NethMap 2017: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands / MARAN 2017: Monitoring of antimicrobial resistance and antibiotic usage in animals in the Netherlands in 2016
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Series/Report no.RIVM report 2017-0056
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TitleNethMap 2017: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands / MARAN 2017: Monitoring of antimicrobial resistance and antibiotic usage in animals in the Netherlands in 2016
Translated TitleNethmap / Maran 2017
PubliekssamenvattingThe number of bacteria that are resistant to antimicrobials is increasing worldwide. In the Netherlands, the number of resistant bacteria that can cause infections in humans has remained broadly stable. Nevertheless there is cause for concern and caution. Compared to 2015, in 2016 more 'outbreaks' in healthcare institutions of bacteria that are resistant to last-resort antimicrobials were reported. There is a chance that these bacteria will become more and more common. Although healthy people are not affected, these bacteria can make vulnerable people very sick. If more and more bacteria become resistant to antimicrobials, the treatment options will eventually become limited and it will also become more difficult to treat less serious conditions such as urinary tract infections.
The more antimicrobials are used, the greater the chance that bacteria will develop resistance. In 2016, general practitioners wrote approximately two percent fewer prescriptions for antimicrobials than in 2015. The total use of antimicrobials in Dutch hospitals remained stable in 2015, compared to an increase in antimicrobial use in the previous year. The use of antimicrobials for animals decreased further in 2016 compared to 2015, but has been decreasing more slowly in recent years than it did previously. The degree of bacterial resistance in animals also decreased further.
This is shown in the annual NethMap/MARAN 2017 report, in which various organisations present their data on antimicrobial use and resistance in the Netherlands, for humans as well as animals.
Firstly, to combat resistance, it is important to base the choice to prescribe antimicrobials on the individual patient and the infection concerned. Secondly, it is important that it quickly becomes clear when resistant bacteria are involved and that proper tests are used to determine this. Thirdly, it is important that healthcare providers carefully follow existing hygiene procedures, such as handwashing, in order to prevent resistant bacteria from spreading. For example, thanks to these measures, the number of MRSA bacteria in hospitals has remained low in recent years. This type of 'hospital bacteria' is transmitted via skin-to-skin contact, particularly via the hands, and is insensitive to many types of antimicrobials.
Part 1: NethMap 2017 pg 1 - 160
Part 2: MARAN 2017 pg 1 - 80
Wereldwijd neemt het aantal bacteriën die resistent zijn tegen antibiotica toe. In Nederland is het aantal resistente bacteriën die bij mensen infecties kunnen veroorzaken, ongeveer stabiel gebleven. Toch blijft er reden voor zorg en oplettendheid. In 2016 zijn er ten opzichte van 2015 meer 'uitbraken' in zorginstellingen gemeld van bacteriën die resistent zijn tegen de antibiotica die als laatste redmiddel worden gebruikt. De kans bestaat dat deze bacteriën nog vaker gaan voorkomen. Gezonde mensen hebben daar geen last van, maar kwetsbare mensen kunnen er ziek van worden. Als steeds meer bacteriën resistent worden tegen antibiotica, worden de behandelmogelijkheden op den duur beperkt en wordt het moeilijker om ook onschuldige kwalen als een blaasontsteking te kunnen behandelen.
Hoe meer antibiotica worden gebruikt, hoe groter de kans dat bacteriën resistent worden. In 2016 hebben huisartsen ongeveer 2 procent minder antibioticakuren voorgeschreven dan in 2015. In Nederlandse ziekenhuizen is het totale gebruik in 2015 stabiel gebleven, in tegenstelling tot een stijging van antibioticagebruik in het jaar ervoor. Het gebruik van antibiotica voor dieren is in 2016 verder gedaald ten opzichte van 2015, maar neemt de laatste jaren minder snel af dan daarvoor. De mate waarin resistente bacteriën bij dieren voorkomen bleek ook verder te zijn afgenomen.
Dit blijkt uit de jaarlijkse rapportage NethMap/MARAN 2017, waarin diverse organisaties de gegevens over het antibioticagebruik en -resistentie in Nederland, zowel voor mensen als voor dieren, gezamenlijk presenteren.
Om resistentie tegen te gaan is het van belang de keuze om antibiotica voor te schrijven af te stemmen op de individuele patiënt en de infectie. Ten tweede is het belangrijk dat snel duidelijk wordt wanneer er sprake is van resistente bacteriën en dat goede tests worden gebruikt om dat te bepalen. Ten derde is het van belang dat zorgverleners zorgvuldig de bestaande (hygiëne)maatregelen, zoals handen wassen, naleven om te voorkomen dat resistente bacteriën zich verspreiden. Door op deze manieren te handelen is bijvoorbeeld het aantal MRSA-bacteriën in ziekenhuizen de afgelopen jaren laag gebleven. Deze 'ziekenhuisbacterie' wordt overgedragen via direct huidcontact, vooral via handen, en is ongevoelig voor veel soorten antibiotica.
