 mg/L) orsimilar standard (1 mg/L).
Countries that useCLSI breakpoint (≥64 mg/L)
Cefotaxime resistance in S. Typhimuriumfrom human samples, 2007-2009
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Countries that reported 0% resistance throughout this period are not shown: Luxembourg.
Countries that useEUCAST ECOFF (>0.5 mg/L) orsimilar standard (1 mg/L).
Countries that useCLSI breakpoint (≥64 mg/L).
Country that usesa national standard (>8 mg/L)
Human AMR data available in 2009Results
• Campylobacter
o 11 MSs and 1 non MS reported AST in Campylobacter
o Number of isolates representing 14% of reported Campylobacterinfection cases in EU/EEA in 2009
High resistance for ampicillin, ciprofloxacin and nalidixic acid
Low resistance (0-10%) for erythromycin
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Antimicrobial resistance in C. jejunifrom human samples, 2007-2009
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Direct comparisons between countries should be avoided due to use of different standards for testing:• Estonia (SRGA-M)• Netherlands (unspecified)• Spain (CLSI)
• UK (modified CLSI)
Ciprofloxacin
Erythromycin
Countries that reported 0% resistance throughout this period are not shown: Malta.
Human AMR data available in 2009Issues identified for human data
• Assessment of EU situation difficult when 2/5 and 3/5 MSs do not report AST data for Salmonella and Campylobacter, respectively
• Harmonisation needed on which guidelines to use when interpreting human data
• Many countries use disc diffusion for Campylobacterantimicrobial susceptibility testing though known problem with poor reproducibility
• International standards on breakpoints for several antimicrobials missing for Campylobacter 12
AMR data in animals and food in 2009Methods (1)
• Data mainly from fowl (Gallus gallus), pigs and cattle, and less data from meat thereofo 24 MSs + 2 non-MSs reported on AMR in Salmonella
o 16 MSs + 2 non-MSs reported on AMR in Campylobacter
o 12 MSs + 2 non-MSs reported on AMR in indicator E. coli
o 9 MSs + 1 non-MSs reported on AMR in indicator enterococci
• The number of MSs reporting quantitative data on AMR increased from 18 MSs to 24 MSs from 2004 to 2009
• Quantitative data were mainly reported as MICs
• Scarce quantitative disk diffusion data (only reported for Salmonella) were analysed in the qualitative chapter 13
AMR data in animals and food in 2009 Analyses
• Harmonised epidemiological cut-off values used for MICs
Epidemiological cut-off values ↔ Microbiological Resistance
• Analyses of trends over the years (in MS / in the EU)o Developments in the EU and in MSs
o Emerging resistance
• Spatial (geographical) distributions through maps
• EFSA is in a process of developing the analyses of AMR data at the Community level (supra-national)
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Presentation of AMR data
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Austria Czech Republic Denmark Greece
Hungary Lithuania Netherlands Poland
Slovakia Slovenia Spain UK
Country N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % Res N % ResGallus gallusAustria 78 0 28 0 78 0 28 0 78 1 28 14 78 0 28 0Czech Republic 31 6 25 4 234 0 31 0 25 0 234 0 30 0 25 4 234 0 234 0Denmark 18 17 13 8 18 6 10 20 18 6 13 0 18 0 10 10 18 17 13 0 18 11 10 10 18 0 13 0 18 0 20 0Estonia 11 0 11 18 11 45Finland 10 0 10 0 10 10 10 0France 132 4 132 2 132 4Greece 105 22 176 10 116 44 105 14 163 2 117 40 105 7 135 2 111 14Hungary 122 61 135 60 122 2 144 0 122 3 154 3 122 0 153 1Italy 136 49 136 19 136 43 136 3Lithuania 19 11 12 0 19 0 12 0 19 16 12 0Netherlands 52 21 164 26 52 10 164 4 52 25 164 40 52 2 164 13Poland 104 0 443 8 178 4 91 22 105 1 443 2 178 0 91 10 105 4 443 7 178 5 91 16 105 0 178 0Romania 81 35 28 4 21 5Slovakia 173 40 89 2 137 10 110 5 89 1 137 0 110 9 89 6 137 1 110 0 89 0 137 0Slovenia 31 6 29 0 26 8 33 12 31 0 29 0 26 0 33 0 32 9 29 0 25 0 33 3 25 0 33 0Spain 36 14 36 0 294 23 36 3 18 0 294 3 36 22 93 2 36 8 18 6 295 8Sweden 15 0 15 0 15 7 15 0United Kingdom 46 2 51 0 120 4 46 0 51 0 116 0 46 2 51 4 120 4Total (18 MSs) 435 25 1025 12 741 21 1457 18 436 5 931 2 751 7 1400 4 437 7 884 5 754 8 1196 13 245 0 91 0 402 0 53 0 36 8 128 1 141 1 991 5
Cefotaxime2004 2007
Tetracycline Chloramphenicol Ampicillin Ceftiofur2004 2005 2006 2004 2007 20052005 2006 2007 2004 2005 2006 20062007 2004 2005 20062007
% R = the number ofresistant isolatesfrom all reportingMSs over the numbertested
% R = the numberof resistantisolates over the number tested
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AMR in indicator E. coli
Tetracycline - pigs
AMR data in animals and food in 2009 Main findings
• Microbiological Resistance to antimicrobials was commonly found in isolates of Salmonella, Campylobacter and indicator E. coli and enterococci from animals and food in the EU
• For many of the antimicrobials tested, there were large differencesin the occurrence of resistance in different MSs
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S. Enteritidis - Gallus gallus - Ciprofloxacin
Main findings (2)Fluoroquinolones
• In food and animal isolates, the highest occurrence of resistance to ciprofloxacin was noted in Salmonella isolates from fowl (Gallus gallus) and broiler meat, where moderate resistance rates were reported.
