Controladores FACTS

DANMAP 2009 Table 18. Comparison of resistance (%) among Campylobacter jejuni from food animals, food of Danish or imported origin and human cases categorized as acquired domestically or reported as associated with travel

In 2009, 3352 human laboratory confirmed cases of campylobacteriosis were reported (61 per 100,000 inhabitants). This was at the same level as in 2008 [EPI-NEWS 2009, no. 12: http://www.ssi.dk/sw73796. asp]. For the surveillance of antimicrobial resistance, the former counties of North Jutland, Funen and Roskilde were selected, representing 2.8% of all cases in Denmark in 2009.

Since 2007, SSI collected travelling information by phone interviews from all Campylobacter patients residing in the former counties of North Jutland, Funen and Roskilde. The patients were asked about the date of disease onset and whether they had travelled abroad within a seven-day period prior to disease onset. Patients who had travelled were asked about their destinations. The case was categorised as “domestically acquired” if the patient had not been travelling one week prior to the onset of infection. In 2009, information was obtained from 78% of

Campylobacter cases in the three former counties.

Among the responding patients, 26% of Campylobacter cases were considered acquired abroad [EPI-NEWS 2009, no. 12: http://www.ssi.dk/sw73796.asp]. In 2009, 93 Campylobacter jejuni isolates were submitted to SSI for susceptibility testing from three former countries (North Jutland, Funen, and Roskilde), continuously over the year. The isolates were randomly selected from all Campylobacter isolated from stool samples in the three former counties. Among the 93 analysed isolates, 31 were from known travel- associated cases and 62 were domestically acquired. The Danish Veterinary and Food Administration (DVFA) collected samples from meat sold at wholesale and retail outlets for Campylobacter testing. The total number of samples tested for Campylobacter included 196 samples of Danish pork and 199 of imported pork;

246 of Danish broiler meat and 159 of imported broiler meat; 152 of Danish beef and 92 of imported beef. From broiler meat, all isolates verified as C. jejuni (26 Danish, 62 imported) were susceptibility tested. In 2009, isolates from food were species identified in the regional laboratories of DVFA and susceptibility tested at the National Food Institute, DTU. Samples from animals were collected at slaughter for the DANMAP program and species identified and

susceptibility tested at the National Food Institute, DTU. No more than one isolate was included per positive farm. For broilers, 93 isolates of C. jejuni were isolated from 398 samples and 75 isolates were susceptibility tested and reported. For cattle, 107 isolates of C.

jejuni and 20 isolates of C. coli were isolated from

a total of 188 samples; 87 isolates of C. jejuni were susceptibility tested and reported, C. coli from cattle were not included. For pigs, 137 isolates of C. coli and 23 isolates of C. jejuni were isolated from a total of 160 samples; 113 isolates of C. coli were susceptibility tested and reported. C. jejuni from pigs were not included.

Comparison of resistance in Campylobacter jejuni isolates from broilers, broiler meat and human clinical infections

Fresh broiler meat is the primary source of human C.

jejuni diarrhoea infections in Denmark [Wingstrand et al. 2006. Emerg. Infect. Dis. 12: 280–285].From 2008 to 2009, ciprofloxacin and nalidixic acid resistance decreased significantly (19%) in C. jejuni from Danish broiler meat (Figure 29). Significant differences in occurence of ciprofloxacin and nalidixic acid resistance were observed between C. jejuni from Danish broilers and Danish broiler meat in 2009, with higher resistance levels found in broilers (Table 18 and Figure 29).In Danish broilers, the highest occurrence of resistance was found for ciprofloxacin and nalidixic acid (13% in 2009 compared to 12% in 2008) and tetracycline

Substance Cattle Broilers Broiler meat Humans

Danish Danish Danish Imported Domestically acquired Travel abroad reported

% % % % % % Tetracycline 2 12 4 52 11 39 Chloramphenicol 0 0 0 0 0 0 Erythromycin 0 0 0 0 0 0 Gentamicin 0 0 0 0 0 3 Streptomycin 5 1 0 0 2 7 Ciprofloxacin 20 13 0 56 24 61 Nalidixic acid 20 13 0 56 24 61 Number of isolates 87 75 26 62 62 31

0 10 20 30 40 50 60 70 80 00010203040506070809 010203040506070809 010203040506070809 00010203040506070809 06070809 % re si st an t is ol at es

Erythromycin Ciprofloxacin Tetracycline

Danish

broilers Danish broiler meat Imported broiler _meat Domestically acquireda) _abroadTravel DANMAP 2009

Figure 29. Trends in resistance to selected antimicrobial agents among Campylobacter jejuni isolates from broilers, broiler meat and human cases, Denmark

a) Until 2007, including cases where origin of infection was not documented and may therefore include isolates acquired abroad but not documented as such

(12% in 2009 compared to 10% in 2008).Among the tested antimicrobial agents, fluoroquinolones were the most commonly used antimicrobial class for broilers until 2006, but this consumption decreased by 97% from 2006–2008 which might explain the decreasing resistance in broiler meat. In 2009, the consumption of fluoroquinolones increased in chickens from specific parent flocks. The consumption of tetracyclines has increased considerable in 2008 and 2009 and was the second most used antimicrobial class next to amoxicillin in Danish broilers; this is a potential explanation for the increasing tetracycline resistance in C. jejuni from Danish broilers.