Part 1: NethMap 2017 pg 1 - 160
Part 2: MARAN 2017 pg 1 - 80
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Nethmap 2015: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands / MARAN 2015: Monitoring of antimicrobial resistance and antibiotic usage in animals in the Netherlands in 2014de Greeff SC; Mouton JW; ZIA; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVMStichting Werkgroep Antibiotica Beleid SWAB, 2015-06-22)Het NethMap/MARAN-rapport is samengesteld door Stichting Werkgroep Antibioticabeleid (SWAB), Centrum Infectieziektebestrijding van het RIVM, Central Veterinary Institute (CVI), onderdeel van Wageningen UR, de Nederlandse Voedsel en Waren Autoriteit (NVWA) en de Stichting Diergeneesmiddelenautoriteit (SDa). NethMap verschijnt dit jaar voor de dertiende keer. Het is de vierde keer dat deze humane gegevens uit de NethMap gezamenlijk worden gepresenteerd met de veterinaire gegevens uit MARAN. MARAN monitort gebruik van en resistentie tegen antibiotica in de dierensector al sinds 1998. part 1: Nethmap 2015 pag 1-116 part 2: MARAN 2015 pag 1-72
NethMap 2020: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlandsin 2019 / MARAN 2020: Monitoring of Antimicrobial Resistance and Antibiotic Usage in Animals in the Netherlands in 2019de Greeff, SC; Schoffelen, AF; Verduin, CM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2020-06-25)The number of bacteria that are resistant to antibiotics is increasing worldwide. In the Netherlands, that number is generally stable, and it is not at such a high level as in many other countries. There were hardly any increases in resistance found in 2019, and the resistance of some species of bacteria actually decreased in comparison to the previous years. The number of bacteria that are resistant to several different antibiotics and are therefore more difficult to treat is also not increasing. However, there is still reason to be vigilant in order to ensure that potential changes can be noticed in time. To prevent resistance from developing, it is important to use antibiotics properly and only when necessary. General practitioners prescribed somewhat fewer courses of antibiotics in the past year compared to previous years. The overall use of antibiotics in hospitals increased somewhat. Fewer antibiotics were prescribed for domestic farm animals in 2019 compared to 2018. In comparison to 2009, the reference year, the sale of antibiotics decreased by almost 70%. Almost no antibiotics that are important for treating infections in humans have been used for domestic farm animals in recent years. The level of antibiotic resistance in the various animal sectors remained the same or decreased somewhat in comparison to 2018. The percentage of ESBL-positive animals decreased further in all animal sectors. The biggest decrease in the percentage of ESBL-positive animals over the last 5 years was seen in broilers and on chicken meat. ESBLs are enzymes that can break down commonly used antibiotics such as penicillins. In recent years, extra measures have been taken in the Netherlands to combat antibiotic resistance. These measures extend beyond the healthcare system because resistant bacteria also occur in animals, in foodstuffs and in the environment. That is why a 'One Health' approach is used in the Netherlands. In the annual NethMap/MARAN 2020 report, various organisations collectively present their data on ntibiotic use and resistance in the Netherlands, for humans as well as animals.
NethMap 2022. Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands in 2021 / MARAN 2022. Monitoring of Antimicrobial Resistance and Antibiotic Usage in Animals in the Netherlands in 2021de Greeff, SC; Kolwijck, E; Schoffelen, AF; Verduin, CM (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2022-06-30)The coronavirus pandemic still impacted heavily on the healthcare system in the Netherlands in 2021. More people ended up in intensive care units and fewer people were able to get appointments in regular healthcare. Despite these changes the number of antibiotic-resistant bacteria has remained the same over the past couple of years. Resistance has even decreased in some strains of bacteria compared to previous years. Furthermore, the number of bacteria that are resistant to various types of antibiotics simultaneously, which makes treatment more difficult, has not changed. In recent years, there has been an increase in antibiotic resistance in some strains of bacteria that usually cause mild infections such as of the skin. Hospitals and care homes for the elderly have reported fewer outbreaks caused by resistant bacteria since the start of the pandemic in 2020. It is unclear what the effects of the pandemic will be on antibiotic resistance on the long-term. The overall quantity of antibiotics prescribed by GPs and hospitals fell during the pandemic. That said, more antibiotics per patient were prescribed. This is due to the fact that many patients with Covid-19 had to be treated for longer and more intensively in hospital. Infections caused by antibiotic-resistant bacteria are becoming increasingly common throughout the world. This problem is not quite so acute in the Netherlands as it is in many other countries as antibiotics are only prescribed if it is absolutely necessary to do so. Still, we do need to remain vigilant in the Netherlands. That entails keeping a close eye on antibiotic use and antibiotic resistance. Monitoring these will enable us to implement measures in a timely fashion to prevent the problem of antibiotic resistance from getting worse. The measures currently in place in the Netherlands to combat antibiotic resistance extend beyond the healthcare sphere. After all, resistant bacteria are also found in animals, in food and in the environment (One Health approach). Over the past decade there has been a fall in resistance in gut bacteria in pigs, cows and chickens kept for food production (farmed animals). A lower quantity of antibiotics was sold and used for farmed animals in 2021 than in 2020. Compared to 2009, the reference year, the drop in sales is over 70%. Since 2015, the antibiotics that are crucial to treat infections in people have only been used on farmed animals in highly exceptional circumstances. This is shown in the annual report NethMap/MARAN 2022, in which various organisations collectively present the data on antibiotic use and antibiotic resistance in the Netherlands, for humans and animals.