Antimicrobial resistance

Antimicrobial resistant bacteria have the ability to resist the effects of antibiotics. Due to resistance, specific antibiotics can no longer be used to treat the infections caused by these bacteria. Multiresistant bacteria have developed resistance to many of the most commonly used antibiotics.

Antimicrobial susceptibility varies between bacteria. Bacteria can be naturally resistant to certain antibiotics or acquire resistance to them. The spread of resistant bacteria and antibiotic resistance genes through animal production can create a significant reservoir of resistance factors in the environment. These bacteria and genes can also end up in foodstuffs and animal feed.

In recent years antimicrobial resistance has increased and diversified globally. Increase in resistance attenuates the effects of antimicrobials and threatens the possibilities to treat infections in both humans and animals. Likewise, antimicrobial resistance increases mortality in humans and animals as well as the cost of health care.

Monitoring of antimicrobial resistance in bacteria

The monitoring of antimicrobial resistance in humans is based on the Communicable Disease Act, in animals on the Animal Disease Act among other acts, and in the food production chain on a common EU directive. The resistance in bacteria found in humans is regularly monitored through the Finres programme, whereas susceptibility to antimicrobials in bacteria of food and animal origin are monitored through the FINRES-Vet programme. Furthermore, additional studies of the incidence of resistance in different bacteria have been made in various independent projects. The monitoring programmes provide information on the emergence of new resistance mechanisms in Finland as well as of the development of the resistance rate over time. The surveillance also enables the study of the interdependence of pharmaceutical consumption and the incidence of resistance. The collected data is then used for preventing the spread of resistance, setting guidelines for antimicrobial use, and for health risk assessments in both humans and animals, among other things. 

The monitoring of antimicrobial resistance in the food production chain has been standardized by EU directives for country-specific data to be comparable. This also enables the overall assessment of the regional situation. The monitoring of resistance in the food production chain entails samples from animals as well as food products. In the resistance surveillance so called epidemiological threshold values are used in order to discover the changes and tendencies in susceptibility to antimicrobials in bacterial population as early a stage as possible. EFSA and the ECDC then compile an annual summary report of the country-specific results on humans and the food productions chain from each European country involved in the monitoring programmes.

Monitoring of humans

The antimicrobial resistance surveillance of bacteria from human origin is based on the susceptibility data routinely provided by clinical microbiology laboratories and the laboratory of the National Institute of Health and Welfare THL. This data is gathered in the Finres-database, which is a part of the National Infectious Disease Register. The data is then annually compiled into a Finres report, which also contains information on the resistance in some zoonotic bacteria.

Monitoring of foodstuffs

Since 2002 the susceptibility of Salmonella strains isolated from Finnish foodstuffs have been monitored.

In 2015 an EU-wide integrated antimicrobial resistance surveillance of retail food products was initiated. EBSL and AmpC producing E. coli bacteria from fresh pork, beef, and broiler meat are included in the surveillance. Also, the incidence of carbapenemase producing E. coli bacteria in meat is monitored in Finland. The incidence of MRSA bacteria in fresh retail pork has been studied in separate projects. The results of the surveillance are discussed in the FINRES-Vet reports.

Monitoring of animals

The antimicrobial susceptibility in Salmonella of animal origin have been monitored in Finland since the 1980s, and in Campylobacter as well as in indicator bacteria since the 1990s. Since regular surveillance began in 2002 (with the FINRES-Vet programme) Salmonella and Campylobacter isolated from animals as well as the antimicrobial susceptibility in pathogenic and indicator bacteria have been monitored. Furthermore, the incidence of MRSA bacteria in pigs and the incidence of EBSL bacteria in domestic farmed animals have been studied in separate projects in Finland. In 2014 a joint resistance surveillance programme of farmed animals began in the EU region. The programme monitors the resistance in zoonotic and indicator bacteria as well as the incidence of ESBL/AmpC producing bacteria isolated from slaughtered pigs, calves, and poultry. The results are presented in the FINRES-Vet reports.

Monitoring of animal feed

The incidence of antimicrobial resistance in animal feed has occasionally been studied in Finland, for example in 2018. The monitoring practices of animal feed has not been standardized in the EU region.

Containing antimicrobial resistance in bacteria

Controlled use and reduced demand of antimicrobials are considered to be the best ways to contain antimicrobial resistance. The first recommendations on the use of antimicrobials for main inflammatory and infectious animal diseases were given already in 1996 in Finland. The recommendations were last updated in 2016.