Analysis of simultaneous space-time clusters of Campylobacter spp. in humans and in broiler flocks using a multiple dataset approach

<p>Abstract</p> <p>Background</p> <p>Campylobacteriosis is the most frequently reported zoonosis in the EU and the epidemiology of sporadic campylobacteriosis, especially the routes of transmission, is to a great extent unclear. Poultry easily become colonised with <it>Campylobacter </it>spp., being symptom-less intestinal carriers. Earlier it was estimated that internationally between 50% and 80% of the cases could be attributed to chicken as a reservoir. In a Norwegian surveillance programme all broiler flocks under 50 days of age were tested for <it>Campylobacter </it>spp. The aim of the current study was to identify simultaneous local space-time clusters each year from 2002 to 2007 for human cases of campylobacteriosis and for broiler flocks testing positive for <it>Campylobacter </it>spp. using a multivariate spatial scan statistic method. A cluster occurring simultaneously in humans and broilers could indicate the presence of common factors associated with the dissemination of <it>Campylobacter </it>spp. for both humans and broilers.</p> <p>Results</p> <p>Local space-time clusters of humans and broilers positive for <it>Campylobacter </it>spp. occurring simultaneously were identified in all investigated years. All clusters but one were identified from May to August. Some municipalities were included in clusters all years.</p> <p>Conclusions</p> <p>The simultaneous occurrence of clusters of humans and broilers positive for <it>Campylobacter </it>spp. combined with the knowledge that poultry meat has a nation-wide distribution indicates that campylobacteriosis cases might also be caused by other risk factors than consumption and handling of poultry meat.</p> <p>Broiler farms that are positive could contaminate the environment with further spread to new broiler farms or to humans living in the area and local environmental factors, such as climate, might influence the spread of <it>Campylobacter </it>spp. in an area. Further studies to clarify the role of such factors are needed.</p

Risk factors for occurrence of cephalosporin-resistant Escherichia coli in Norwegian broiler flocks

AbstractA longitudinal study of 27 broiler farms including 182 broiler flocks was performed to determine risk factors for occurrence of cephalosporin-resistant Escherichia coli in Norwegian broiler flocks. Information regarding possible risk factors was collected by an online questionnaire and by samples obtained from broiler and parent flocks during the study period. Additional information was provided by the broiler production company. The prevalence of cephalosporin-resistant E. coli in parent flocks and broiler flocks sampled in the study was estimated.Cephalosporin-resistant E. coli was detected in 13.8% of the parent flocks and 22.5% of the broiler flocks included in the study.A multivariable generalized linear model was used to estimate risk factors. The risk for occurrence of cephalosporin-resistant E. coli was associated with the status of the previous flock in the broiler house (odds ratio=12.7), number of parent flocks supplying the broiler flock with day-old chickens (odds ratio=6.3), routines for disinfection of floor between production cycles (odds ratio=0.1), and transport personnel entering the room where the broilers are raised (odds ratio=9.3).Our findings highlights that implementation of a high level of biosecurity with a minimal number of people entering the broiler house during production cycles, as well as rigorous cleaning and disinfection routines between production cycles will contribute to a decrease in the occurrence of cephalosporin-resistant E. coli in broiler flocks provided that there is no selection pressure from antimicrobial use in the broiler production

Evaluation of the One Health-Ness of 20 Years of Antimicrobial Resistance Surveillance in Norway

We evaluated the One Health-ness (OH-ness) of the surveillance system for antimicrobial resistance (AMR) in Norway by using the recently developed “Evaluation tool for One Health epidemiological surveillance capacities and capabilities” (OH–EpiCap tool). First, we defined the Norwegian AMR surveillance system that we would evaluate. The tool was applied by a group of stakeholders (key persons in the Norwegian AMR surveillance programmes and authors of this paper). The evaluation was performed using a consensus approach. The evaluation resulted in an overall OH-ness score of 68% across all three dimensions included in the tool: Organisation, Operation, and Impact. Suggestions for improvement were only indicated within the areas of internal evaluation and operational costs, whereas most of the indicators included in the tool showed good adherence to the One Health principles. By performing this internal evaluation, we recognized that AMR surveillance in the environment needs to be included in a more systematic and standardized way to improve the OH-ness as defined by the quadripartite organisations. Last but not least, it was beneficial to bring key stakeholders together to conduct the evaluation. It increased a joint perception of the OH-ness of AMR surveillance in Norway and encouraged further collaboration in the future

