Increased resistance due to

1
Increased resistance due tonon-human
antibiotic use(veterinary and zootechnical use)

• Christina Greko
• Dept of Antibiotics
• National Veterinary Institute (SVA)
• Uppsala, Sweden

2
Why use antibiotics for animals?

• Therapy
• Prophylaxis
• Growth promotion

3
Feed additives for performance enhancement,
70/524/EEC

• spiramycin (-99)
• tylosin (-99)
• virginiamycin (-99)
• avoparcin (-97)
• ardacin (-97)
• bacitracin (-99)
• avilamycin

• carbadox (-99)
• olaquindox (-99)
• flavofosfolipol
• monensin
• salinomycin

4
Some indications for veterinary use
5
Antibiotics approved for use in bovines and/or
porcines (Sweden 2001)

• Individual medication
• penicillin-G
• penicillin-DHS
• amoxicillin
• ceftiofur
• macrolides (16-M)
• pleuromutilins
• trim/sulph.
• tetracyclines
• fluoroquinolones
• aminoglycosides

• Group medication
• macrolides (16-M)
• pleuromutilins
• tetracyclines
• fluoroquinolones

From FASS VET. 2001
6
Sales of antibiotics for animals, EU 1997 asg
antibiotic/tonnes of livewheight slaughtered
Calculated from data in EMEA/CVMP/342/99-Final,
table 17 (FEDESA data)
7
Resistance to APE in E.faecium from broilers in
Denmark
From DANMAP 95,96,97,98,99,00 (www.svs.dk)
8
Penicillin resistance among S.aureus from
clinical mastitis in cows and sales of penicillin
Data as cited in Greko, 1996 KSLA 135 (15) p27-
and SVARM 2000 (www.sva.se)
9
Transfer ofzoonotic bacteria
10
Antibiotic resistance,S. Typhimurium from animals
Data from DEFRA Salmonella in livestock
production 2000, DANMAP 2000 and SVARM 2000
11
Quinolone resistance in Campylobacter (NL)
From Endtz et al, 1991, JAC, 27211-217
12
Resistance to nalidixic acid among C. jejuni,
Denmark
Source DANMAP 00 (www.svs.dk)
13
Quinolone resistance in Campylobacter jejuni (DK,
1999)
From DANMAP 99 (www.svs.dk)
14
Fluoroquinolones - human vs veterinary use in
Sweden
Data from Naturvårdsverket, 1994 and Statistics
Sweden
15
Transfer ofresistance genes
16
Food as source - tetracycline resistance in
coliforms of helthy volunteers on control or
sterile diet
From Corpet, NEJM 1988, 3181205-
17
Transfer of genes - spread of streptothricin-resis
tance (Tn1825), GDR
From Witte, 1996 (Ciba Foundation Symposium 207)
18
Transfer of genes- base pair variants of Tn1546
from VRE
From Jensen, AAC 1998 422463
19
Effect of interventions - withdrawal of growth
promoting antibiotics
20
Sales of antibacterials for animal use (Sweden)
Compiled from published data, references given in
SVARM 2000 (www.sva.se)
21
Resistance among E. faecium SVARM 2000 vs
DANMAP 97
(Pig Se n48, Dk n54 chicken Se n151, Dk
n207)
22
Resistance to vancomycin in E.faecium from
chicken and chicken meat, Denmark
From DANMAP 95,96,97,98,99,00 (www.svs.dk)
23
Avoparcin and vancomycin resistant enterococci
(VRE) of vanA type

• VRE easily found in animals (and food) in most
  countries - but NOT in Sweden
• Community carriage in humans EU 2-5?
• Community carriage in Sweden lt0.1 (1/670
  Torell et al, JCM 1999, 373509)

24
The flow of resistance genes
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25

• monitor use
• monitor resistance
• promote prudent use
• control infectious diseases
• increase knowledge

Who is to blame?
What can be done?
What can I do?