Tran Tam T, Krolicka Adriana, Tiwari Ananda, Pitkänen Tarja, Lood Rolf, Ásmundsdóttir Ásta Margrét, Wikmark Odd-Gunnar
NORCE Research AS, Nygårdstangen, Bergen, 5838, Norway.
Microbiology Unit, Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, 70701, Finland.
Antimicrob Resist Infect Control. 2025 May 28;14(1):55. doi: 10.1186/s13756-025-01552-3.
BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic constituted the largest global health crisis in recent generations. It may also have disrupted the pattern of antimicrobial use (AMU) and subsequently affected the development of antimicrobial resistance (AMR) - a grave human health concern. This study aimed to give an overview of existing AMR surveillance systems and evaluate the impact of COVID-19 on AMU and AMR in the Nordics using data from these systems. METHODS: Nordic AMU data (2017-2022) were extracted from national annual reports (for both humans and animals) and the European Surveillance System (TESSy) (for humans only). For humans, AMU was expressed in defined daily dose (DDD) per 1000 inhabitants per day; for animals, it was expressed in kilogram (kg). Nordic human AMR data (2017-2022) were extracted from TESSy. Multilevel linear regression and negative binomial regression models were used to fit the TESSy data. Data between 2017 and 2019 were categorised as the pre-COVID-19 time, while data between 2020 and 2022 were the per-COVID-19 time. RESULTS: Denmark had a remarkably greater AMU in animals (about 10 times greater) than Norway, Sweden, and Finland. Iceland had the highest human AMU, while Sweden had the lowest. Drug categories, countries, and sectors were significant predictors in the model used to fit human AMU. Bacterial species and drug categories were significant predictors in the models used to fit human resistant Gram-negative and Gram-positive bacteria. The COVID-19 time was not a significant predictor in these models. Among the Nordics, Iceland had the lowest number of resistant isolates; however, high human AMU remains a great concern for Iceland. CONCLUSIONS: The study provided insight into current existing AMR surveillance systems in the Nordics. It also showed that the COVID-19 pandemic had very little impact on AMU and AMR in theses countries. This implied that strict regulations on AMU as well as well-coordinated national AMR surveillance systems in the Nordics mitigated the development of AMR crisis also during COVID-19 pandemic. However, the Nordics would still benefit further from a standardized AMR surveillance at regional level, which ultimately facilitate timely information sharing and improve our preparedness for and response to future pandemics and/or large-scale outbreaks.
背景：2019冠状病毒病（COVID-19）大流行是近几代人以来最大的全球卫生危机。它还可能扰乱了抗菌药物使用模式（AMU），进而影响了抗菌药物耐药性（AMR）的发展，而AMR是一个严重的人类健康问题。本研究旨在概述现有的AMR监测系统，并利用这些系统的数据评估COVID-19对北欧地区抗菌药物使用和AMR的影响。 方法：北欧地区的AMU数据（2017 - 2022年）从国家年度报告（包括人类和动物）以及欧洲监测系统（TESSy，仅用于人类）中提取。对于人类，AMU以每1000居民每天的限定日剂量（DDD）表示；对于动物，以千克（kg）表示。北欧地区的人类AMR数据（2017 - 2022年）从TESSy中提取。使用多级线性回归和负二项回归模型对TESSy数据进行拟合。2017年至2019年的数据被归类为COVID-19之前的时期，而2020年至2022年的数据为COVID-19期间的数据。 结果：丹麦动物的AMU显著高于挪威、瑞典和芬兰（约高10倍）。冰岛的人类AMU最高，而瑞典最低。药物类别、国家和部门是用于拟合人类AMU的模型中的显著预测因素。细菌种类和药物类别是用于拟合人类耐药革兰氏阴性菌和革兰氏阳性菌的模型中的显著预测因素。在这些模型中，COVID-19期间并非显著的预测因素。在北欧国家中，冰岛的耐药菌株数量最少；然而，较高的人类AMU仍然是冰岛极为关注的问题。 结论：该研究深入了解了北欧地区当前现有的AMR监测系统。研究还表明，COVID-19大流行对这些国家的抗菌药物使用和AMR影响甚微。这意味着北欧地区对抗菌药物使用的严格监管以及协调良好的国家AMR监测系统在COVID-19大流行期间也减轻了AMR危机的发展。然而，北欧地区仍将从区域层面的标准化AMR监测中进一步受益，这最终将促进及时的信息共享，并提高我们对未来大流行和/或大规模疫情的防范和应对能力。
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