HM Medical Clinic

Session_2c_resistance_monitoring

Monitoring of Antimicrobial Resistance in Zoonotic Bacteria Petra Luber
Federal Office of Consumer Protection and Food Safety

Provisions for monitoring of antimicrobial resistance in zoonotic bacteria: • Directive 2003/99/EC • Commission Decision 2007/407/EC • EFSA Manual for Reporting on Zoonoses + Resistance Joint Opinion on antimicrobial resistance focused on zoonotic infections (October 2009) Staff working paper of the services of the Commission on antimicrobial resistance (November 2009)

Directive 2003/99/EC on the monitoring and reporting of antimicrobial resistance in zoonotic bacteria Article 2 Definitions
(c) "antimicrobial resistance" means the ability of microorganisms
of certain species to survive or even to grow in the presence of a
given concentration of an antimicrobial agent, that is sufficient to
inhibit or kill microorganisms of the same species
Article 7 Monitoring of antimicrobial resistance
1. Member States shall ensure, in accordance with the requirements
set out in Annex II, that monitoring provides comparable data on the
occurrence of antimicrobial resistance in zoonotic agents and, in
so far as they present a threat to public health, other agents

Directive 2003/99/EC on the monitoring and reporting of antimicrobial resistance in zoonotic bacteria B. Specific requirements
Member States must ensure that the monitoring system provides
relevant information at least with regard to a representative number
of isolates of Salmonella spp., Campylobacter jejuni and
Campylobacter coli from cattle, pigs and poultry and food of
animal origin derived from those species

COMMISSION DECISION 2007/407/EC on a harmonised monitoring of antimicrobial resistance in Salmonella in poultry and pigs Article 1
This decision lays down detailed rules for monitoring antimicrobial
resistance in accordance with Article 7(3) and Annex II(B) of Directive
2003/99/EC to be carried out in the Member States.
It shall cover Salmonella spp. in fowl (Gallus gallus), turkeys, and
slaughter pigs without prejudice to additional antimicrobial
resistance monitoring in accordance with the requirements in Article
7(1) of Directive 2003/99/EC.
Decision 2007/407/EC applies from 1 January 2008

COMMISSION DECISION 2007/407/EC on a harmonised monitoring of antimicrobial resistance in Salmonella in poultry and pigs Per year 170 Salmonella isolates per study population shall be included in
the antimicrobial resistance monitoring