From tide to table: A whole-year, coastal-wide surveillance of antimicrobial resistance in Escherichia coli from marine bivalves

This work is the first of its kind to report a whole-year and coastal-wide surveillance of antimicrobial resistance (AMR) of Escherichia coli with samples from the EU imposed Norwegian surveillance programme for marine bivalves. In total, 390 bivalve samples collected from January to December in 2016 at 59 different harvest locations, were examined. The occurrence of resistant E. coli in relation to the concentration of E. coli was also analysed. From each sample with E. coli (n = 261), one isolate was susceptibility tested against a panel of 14 antimicrobials from ten classes. The occurrence of resistance to at least one antimicrobial was 8.4 %. Resistance to tetracycline was most commonly detected (5.7 %), followed by resistance to ampicillin (4.6 %) and sulfamethoxazole (3.1 %). The occurrence of extended spectrum cephalosporin (ESC)-resistant E. coli, quinolone-resistant E. coli (QREC) and carbapenem-resistant Enterobacteriaceae (CRE) were detected through selective screening in 3.3 %, 12.8 % and none of the samples, respectively. Among the ESC-resistant E. coli, the blaCTX-M-15 gene was detected in nine isolates, where two isolates also carried the blaCMY-42 gene, followed by blaCTX-M-3 in two and blaCTX-M-1 in one. One isolate was resistant to ESC due to the n.-42C>T mutation in the AmpC gene. Only the presence of QREC clustered significantly (p < 0.013) in space including nine harvest locations. An increased risk (OR 9.4) of detecting ESC-resistant E. coli or QREC was found for samples with E. coli concentrations above the threshold of Class A for direct distribution to the market (i.e. 230 E. coli/100 g). However, five of the ESC-resistant E. coli and 26 of the QREC positive samples, had levels of E. coli below the threshold, thus from areas cleared for sale. Among the 17 ESC-resistant E. coli subjected to whole genome sequencing, two originated from two samples of great scallops and two samples of flat oysters, which are often consumed raw or lightly processed. One of these isolates belonged to the high-risk clone sequence type 131 and carried a plasmid born senB gene encoding the Shigella enterotoxin 2 (ShET2) attributed to cause watery diarrhoea in infections caused by Enteroinvasive E. coli (EIEC). Thus, our study shows that there is a potential risk for transmission of resistant and pathogenic E. coli to the consumers from these products.publishedVersio

Screening for antimicrobial- and heavy metal resistant bacteria in copper contaminated areas

A One heath approach is essential to examine the role of the marine environment in the selection and spread of antimicrobial resistance. Norwegian aquaculture used high amounts of antimicrobials during the 80s and 90s, which facilitated widespread resistance among fish pathogens. Moreover, fish farms have since their beginning used copper containing coating as anti-fouling agents on the fish nets, in addition to copper supplements in the fish feed. Consequently, some fish farms have high concentrations of copper in det sediments beneath the pens. Several studies have reported that even sublethal concentrations of heavy metals can facilitate co-selection of antimicrobial resistance and heavy metal resistance. This study applied Vibrio spp. as indicator of antimicrobial- and heavy metal resistance in copper contaminated areas. Six different locations were sampled twice. These represented four different areas in regard of aquaculture activity; Active aquaculture, Non-active aquaculture, Non-aquaculture and Unpolluted. In total, 70 samples, including sediments, seawater, marine fauna and marine algae, were examined for the presence of Vibrio spp. and Escherichia coli. The sediments were examined for heavy metals, where sediments from Active aquaculture areas held exstensively toxic mean concentration with 272.3 mg/kg dry weight (d.w.) copper, significant higher than Non active (24.4 mg/kg d.w.), Non-aquaculture (34.8 mg/kg d.w.) and Unpolluted (2.28 mg/kg d.w.), and moderate toxic mean concentration with 424.6 mg/kg d.w. zinc, also significant higher than Non-active (70.7 mg/kg d.w.), Non-aquaculture (144.6 mg/kg d.w.) and Unpolluted (16.4 mg/kg d.w.). The majority of the retrieved 350 Vibrio splendidus and 72 Vibrio anguillarum isolates were susceptible to all the antimicrobials tested for. Increased minimum inhibition concentrations (MIC) to oxytetracycline and copper were seen for some isolates from Active aquaculture, however only one- to two-fold higher than from Non-active and Non-aquaculture areas. Several antimicrobial- and heavy metal resistance genes were found across the different examined areas, with exception of the nlpE gene encoding a copper sensing lipoprotein inducing efflux pumps, that were only found in one isolate from one location with aquaculture. The majority of the 336 E. coli isolates were susceptible to all antimicrobial tested for. The Active aquaculture areas conferred highest number of E. coli, and most of the resistant E. coli. Many factors, such as weather and topography, can influence the inflow of E. coli from sewage and run-offs from land. No association was found between the detected phenotypic and genotypic resistance traits in V. splendidus and in E. coli in any of the examined areas. Importantly, a higher sample size including more locations is needed to determine whether any possible indicated differences are significant. In conclusion, the high proportion of susceptible isolates found in this project, indicates that the prevalence of selectable resistance mechanisms in the examined marine vibrios from copper contaminated areas are low.publishedVersio

