Transcript Resistance

Integrated surveillance systems
for use of antimicrobials and the
monitoring of antimicrobials
resistance
Paule Carnat-Gautier
French Ministry of Agriculture
Introduction
• Antimicrobial agents represent one of the main therapeutic
tools both in human and veterinary medicine to control and
treat bacterial infectious diseases.
• However, the use and misuse of antimicrobials in both human
and veterinary medicine has resulted in the emergence of
strains of bacteria that no longer respond to antimicrobial
therapy.
• This is a problem for animal health, but also for public health
when transmitted to humans.
• As very few new antimicrobials are coming on the market,
addressing the issue of antimicrobial resistance is a priority in
the fields of public health today
Background
Council Conclusions on Antimicrobial
Resistance (AMR)
2876th EMPLOYMENT, SOCIAL POLICY,
HEALTH AND CONSUMER AFFAIRS
Council meeting
Luxembourg, 10 June 2008
Council Conclusions on Antimicrobial
Resistance (AMR)
• CALLS UPON THE MEMBER STATES to:
− strengthen surveillance systems and improve data quality on AMR
and use of antimicrobial agents from both human health and veterinary
sector, and healthcare associated infections;
− further promote prudent use of antibiotics in both the human and
veterinary sector
− control the prevalence of pathogens that cause food-borne
(potentially) resistant infections in animals and food by the application
of both pre- and post-harvest risk management strategies in food
production and other preventive measures, including, where appropriate
according to national circumstances, vaccination, in order to reduce the
burden of infection.
Council Conclusions on Antimicrobial
Resistance (AMR)
• CALLS UPON THE COMMISSION TO:
–
–
–
–
–
–
improve surveillance and control of antimicrobial
resistance;
promote mutual cooperation between all Directorates General and
concerned Agencies and facilitate cooperation between Member
States' on all aspects of AMR,
consider further control options when appropriate;
support research on the potential impact of antimicrobial usage
in food animals and crop production, on emergence and prevalence
of AMR in the most common microorganisms responsible for
infections in humans;
facilitate the exchange of information, best practices and
experiences on reducing AMR and healthcare-associated infections,
facilitate training on prudent use of antimicrobials.
Council Conclusions on Antimicrobial
Resistance (AMR)
• CALLS UPON THE COMMISSION AND MEMBER
STATES TO:
− maintain and improve co-ordinated and coherent
surveillance for antimicrobial resistance, consumption of
antimicrobial agents and healthcare-associated infections at
the European level
− co-ordinate an annual European initiative to increase
awareness of the general public and veterinary and
healthcare professionals about the AMR, the prudent use of
antibiotics on humans and animals and infection control
practices."
Surveillance of use of antimicrobials
in animals
• OIE - World Organisation for Animal Health
– Terrestrial animal health Code
– Chapter 6.8 Monitoring of antimicrobials and
usage patterns of antimicrobials used in food
producing animals
– Chapter 6.7 : harmonisation of national
animicrobial resistance surveillance and
monitoring programs
• http://www.oie.int/en/international-standardsetting/terrestrial-code/access-online/
Surveillance of use of antimicrobials
in animals
• ESVAC : European surveillance of
veterinary antimicrobials consumption
(EVAC for human consumption)
• Set up in June 2010
• Develop a harmonized approch for the
collection and reporting of data on the
use of antimicrobials in animals.
Surveillance of use of antimicrobials
in animals
• Collected data on a regular basis
• Reported by :
– Weight (kg) of active substance per animal or
species
– Subdivised in therapeutic use or growth
promotion use
– Per routes of administration : in feed, in water,
injectable, oral, intramammary, intra–uterine, topical
– Class of antimicrobials (nomenclature sould comply with
international standards)
Surveillance of use of antimicrobials
in animals
• Data should be obtained by different sources
– Pharmaceutical industry : manufacturing sales
data
– Wholesalers
– Pharmacies, veterinarians
• Data sources depend upon the national
situation
– Different distribution systems
Surveillance of use of antimicrobials
in animals
• Usage data should be combined with
data regarding
– Animal population size
– Animal health status
– Occurrence of different infections thus
reflecting the need of using different kinds
of antimicrobials
Surveillance of use of antimicrobials
in animals
• ESVAC 1
– Call for 2010 data to 23 european countries
(21 Members states) aggregated by
antimicrobials class
– Overall sales data aggregated by class
from 9 european countries (2004- 2009)
50%
5%
40%
4%
30%
3%
20%
2%
10%
1%
0%
0%
Tetracyclines
β-lactams, penicillins
Sulfonamides
Macrolides
Pleuromutilins
Amphenicols
Cephalosporins
Lincosamides
Aminoglycosides
Quinolones
Polymyxins
Others
20
09
6%
20
08
60%
20
07
7%
20
06
70%
20
05
8%
20
09
80%
20
08
9%
20
07
90%
20
06
10%
20
05
100%
Figure 1b. Overall sales of veterinary antimicrobial agents in the
Czech Republic in 2005-2009. Note that the values on the two
y-axises are different.