COMMISSION DECISION 2007/407/EC on a harmonised monitoring of antimicrobial resistance in Salmonella in poultry and pigs Resistance against an antimicrobial is considered to be present if the
Minimum Inhibitory Concentraion (MIC) exceeds the breakpoint or the
epidemiological cut-off value.
Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial resistance in the framework of Directive 2003/99/EC The EFSA Journal (2009) 255, 1-90 The manual is on the course CD Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Chapter 8: Reporting on antimicrobial resistance For the purpose of following trends, every year or at regular
intervals (e.g. every 2. or 3. year) the following information on
antimicrobial resistance needs to be reported:
• Resistance in Salmonella Enteritidis, S. Typhimurium, Campylobacter jejuni, and C. coli isolates from broiler flocks • Resistance in Campylobacter jejuni, and C. coli isolates from • Resistance in S. Typhimurium isolates from pigs Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in Salmonella spp.
Relevant animal species / food categories to be reported:
• Laying hens and broilers (Gallus gallus)• Turkeys• Pigs• Cattle• Meat from broilers, pigs, and cattle Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in Salmonella spp.
Relevant agent species / serovars to be reported:
Qualitative antimicrobial susceptibility (resistant / susceptible) • S. Enteritidis and S. Typhimurium• Group of next 5 most prevalent serovars in the country• Group of other serovars Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in Salmonella spp.
Relevant agent species / serovars to be reported:
Quantitative antimicrobial susceptibility (MIC) • S. Enteritidis and S. Typhimurium for poultry species and meat thereof• S. Typhimurium and S. Derby for pigs and meat thereof • S. Typhimurium and S. Dublin for cattle and bovine meat• Other Salmonella serovars grouped together for all species Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in Salmonella spp.
Recommended antimicrobials to be reported:
Antimicrobial resistance monitoring in Salmonella spp.
The antimicrobials belong to 7 different substance classes:
(3rd and 4th generation)
Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in Campylobacter spp.
Relevant animal species / food categories to be reported:
• Broilers (Gallus gallus)• Turkeys• Pigs• Cattle• Meat from broilers and other poultry Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in Campylobacter spp.
Relevant agent species to be reported:
• C. jejuni and C. coli separately Reporting of susceptibility data for Campylobacter spp. overall is discouraged because resistance patterns vary for different species Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in Campylobacter spp.
Recommended antimicrobials to be reported:
Antimicrobial resistance monitoring in Campylobacter spp.
The antimicrobials belong to 4 different substance classes:
Macrolides
Manual for reporting on Zoonoses, Zoonotic Agents and Antimicrobial
resistance in the framework of Directive 2003/99/EC
Antimicrobial resistance monitoring in
• non-pathogenic E. coli
• Enterococcus spp.
Detailed information on the relevant animal species, food categories, agent species and antimicrobials to be reported can be found in chapter 8 of the Manual Diagnostic / analytical methods typically used
Three types of methods are used in antimicrobial resistance testing
for Salmonella bacteria: disk diffusion, agar dilution and broth
dilution. For Campylobacter, only dilution methods are considered
reproducible.
Diagnostic / analytical methods typically used
Disk diffusion, agar dilution and broth dilution
Delivers an inhibition zone diameter A diffusion test that
delivers a Minimum
Inhibitory Concentration
Diagnostic / analytical methods typically used
Disk diffusion, agar dilution and broth dilution
Quantitative Method that delivers MIC
Different concentrations of antimicrobials are mixed with warm agar and poured in petri dishes to generate a series of agar plates with increasing amounts of the antimicrobial substance. The bacteria are applied to the surface of the agar plates (usually several different strains can be tested on one plate). After incubation growth / no growth is determined.
Diagnostic / analytical methods typically used
Disk diffusion, agar dilution and broth dilution
Quantitative Method that delivers MIC
Joint Opinion on antimicrobial resistance (AMR)
focused on zoonotic infections
European Centre for Disease prevention and Control (ECDC)
European Food Safety Athority (EFSA)
European Medicines Agency (EMEA)
Scientific Committee on Emerging and Newly Identified Health Risks
(SCENIHR)
The EFSA Journal 2009; 7(11):1372 Published in October 2009 Joint Opinion on antimicrobial resistance (AMR) focused on
zoonotic infections
Question by the European Commission:
Based on the existing data on AMR in zoonotic agents, which animal species/agent/antimicrobial combinations are considered of high concern and should be considered as a priority for the Commission? Microorganisms: Salmonella and Campylobacter
Antimicrobial classes: Quinolones (including Fluoroquinolones),
Cephalosporins (third- and fourth-generation), and Macrolides
This is in accordance with the WHO categorization of critically-important antimicrobials for human medicine Joint Opinion on antimicrobial resistance (AMR) focused on
zoonotic infections
The Combinations:
Salmonella / Quinolone resistance Campylobacter / Quinolone resistance Salmonella / Cephalosporin resistance (third- and fourth-generation) Campylobacter / Macrolide resistance Staff working paper of the services of the Commission on antimicrobial resistance (SANCO/6876/2009r6) Purpose of the document is: • to provide an overview of ongoing EU activities related to AMR • to initiate a holistic reflection and discussion on AMR, to identify possible areas for further action and the types of possible actions.
Published in November 2009 The results from antimicrobial resistance monitoring activities of Member States will be published by EFSA as Community summary reports. In general control measures for Salmonella (e.g. reduction targets in poultry populations, food safety criteria for several foodstuffs) are expected to lead to a reduction of Salmonella strains resistant to antimicrobials.
Thank you for your attention

Source: http://old.wetgiw.gov.pl/files/4011_Session_2c_Resistance_Monitoring.pdf