欧洲疾控中心-2022-2023年欧盟关于人类_动物和食品中人畜共患细菌和指示细菌抗菌药物耐药性的总结报告（英）_174页_38mb

Summary of the European Union Report on Antimicrobial Resistance in Zoonotic and Indicator Bacteria (2022-2023)

Core Content

This report presents the findings of the 2022-2023 harmonised antimicrobial resistance (AMR) monitoring in zoonotic and indicator bacteria, including Salmonella spp., Campylobacter jejuni, Campylobacter coli, Escherichia coli (indicator commensal and ESBL-/AmpC-/carbapenemase (CP)-producing), and Methicillin-resistant Staphylococcus aureus (MRSA) from humans, food-producing animals, and derived meat.

Main Findings

• Resistance Patterns Vary by Country and Antimicrobial: AMR levels differ significantly across EU Member States (MSs), with some countries showing higher resistance to certain antimicrobials.
• High Resistance to Common Antimicrobials: A high proportion of Salmonella and Campylobacter isolates from both humans and animals showed resistance to ampicillin, tetracyclines, and sulfonamides.
• Increasing Trends in Critical Antimicrobials: Resistance to ciprofloxacin, a critically important antimicrobial (CIA), increased in some countries for Salmonella and Campylobacter isolates.
• Low Levels of Last-Line Antimicrobial Resistance: Resistance to azithromycin and tigecycline was generally low in Salmonella and E. coli isolates from humans and animals.
• Carbapenemase-Producing Bacteria: CP-producing E. coli and Salmonella were detected in some countries, with bla genes such as bla_{OXA-48} and bla_{NDM-5} being the most common.
• Progress in Reducing AMR: Temporal trend analyses showed a decline in resistance to ESBL-/AmpC-producing E. coli in several MSs over the last 10 years.
• MRSA Monitoring: MRSA was detected in food and animals, with laCC398 being the most common clonal complex. Resistance to linezolid and vancomycin was not observed in any reported MRSA isolates.
• Resistance in Enterococci: E. faecium showed higher resistance than E. faecalis, with vancomycin resistance found in E. faecium only.

Key Points

Salmonella spp.

• Human Isolates (2023): High resistance to ampicillin, tetracyclines, and sulfonamides. Resistance to ciprofloxacin was 21.8%, with S. Kentucky showing 80.5% resistance.
• Animal and Meat Isolates (2022-2023): Resistance to ampicillin, tetracyclines, and sulfonamides was moderate to very high. Resistance to third-generation cephalosporins was low in some animal populations.
• Ciprofloxacin Resistance Trends: Increasing trends in ciprofloxacin resistance were observed in broiler and laying hen flocks. In S. Enteritidis, resistance increased in 13 countries.
• Carbapenem Resistance: CP-producing Salmonella was not detected in animals but was reported in human cases. bla_{OXA-48}-like genes were the most common.
• ESBL and AmpC Producers: In Salmonella isolates, ESBL and AmpC producers were more common in some serovars, with S. Kentucky and S. Infantis showing elevated levels of combined resistance.

Campylobacter spp.

• Human Isolates (2022-2023): High resistance to fluoroquinolones (ciprofloxacin), with resistance levels ranging from very high to extremely high.
• Animal Isolates (2022-2023): Resistance to ciprofloxacin was higher in C. coli than C. jejuni. Resistance to erythromycin was low in both human and animal isolates.
• Combined Resistance: Combined resistance to ciprofloxacin and erythromycin was more common in C. coli than in C. jejuni. Mutation A2075G in the 23S rRNA gene was detected in many isolates, while the erm(B) gene was rarely found.
• Temporal Trends: Ciprofloxacin resistance increased in 11 countries for C. jejuni, while erythromycin resistance decreased in 10 countries. For C. coli, ciprofloxacin resistance decreased in nine countries and erythromycin resistance in four.

Indicator E. coli

• Resistance Levels: Resistance to third-generation cephalosporins was very low or low in most animal populations, but moderate in imported poultry meat.
• ESBL and AmpC Producers: A significant decrease in ESBL-producing E. coli was observed in several animal populations. ESBL genes were more common than AmpC genes.
• CP-Producing E. coli: CP-producing E. coli was detected in broilers, fattening turkeys, pigs, and cattle. Genes like bla_{OXA-181} and bla_{NDM-5} were frequently reported.

MRSA

• Occurrence: MRSA was detected in food and animals, with laCC398 being the most common. Resistance to linezolid and vancomycin was not observed.
• Voluntary Monitoring: Limited in scope and not harmonised, but provided valuable insights into MRSA distribution and resistance patterns.

Enterococci

• Resistance: E. faecium showed higher resistance than E. faecalis. Vancomycin resistance was found in E. faecium, with the highest levels in cattle under 1 year of age (1.5%).
• Linezolid Resistance: Low in E. faecalis (highest in cattle under 1 year, 6.6%) and very low in E. faecium (highest in fattening pigs, 0.6%).

Key Outcome Indicators (KOIs)

• Complete Susceptibility (KOI_CS): A statistically significant increase in complete susceptibility was observed in 12 MSs.
• ESBL-/AmpC-Producing E. coli (KOI_ESC): A significant decrease in prevalence was noted in 19 MSs and two non-MSs, indicating progress in reducing AMR in food-producing animals.

Conclusion

The report highlights the ongoing challenge of antimicrobial resistance in zoonotic and indicator bacteria across the EU. While progress has been made in reducing resistance to certain antimicrobials, particularly ESBL-/AmpC-producing E. coli, resistance to fluoroquinolones and other critically important antimicrobials remains a concern. Continued monitoring, targeted interventions, and a One Health approach are essential to address AMR effectively.