Thursday, February 11, 2016

ECDC EFSA Report: Antimicrobial Resistance On The Rise In The EU



While pandemics and outbreaks of novel diseases like avian flu, MERS, and Zika make the immediate headlines, in terms of long term threats, there is little that can match the potential harm from the rise of antibiotic resistant bacteria around the globe.

It's a threat that has prompted both CDC Director Thomas Frieden and WHO Director General Margaret Chan to warn that the world faces a `post-antibiotic' era.  

Although today's report from the ECDC/EFSA is technically current through the end of 2014, it contains references to the recently discovered MCR-1 Colistin resistance gene (see The Lancet: Dissemination Of The MCR-1 Colistin Resistance Gene and Referral: McKenna On The Latest MCR-1 Finding) which is turning out to already be surprisingly widespread.  

A discovery made all the more concerning because, like the NDM-1 gene, MCR-1 resistance can be transferred laterally via plasmids - tiny snippets  of DNA - that can shuttle from one bacterial strain to another (see MCR-1: The Return Of The Plasmids).

First the press release, then the abstact and link to the full report:

Antimicrobial resistance on the rise in the European Union, ECDC and EFSA warn

11 Feb 2016

​Bacteria in humans, food and animals continue to show resistance to the most widely used antimicrobials, says the latest report on antimicrobial resistance in zoonotic bacteria in Europe. Resistance to ciprofloxacin, an antimicrobial that is critically important for the treatment of human infections, continues to be very high in Campylobacter, thus reducing the options for effective treatment of severe foodborne infections. In addition, multi-drug resistant Salmonella bacteria continue to spread across Europe.

The report also found evidence of resistance to the antimicrobial colistin in Salmonella and E. coli  among poultry in the EU. “This is worrying because it means that this last-resort drug may soon no longer be effective for treating severe human infections with Salmonella” said Mike Catchpole, Chief Scientist for ECDC.

Besides the high levels of resistance shown throughout Europe, there are significant regional differences. The highest levels of antimicrobial resistance are observed in eastern and southern Europe. “In northern Europe, there is lower resistance in bacteria from poultry, particularly in countries with low use of antimicrobials in animals,” said Marta Hugas, Head of EFSA’s Biological Hazards and Contaminants unit.

Turning the tide on antimicrobial resistance is at the top of ECDC’s agenda. In 2015, the eighth European Antibiotic Awareness Day was launched, with more than 40 countries participating. This European health initiative coordinated by ECDC aims to support Member States in their efforts to promote prudent use of antimicrobials. 
(Continue . . . )

At 200+ pages, the following PDF file isn't exactly light reading, but the following report provides a remarkable amount of data on the rise and spread of antimicrobial resistance in the EU.

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2014 

European Food Safety Authority
European Centre for Disease Prevention and Control

The data on antimicrobial resistance in zoonotic and indicator bacteria in 2014, submitted by 28 EU Member States (MSs), were jointly analysed by EFSA and ECDC. Resistance in zoonotic Salmonella and Campylobacter species from humans, animals and food, and resistance in indicator Escherichia coli as well as meticillin-resistant Staphylococcus aureus in animals and food was assessed.
‘Microbiological’ resistance was assessed using epidemiological cut-off (ECOFF) values; for some countries, quantitative data on human isolates were interpreted in a way which corresponds closely to the ECOFF-defined ‘microbiological’ resistance. In Salmonella from humans, high proportions of isolates were resistant to ampicillin, sulfonamides and tetracyclines, whereas resistance to third-generation cephalosporins and to fluoroquinolones remained generally low, although it was markedly higher in some serovars commonly associated with broilers and turkeys.
In Salmonella and Escherichia coli isolates from broilers, fattening turkeys and meat thereof, resistance to ampicillin, (fluoro)quinolones, tetracyclines and sulfonamides was frequently detected, whereas resistance to third-generation cephalosporins was uncommon. For the first time, presumptive extended spectrum beta-lactamase (ESBL)-/AmpC-/carbapenemase production in Salmonella and Escherichia coli was monitored in poultry. The occurrence of ESBL-/AmpC-producers was low, and carbapenemase-producers were not detected. Resistance to colistin was observed at low levels in Salmonella and Escherichia coli from poultry and meat thereof.
In Campylobacter from humans, a high to very high proportion of isolates were resistant to ciprofloxacin and tetracyclines, whereas resistance to erythromycin was low to moderate. Resistance to fluoroquinolones in some MSs was extremely high; in such settings, the effective treatment options for human enteric Campylobacter infection may be significantly reduced. High resistance to ciprofloxacin and tetracyclines was observed in Campylobacter isolates from broilers and broiler meat, whereas much lower levels were recorded for erythromycin.
Co-resistance to critically important antimicrobials in both human and animal isolates was generally uncommon, but very high to extremely high MDR levels were observed in some Salmonella serovars. A minority of Salmonella isolates from animals belonging to a few serovars (notably Kentucky and Infantis) exhibited high-level resistance to ciprofloxacin.
© European Food Safety Authority and European Centre for Disease Prevention and Control, 2016

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