Antibiotic use and antimicrobial resistance Martin Steinbakk Norwegian Institute of Public Health

Surveillance of antibiotic use and antimicrobial resistance in Norway and Europe Vi har flere ulike systemer for å overvåke forekomst av antibiotikaresistens og forbruk av antibiotika i Norge. En viktig kilde til informasjon er den årlige NORM-rapporten. EARS-Net ESAC-Net ESVAC

Development of antibiotic resistance Change in bacterial genes By mutation or horizontal gene transfer (from other live or dead bacteria) Selection of the new more resistant bacteria By antibiotics and other substances (with antimicrobial activity) CDC

EAAD 18/11-16 Patients who are infected with bacteria resistant to antibiotics are more likely to develop complications and up to three times more likely to die from the infection. It is estimated that the global burden of deaths could reach 10 million each year by 2050 if no action is taken. This poses serious challenges to the functioning of healthcare systems and represents high economic costs to society. High mortality rates, ranging from 26% to 44% are directly associated with having an infection with these highly resistant bacteria. https://vimeo.com/181041782

O’Neill-report 2014 What can happen if AMR crises is not tackled Den engelske statsminister David Camron har oppnevnt en komite som er bedt om å se nærmere på «fremtidsutsiktene» knyttet til antibiotikaresistens. I rapporten fremkommer det at AMR kan få alvorlige konsekvenser for økonomi og fremtidig helse. I rapporten anslår de at på verdensbasis vil i 2050 om lag 10 millioner dødsfall være forårsaket av antibiotikaresistens og det er mer enn alle dødsfall forsaket av kreftsykdommer.

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Figur 3. Gjennomsnittsbruk over siste 5 år av alle antibiotika i ATC gruppe J01 (systemiske antibakterielle midler) utenom metenamin i alle fylker. Antall resepter/1000 innbygger/år (røde kolonner) og DDD/1000innbygger/år (blå linje). Det forskrives 40% flere resepter per 1000 innb/år i Østfold enn i Troms

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Norway nr 8 in 205 (11 i 2012)

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Prevalence of ESBL production among Escherichia coli and Klebsiella spp. isolates from blood and urine 2003-2015. NORM / NORM-VET 2015

Figure 4. Escherichia coli : percentage of invasive isolates with resistance to third-generation cephalosporins, EU/EEA, 2012 (left), 2015 (right) 2005

Escherichia coli : percentage of invasive isolates with combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides, EU/EEA, 2012 (left), 2015 (right)

Klebsiella pneumoniae: percentage of invasive isolates with combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides, EU/EEA, 2012 (left), 2015 (right)

Klebsiella pneumoniae: percentage of invasive isolates with resistance to carbapenems, EU/EEA, 2012 (left), 2015 (right)

ECDC Policy Briefing Last-line antibiotics are failing: options to address this urgent threat to patients and healthcare systems Occurence of carbapenemase-producing Enterobacteriaceae in 38 European countries 2013 and 2015 2013 2015 Active screening should be done for all patients who are at-risk of being carriers of these highly resistant bacteria.

Staphylococcus aureus: percentage of invasive isolates with resistance to meticillin (MRSA), EU/EEA, 2012 (left), 2015 (right)

Acinetobacter spp: percentage of invasive isolates with combined resistance to fluoroquinolones, aminoglycosides and carbapenems, EU/EEA, 2012 (left), 2015 (right)

Antibiotic resistant gut bacteria Antibiotikaresistens finnes ikke bare i sykdomsfremkallende bakterier. Fra år 2000 og frem til nå har det skjedd en alarmerende økning av resistens i den normale bakterieflora. Ref: Woerther, P.L., Burdet, C., Chachaty, E., Andremont, A., 2013. Trends in human fecal carriage of extended-spectrum beta-lactamases in the community: toward the globalization of CTX-M. Clinical microbiology reviews 26, 744-758

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Antibiotic use per kg meat produced by country, EU/EEA 2013 5th ESVAC Report 2015

Data orininal from 5th ESVAC Report Sales of veterinary antimicrobial agents in 26 EU/EEA countries in 2013

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Antibiotic use to land animals(excluding fish) – Norway 2010-2015 (mg antibiotic/kg meat produced) NORM/NORM-VET 2015

Antibiotics only when needed

Thank you for your attention!

Production correction unit (PCU, ~ kg meat) produced by country, EU/EEA 2013 5th ESVAC Report 2015