Monitoring Antimicrobial Resistance and Drug Usage in the Human and Livestock Sector and Foodborne Antimicrobial Resistance in Six European Countries

Introduction: Antimicrobial resistance (AMR), associated with antimicrobial use (AMU), is a major public concern. Surveillance and monitoring systems are essential to assess and control the trends in AMU and AMR. However, differences in the surveillance and monitoring systems between countries and sectors make comparisons challenging. The purpose of this article is to describe all surveillance and monitoring systems for AMU and AMR in the human and livestock sectors, as well as national surveillance and monitoring systems for AMR in food, in six European countries (Spain, Germany, France, the Netherlands, the United Kingdom and Norway) as a baseline for developing suggestions to overcome current limitations in comparing AMU and AMR data. Methods: A literature search in 2018 was performed to identify relevant peer-reviewed articles and national and European grey reports as well as AMU/AMR databases. Results: Comparison of AMU and AMR systems across the six countries showed a lack of standardization and harmonization with different AMU data sources (prescription vs sales data) and units of AMU and AMR being used. The AMR data varied by sample type (clinical/non-clinical), laboratory method (disk diffusion, microdilution, and VITEK, among others), data type, ie quantitative (minimum inhibition concentration (MIC) in mg/L/inhibition zone (IZ) in mm) vs qualitative data (susceptible-intermediate-resistant (SIR)), the standards used (EUCAST/CLSI among others), and/or the evaluation criteria adopted (epidemiological or clinical). Discussion: A One Health approach for AMU and AMR requires harmonization in various aspects between human, animal and food systems at national and international levels. Additionally, some overlap between systems of AMU and AMR has been encountered. Efforts should be made to improve standardization and harmonization and allow more meaningful analyses of AMR and AMU surveillance data under a One Health approach.Peer Reviewe

Users’ perception of the OH-EpiCap evaluation tool based on its application to nine national antimicrobial resistance surveillance systems

Introduction: Antimicrobial resistance (AMR) is a One Health (OH) challenge. To achieve or maintain an effective and efficient AMR surveillance system, it is crucial to evaluate its performance in meeting the proposed objectives, while complying with resource restrictions. The OH-EpiCap tool was created to evaluate the degree of compliance of hazard surveillance activities with essential OH concepts across the following dimensions: organization, operational activities, and impact of the surveillance system. We present feedback on the application of the OH-EpiCap tool from a user's perspective, based on the use of the tool to evaluate nine national AMR surveillance systems, each with different contexts and objectives. Methods: The OH-EpiCap was assessed using the updated CoEvalAMR methodology. This methodology allows the evaluation of the content themes and functional aspects of the tool and captures the user's subjective experiences via a strengths, weaknesses, opportunities, and threats (SWOT) approach. Results and discussion: The results of the evaluation of the OH-EpiCap are presented and discussed. The OH-EpiCap is an easy-to-use tool, which can facilitate a fast macro-overview of the application of the OH concept to AMR surveillance. When used by specialists in the matter, an evaluation using OH-EpiCap can serve as a basis for the discussion of possible adaptations of AMR surveillance activities or targeting areas that may be further investigated using other evaluation tools.This study was funded by the Canadian Institutes for Health Research through the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). The Portuguese case study was supported by funding from the European Union’s Horizon 2020 Research and Innovation programme under grant agreement No 773830: One Health European Joint Programme (MATRIX project).info:eu-repo/semantics/publishedVersio

Defining the scope of the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet): a bottom-up and One Health approach

