AMR from Nordic perspective
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The Nordic countries have comparatively low rates of antibiotic resistance in important pathogens, though rates are increasing. Surveillance of antibiotic resistance has been integrated across the Nordic countries since the late 1990s. While antibiotic use is comparatively low overall, there have been outbreaks of resistant infections and evidence of cross-border transmission of resistant bacteria between Nordic countries. Nordic countries collaborate extensively on surveillance, standards, and research related to antibiotic resistance through agreements and professional organizations.
AMR from Nordic perspective
- 1. .Sid AMR from a Nordic perspective Johan Struwe Public Health Agency of Sweden johan.struwe@folkhalsomyndigheten.se
- 2. .Sid Nordic countries • Comparatively low rates of resistance in important human pathogens – but increasing • Epidemiology of AMR changing – MRSA –Gramnegatives – Cross-border transmission – Outbreaks • Comparatively low antibiotic use (in all sectors) driving resistance • Comparatively high proportion of use of narrow spectrum antimicrobials in humans • Official treatment guidelines for common infections?
- 4. .Sid International networks for AMR- surveillance in Europe EARS-Net EU and EES/ (European CDC) CAESAR Central Asian and Eastern European/ (WHO EURO) GLASS (WHO Global) Escherichia coli X X X Klebsiella pneumoniae X X X MRSA X X X Streptococcus pneumoniae X X X Pseudomonas aeruginosa X X Acinetobacter species X X X Enerococcus faecium X X Enerococcusfecalis X X Salmonella species* X* X* *In diarrhea only
- 5. .Sid Participation in GLASS as of Dec 2018
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- 9. .Sid Integrated surveillance of AMR in the Nordic countries Since 1996 Since 2000/2001 Since 1999 Since 1999
- 10. .Sid National outbreaks of vancomycin resistant enterococcus faecium 0 5 10 15 20 25 v50 v52 v2 v4 v6 v8 v10 v12 v14 v16 v18 v20 v22 v24 v26 v28 v30 2017 2018 År Stockholm Södermanland Västerbotten Örebro Jämtland Västernorrland Västmanland Källa: Folkhälsomyndigheten Antal fall 219 cases
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- 14. .Sid 0 5 10 15 20 25 DDD/1000INVÅNAREOCHDAG Antibiotic use (J01 exkl metenamin) in the Nordic countries 1978-2017 DDD/1000 inhabitants/ day Island Finland Sverige Norge Danmark* *Hospital use was not included in Denmark before 1998
- 15. .SidSource: ESVAC seventh report, 2017; www.ema.europa.eu PCU = population correction unit (~per kilogram biomass)
- 16. .Sid Examples of nordic collaborations ”High-level” agreements/ initiatives Nordic One Health Group Nordic council´s white paper on 12 initiatives NDPHS; Northern Dimension Partnership for Public Health and Social well-being Swedish government´s assignment on sustained access to important antibiotics SE+NO (WHO cc) Survey of knowledge about AMR in general population (NO lead) Driven by the profession Microbiology -Standards/ methodology, NordicAST: http://www.nordicast.org/ -MRSA http://www.nordicmrsa.org/map.html -Research -Strama dentists’ network Infection control -Master´s course in IPC
- 17. .Sid Thank you!
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- 22. .Sid Strengthen knowledge through surveillance and research Optimize the use of antimicrobial agents Reduce the incidence of infection Develop the economic case for investment in new medicines, diagnostic tools, vaccines and other interventions Improve awareness and understanding of antimicrobial resistance WHO´s Global Action Plan on Antibiotic resistane ”GAP” Five strategic objectives
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