Increased resistance due to ”non-human” antibiotic use (veterinary and zootechnical use),Christina Greko Dept of Antibiotics National Veterinary Institute (SVA) Uppsala, Sweden,Why use antibiotics for animals?,Therapy Prophylaxis Growth promotion,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,Some indications for veterinary use,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,Sales of antibiotics for animals, EU 1997 as g antibiotic/tonnes of livewheight slaughtered,Calculated from data in: EMEA/CVMP/342/99-Final, table 17 (FEDESA data),Resistance to APE in E.faecium from broilers in Denmark,From: DANMAP 95,96,97,98,99,00 (www.svs.dk),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),Transfer of zoonotic bacteria,Antibiotic resistance, S. Typhimurium from animals,Data from: DEFRA: Salmonella in livestock production 2000, DANMAP 2000 and SVARM 2000,Quinolone resistance in Campylobacter (NL),From: Endtz et al, 1991, JAC, 27:211-217,Resistance to nalidixic acid among C. jejuni, Denmark,Source: DANMAP 00 (www.svs.dk),Quinolone resistance in Campylobacter jejuni (DK, 1999),From: DANMAP 99 (www.svs.dk),Fluoroquinolones - human vs veterinary use in Sweden,Data from Naturvrdsverket, 1994 and Statistics Sweden,Transfer of resistance genes,Food as source - tetracycline resistance in coliforms of helthy volunteers on control or sterile diet,From: Corpet, NEJM 1988, 318:1205-,Transfer of genes - spread of streptothricin-resistance (Tn1825), GDR,From: Witte, 1996 (Ciba Foundation Symposium 207),Transfer of genes- base pair variants of Tn1546 from VRE,From: Jensen, AAC 1998 42:2463,Effect of interventions - withdrawal of growth promoting antibiotics,Sales of antibacterials for animal use (Sweden),Compiled from published data, references given in SVARM 2000 (www.sva.se),Resistance among E. faecium SVARM 2000 vs DANMAP 97,(Pig: Se n=48, Dk n=54; chicken: Se n=151, Dk n=207),Resistance to vancomycin in E.faecium from chicken and chicken meat, Denmark,From: DANMAP 95,96,97,98,99,00 (www.svs.dk),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 0.1% (1/670; Torell et al, JCM 1999, 37:3509),The flow of resistance genes,geneX geneX geneX geneX geneX geneX geneX geneX geneX geneX,geneX,geneX geneX geneX geneX geneX geneX geneX geneX geneX geneX,geneX,Who is to blame?,What can be done?,What can I do?,monitor use monitor resistance promote prudent use control infectious diseases increase knowledge,