Background Building the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) was proposed to strengthen the European One Health antimicrobial resistance (AMR) surveillance approach. Objectives To define the combinations of animal species/production types/age categories/bacterial species/specimens/antimicrobials to be monitored in EARS-Vet. Methods The EARS-Vet scope was defined by consensus between 26 European experts. Decisions were guided by a survey of the combinations that are relevant and feasible to monitor in diseased animals in 13 European countries (bottom-up approach). Experts also considered the One Health approach and the need for EARS-Vet to complement existing European AMR monitoring systems coordinated by the ECDC and the European Food Safety Authority (EFSA). Results EARS-Vet plans to monitor AMR in six animal species [cattle, swine, chickens (broilers and laying hens), turkeys, cats and dogs], for 11 bacterial species (Escherichia coli, Klebsiella pneumoniae, Mannheimia haemolytica, Pasteurella multocida, Actinobacillus pleuropneumoniae, Staphylococcus aureus, Staphylococcus pseudintermedius, Staphylococcus hyicus, Streptococcus uberis, Streptococcus dysgalactiae and Streptococcus suis). Relevant antimicrobials for their treatment were selected (e.g. tetracyclines) and complemented with antimicrobials of more specific public health interest (e.g. carbapenems). Molecular data detecting the presence of ESBLs, AmpC cephalosporinases and methicillin resistance shall be collected too. Conclusions A preliminary EARS-Vet scope was defined, with the potential to fill important AMR monitoring gaps in the animal sector in Europe. It should be reviewed and expanded as the epidemiology of AMR changes, more countries participate and national monitoring capacities improve.Peer reviewe

Users’ perception of the OH-EpiCap evaluation tool based on its application to nine national antimicrobial resistance surveillance systems

IntroductionAntimicrobial resistance (AMR) is a One Health (OH) challenge. To achieve or maintain an effective and efficient AMR surveillance system, it is crucial to evaluate its performance in meeting the proposed objectives, while complying with resource restrictions. The OH-EpiCap tool was created to evaluate the degree of compliance of hazard surveillance activities with essential OH concepts across the following dimensions: organization, operational activities, and impact of the surveillance system. We present feedback on the application of the OH-EpiCap tool from a user’s perspective, based on the use of the tool to evaluate nine national AMR surveillance systems, each with different contexts and objectives.MethodsThe OH-EpiCap was assessed using the updated CoEvalAMR methodology. This methodology allows the evaluation of the content themes and functional aspects of the tool and captures the user’s subjective experiences via a strengths, weaknesses, opportunities, and threats (SWOT) approach.Results and DiscussionThe results of the evaluation of the OH-EpiCap are presented and discussed. The OH-EpiCap is an easy-to-use tool, which can facilitate a fast macro-overview of the application of the OH concept to AMR surveillance. When used by specialists in the matter, an evaluation using OH-EpiCap can serve as a basis for the discussion of possible adaptations of AMR surveillance activities or targeting areas that may be further investigated using other evaluation tools

Pilot testing the EARS-Vet surveillance network for antibiotic resistance in bacterial pathogens from animals in the EU/EEA

IntroductionAs part of the EU Joint Action on Antimicrobial Resistance (AMR) and Healthcare-Associated Infections, an initiative has been launched to build the European AMR Surveillance network in veterinary medicine (EARS-Vet). So far, activities included mapping national systems for AMR surveillance in animal bacterial pathogens, and defining the EARS-Vet objectives, scope, and standards. Drawing on these milestones, this study aimed to pilot test EARS-Vet surveillance, namely to (i) assess available data, (ii) perform cross-country analyses, and (iii) identify potential challenges and develop recommendations to improve future data collection and analysis.MethodsEleven partners from nine EU/EEA countries participated and shared available data for the period 2016–2020, representing a total of 140,110 bacterial isolates and 1,302,389 entries (isolate-antibiotic agent combinations).ResultsCollected data were highly diverse and fragmented. Using a standardized approach and interpretation with epidemiological cut-offs, we were able to jointly analyze AMR trends of 53 combinations of animal host-bacteria–antibiotic categories of interest to EARS-Vet. This work demonstrated substantial variations of resistance levels, both among and within countries (e.g., between animal host species).DiscussionKey issues at this stage include the lack of harmonization of antimicrobial susceptibility testing methods used in European surveillance systems and veterinary diagnostic laboratories, the absence of interpretation criteria for many bacteria–antibiotic combinations of interest, and the lack of data from a lot of EU/EEA countries where little or even surveillance currently exists. Still, this pilot study provides a proof-of-concept of what EARS-Vet can achieve. Results form an important basis to shape future systematic data collection and analysis