For C. jejuni from imported broiler meat, erythromycin resistance decreased significantly in 2009 to the level in Danish broiler meat. As in previous years, resistance to ciprofloxacin, nalidixic acid and tetracycline was significantly higher in C. jejuni from imported broiler meat compared to Danish broiler meat (Figure 29). In 2009, the level of resistance to ciprofloxacin, nalidixic acid and tetracycline from C. jejuni isolates from domestically acquired human infections was in between the level of resistance for isolates obtained from Danish broiler meat and imported broiler meat, as observed in previous years.The consumption of imported broiler meat continued to increase in Denmark, from 17% in 2003 to 37% in 2009 [Annual report on zoonoses in Denmark 2009]. It is likely that imported broiler meat

contributes to the high occurrence of ciprofloxacin and nalidixic acid resistance in C. jejuni isolates from domestically acquired human infections.

The occurrence of resistance to ciprofloxacin, nalidixic acid, and tetracycline continued to be significantly higher in travel associated C.

jejuni isolates compared to isolates acquired

domestically. For the other antimicrobial agents tested, no significant differences in the resistance level could be detected. Ciprofloxacin or other fluoroquinolones are often used for empiric treatment of adults with bacterial gastroenteritis because of the activity against enteric bacterial pathogens. Fluoroquinolones are also used in animal husbandry; however, in Denmark the consumption of fluoroquinolones in animal husbandry has been restricted since 2002. Travelling to or consuming meat from countries where fluoroquinolone

restrictions are not implemented can be associated with a higher risk of acquiring infection with

ciprofloxacin resistant C. jejuni.

MIC distributions and the occurrence of antimicrobial resistance among C. jejuni from broilers, broiler meat of Danish and imported origin, domestically acquired human cases, and human cases associated with travel are shown in Tables 45, 46, 47 in Appendix 1.

Figure 30. Trends in resistance to selected antimicrobial agents among Campylobacter jejuni isolates from cattle, Denmark 0 10 20 30 40 00 01 02 03 04 05 06 07 08 09 % re si st an t is ol at es

Erythromycin Ciprofloxacin Tetracycline

DANMAP 2009 0 20 40 60 00 01 02 03 04 05 06 07 08 09 % re si st an t is ol at es

Erythromycin Ciprofloxacin Tetracycline

DANMAP 2009

Figure 31 Trends in resistance to selected antimicrobial agents among Campylobacter coli isolates from pigs, Denmark

Campylobacter jejuni from cattle

Resistance to ciprofloxacin and nalidixic acid among C.

jejuni from cattle was unchanged from 2008 to 2009, at

a level around 20% (Figure 30).A significant increase in the level of fluoroquinolone resistance occurred in 2005, despite a low consumption of fluoroquinolones in cattle since 2003. Few of the fluoroquinolone resistant isolates were also resistant to tetracycline, indicating that co-selection by tetracycline (one of the major drugs for treatment of calves) was not the explanation for the high occurrence of fluoroquinolone resistance.As discussed in DANMAP 2007, clonal spread particularly between farms - initially in the Southern part of Jutland, or other risk factors in this area - might be an explanation. The occurrence has been moving north during 2007–2009; thus in 2009, all the ciprofloxacin and nalidixic acid resistant C. jejuni isolates originated from farms in Jutland, with a high prevalence in Northern Jutland.

MIC distributions among C. jejuni from cattle in 2009 are shown in Table 45 in Appendix 1.

Campylobacter coli

Among the human Campylobacter isolates selected for susceptibility testing, only a few Campylobacter

coli isolates from domestically acquired infections and

travel associated infections were detected (data not shown).Due to uncertainty about the identification of C.

coli from imported broiler meat, these are not reported.

The number of C. coli isolates from Danish broilers, Danish broiler meat and cattle were less or equal to 20. Therefore, only antimicrobial resistance among C. coli isolates from pigs is reported in this DANMAP report. MIC distributions and the occurrence of antimicrobial resistance among C. coli from pigs are shown in Table 44 in Appendix 1.

From 2008 to 2009, no significant changes in resistance were observed among C. coli from pigs. Fluoroquinolone resistance was detected in 12% of the tested isolates (Figure 31) despite low consumption of fluoroquinolones in pigs since 2003 (Table 34 in Appendix 1). In 2009, the erythromycin resistance in

C. coli from pigs was 12%. A continuous decrease in

erythromycin resistance in C. coli was observed after withdrawal of the growth promoter tylosin from the Danish pig production in 1998–1999, but in the past years the prevalence of resistance has not changed significantly; since 2006, the level of resistance to erothromycin has been 10–15% (Figure 31).

Resistance in indicator bacteria