Niels Frimodt-Møller, MD, DMSc.; Dept. for Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen

1. Transfer of resistant bacteria from animals to humans – relation to antibiotic use as growth promoters and therapeutics Niels Frimodt-Møller Professor, MD, DMSc. Dept. for Microbiological Surveillance and Research Statens Serum Institut Copenhagen Denmark

2. Antibiotic resistance: Clinical consequence * P < 0.05 1,29 (1,04 – 1,59)* S.pneumoniae : PenR vs PenS Tleyjeh et al. CID 2006;42:778-97 2,52 (1,9 - 3,4)* Enterococcus : VR vs VS DiazGranados et al. CID 2005;41:327-33 4,41 (1,03 – 18,81)* E. coli : FQ-R vs FQ-S Lautenbach et al. CID 2005;41:923-9 1,93 (1,54 – 2,42)* S.aureus : MR vs MS Cosgrove et al. CID 2003;36:53-59 Odds Ratio (95% CI) for mortality

8. Transfer of VRE from animal to humans: Scientific evidence Same type VRE in poultry and farmer Simonsen et al. Microb Drug Resist. 1998; 4: 313-8. Same VRE in poultry before and after slaughter Aarestrup et al. APMIS 1998; 106:606–22 VRE in food . Wegener et al. Int J Food Microbiol 1997; 35:57–66. Robredo Int J Food Microbiol. 2000; 54: 197-204. VRE carriers in countries, where avoparcin used, but not else Ieven [abstract LB-8, 41st ICAAC, 2001. Klare et al. Microb Drug Resist. 1999; 5: 45-52. Klare et al. Microb Drug Resist. 1995;1: 265-72. Same type VRE in pigs and patients Jensen et al. AAC 1999; 43:724–5; Hammerum et al. JAC 2004; 53:547–9.

9. Results of ban of growth promoters Avoparcin and Virginiamycin in Denmark

10. Fecal carrier rates of Vancomycin Resistant E. faecium (VRE) in non-hospitalised humans 12/100 11/40 6/100 13/400 1/670 3/169 2/6023 % pos with VRE Ban of Avoparcin Van den Bogard et al., JAC 2000, 46: 146 Van den Auwera et al. JID 1996, 173: Klare et al. Microb Drug Resist. 1999;5:45-52. Gambarotto et al. J Clin Microbiol. 2000; 38: 620–624. Torell et al. J Clin Microbiol . 1999; 37: 3509–3513 Kolar et al.J Med Microbiol. 2005; 54: 965-7. . S F D NL D Cz D

11. Significant decrease of VRE infections and colonization rates in patients at hospital admission after AGP ban Colonization at admission Infections in hospitals W. Witte, personal comm. M. Leven et.al. ICAAC 2001 Germany Belgium N=335 N=353 % vanA % vanA

13. Use of Streptogramin Growth Promoters in Poultry and Isolation of Streptogramin-Resistant Enterococcus faecium from Humans Kieke et al. The Journal of Infectious Diseases 2006; 194:1200–8 Minnesota, Wiscosin, USA

17. Macrolide use and - resistance in Campylobacter coli from pigs

21. No. of human Salmonella, Campylobacter and Yersinia cases in Denmark 1980-2009

27. Why was VRE more prevalent in US hospitals than in Europe ? Vancomycin usage in USA vs. Europe Klare et al. IJFM 2003

28. EARSS 2008

29. Staphylococcus aureus (Sa) : MRSA epidemiology Spa types in 2008 1 % of SA bacteraemias ~