Monitoring of antimicrobials
resistance
• Provisions for monitoring of
antimicrobial resistance in zoonotic
bacteria :
– Directive 2003/99
– Commission decision 2007/407/EC
– EFSA Manuel for reporting on Zoonoses +
Resistance
Monitoring of antimicrobials
resistance
• Directive 2003/99/EC on the monitoring and
reporting of antimicrobial resistance in
zoonotic bacteria
– Article 7 Monitoring of antimicrobials resistance
1. Member states shall ensure, in accordance
with the requirements set out in annex II that
monitoring provides comparable data on the
occurrence of antimicrobial resistance in zoonotic
agents and, in so far as they present a threat to
public health other agents
Monitoring of antimicrobials
resistance
• Directive 2003/99/EC on the monitoring and
reporting of antimicrobial resistance in
zoonotic bacteria
– Annexe II B Specific requirements
Member States must ensure that the monitoring
system provides relevant information at least with
regards to a relevant number of isolates of
Salmonella spp., Campylobacter jejuni and
Campylobacter coli from cattle, pigs and poultry
and food of animal origin derived from those
species
Monitoring of antimicrobials
resistance
COMMISSION DECISION 2007/407/EC
on a harmonised monitoring of antimicrobial resistance in
Salmonella in poultry and pigs
Article 1
This decision lays down detailed rules for monitoring antimicrobial
resistance in accordance with Article 7(3) and Annex II(B) of Directive
2003/99/EC to be carried out in the Member States.
It shall cover Salmonella spp. in fowl (Gallus gallus), turkeys, and
slaughter pigs without prejudice to additional antimicrobial
resistance monitoring in accordance with the requirements in Article
7(1) of Directive 2003/99/EC.
Decision 2007/407/EC applies from 1 January 2008
COMMISSION DECISION 2007/407/EC on a harmonised monitoring
of antimicrobial resistance in Salmonella in poultry and pigs
Table 1
Per year 170 Salmonella isolates per study population shall be included in
the antimicrobial resistance monitoring
COMMISSION DECISION 2007/407/EC on a harmonised monitoring
of antimicrobial resistance in Salmonella in poultry and pigs
Table 2
Resistance against an antimicrobial is considered to be present if the
Minimum Inhibitory Concentration (MIC) exceeds the breakpoint or the
epidemiological cut-off value.
Manual for reporting on Zoonoses, Zoonotic Agents and
Antimicrobial resistance in the framework of Directive
2003/99/EC
The EFSA Journal (2009) 255, 1-90
…and of some other pathogenic microbiological agents
for information derived from the reporting year 2009
The EFSA Journal (2010) 8(4):1579
The manuals are on the course CD
Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Chapter 8: Reporting on antimicrobial resistance
For the purpose of following trends, every year or at regular
intervals (e.g. every 2. or 3. year) the following information on
antimicrobial resistance needs to be reported:
• Resistance in Salmonella Enteritidis, S. Typhimurium,
Campylobacter jejuni, and C. coli isolates from broiler flocks
• Resistance in Campylobacter jejuni, and C. coli isolates from
broiler meat
• Resistance in S. Typhimurium isolates from pigs
Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Diagnostic / analytical methods typically used
Three types of methods are used in antimicrobial resistance testing
for Salmonella bacteria: disk diffusion, agar dilution and broth
dilution. For Campylobacter, only dilution methods are considered
reproducible.
Figure CA13. Spatial distribution of ciprofloxacin resistance among
Campylobacter jejuni from Gallus gallus in countries reporting
quantitative data in 2008
Guidelines on Laboratory
methodologies for bacterial
antimicrobial susceptibility testing
(AST)
Laboratory methodologies for AST testing
Recommendations for validated methods
and proficiency testing
Need for every country to start a
program aiming at “monitoring AMR
and consumptions of antibiotics”
World Health Day – 7 April 2011
Antimicrobial resistance: no action today,
no cure tomorrow
Antimicrobial resistance is not a new
problem but one that is becoming
more dangerous; urgent and
consolidated efforts are needed to
avoid regressing to the pre-antibiotic
era.
On World Health Day 2011, WHO will
introduce a six-point policy package
to combat the spread of antimicrobial
resistance.