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C. jejuni - Gallus gallus - Ciprofloxacin
Main findings (2)Fluoroquinolones
• High resistance to fluoroquinolones was commonly observed in Campylobacter isolates from Gallus gallus and broiler meat, as well as from pigs and cattle.
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Main findings (3)Third-generation cephalosporins
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• Resistance to third-generation cephalosporins wasobserved in Salmonella and indicator E. coli isolates fromGallus gallus, pigs and cattle, and the meat derived fromthose species, but at low or very low levels in the EU.
Salmonella spp. MS-group level
• Gallus gallus 2% (0 - 12%)
• Pigs 0.7% (0 - 2%)
• Cattle 0.4% (0 - 0.9%)
Indicator E. coli MS-group level
• Gallus gallus 9% (0 - 26%)
• Pigs 2% (0 - 4%)
• Cattle 0.7% (0 - 4%)
Main findings (3)Macrolides
• Resistance to erythromycin was detected in Campylobacterisolates from Gallus gallus and poultry meat. The highest occurrence of resistance to erythromycin was in C. coli from pigs.
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C. jejuni - Gallus gallus - Erythromycin
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Additional analyses
• Farm-to-Fork Analysiso Comparison between human and animal and food data difficult
due to use of clinical breakpoints vs. epidemiological cut-off (ECOFF) values
o Presenting resistance along the food chain: animal, food, human
• MRSAo Baseline survey on MRSA + “routine” monitoring
o Countries are encouraged to monitor and to report
• Third Generation Cephalosporin resistanceo Salmonella and indicator E. coli
o Data to be used in the framework of a mandate on ESBLs
Conclusions
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• First joint report on AMR ever published by ECDC and EFSA
• AMR commonly found in zoonotic bacteria from animals and food
• Low levels of clinical resistance to “CIA” in humans
• AMR to critically important antimicrobials in human medicine detected in Salmonella and Campylobactero High levels for fluoroquinoloneso Low levels for macrolides in Campylobactero Low levels for 3rd generation cephalosporins
• AMR varies among animal species
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In the 2010 EU-SR …
• Coordination meeting with ECDC on 11 March
• General structure similar to that of 2009 EU-SR
• Some enhancements are planned
o monophasic S. Typhimurium
o Statistical tests for trends
o Farm-to-fork analysis in broilers and pigs
o Analyses of isolate level data collected by pilot exercise(in depth presentation tomorrow)
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In the future…
• Integrated monitoring of antimicrobial resistance and antimicrobial consumption in humans and animals– ECDC, EFSA, EMA– Joint report is planned– Relationship between resistance and consumption– Discussions are on-going between Agencies and EC
• Enhancement of monitoring of resistance in animals– Indicator bacteria (mandatory)– Isolate level data needed
to account for co-resistance
Acknowledgements
• EFSA wishes to thank the MSs and non-MSs for providing the AMR data
• The Veterinary Laboratories Agency (VLA) is kindly acknowledged for analysing the 2009 AMR data
• ECDC is kindly acknowledged for providing for and analysing the AMR data in human isolates of Salmonellaand Campylobacter
• 2009 EU Summary Report on AMR to be published soon on www.efsa.europa.eu (zoonoses unit)
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Thank you for your attention!