Surveillance of antimicrobial resistance

Surveillance of antimicrobial resistance is used to measure the effectiveness of the actions used to combat antimicrobial resistance and detect new threats.

In Finland, different systems are used to monitor the antimicrobial resistance situation. There is also cooperation with expert networks operating across Europe. Finland participates in European Antimicrobial Resistance Surveillance Network (EARS-Net) and European Surveillance of Antimicrobial Consumption Network (ESAC-Net) monitoring networks.

FiRe – Finnish Study Group for Antimicrobial Resistance

FiRe – Finnish Study Group for Antimicrobial Resistance is collaborative body based on voluntariness. The group includes Finnish clinical microbiology laboratories and the Finnish Institute for Health and Welfare (THL).

FiRe was established in 1992 and one of its first objectives was to harmonise the methods used for determining drug susceptibility of diagnostic bacterial findings in Finland.

The FiRe standard was completed in 1996 and has since been in use in all FiRe laboratories. The standard is based on the American CLSI (formerly NCCLS) sensitivity specification standard. In 2011, all FiRe laboratories transitioned to using the European EUCAST standard.

Fire produces data and recommendations

The primary task of FiRe is to produce reliable and comparable data on the prevalence of drug resistance in the most clinically significant bacteria in Finland.

This resistance data is used as the basis for compiling the annual Finres report. FiRe reports findings isolated from invasive patient samples to the ECDC’s EARS-Net surveillance network for the bacteria marked with an asterisk (*).
Finres reports (in Finnish)

The EARS-Net database can be freely viewed on the ECDC website. Surveillance data on antimicrobial resistance in Europe is available from 2005 onwards.

The examined bacteria:

Streptococcus pneumoniae*
Streptococcus pyogenes
Escherichia coli*
Klebsiella pneumoniae*
Klebsiella oxytoca
Pseudomonas aeruginosa*
Staphylococcus aureus*
Haemophilus influenzae
Moraxella catarrhalis
Neisseria gonorrhoeae
Neisseria meningitidis
Enterococcus faecalis/faecium*
Acinetobacter*
Enterobacter cloacae

Another important task for FiRe is to draw up and maintain national guidelines and recommendations, for instance, because of new resistance problems caused by e.g. ESBL and CPE bacteria.

THL coordinates the FiRe network

FiRe consists of 23 Finnish clinical microbiology laboratories and the Bacteriology Unit of the Finnish Institute for Health and Welfare.
FiRe laboratories (in Finnish)

The group meets twice a year in a negotiation and a training meeting. FiRe’s operations are led by a board elected for a three-year term.

The Finnish Institute for Health and Welfare coordinates the FiRe network and provides both technical and specialist support. The institute maintains and develops the Finres antimicrobial susceptibility database.

FiRe has no cooperation agreements with industry.

FiRe has also received development project funding in the period 2009–2012 from the appropriation for the surveillance of communicable diseases of the Ministry of Social Affairs and Health.

Surveillance of antimicrobial drug consumption

The use of antimicrobial drugs has a significant impact on the emergence of antimicrobial resistance. Broad-spectrum antimicrobial drugs cause the selection and reproduction of resistant microbial strains in the body.

Choices made on antimicrobial drugs in hospitals can be used to influence the rise in prevalence of multidrug-resistant microbial strains. However, most antimicrobial drug use takes place outside hospitals. The antimicrobials used in livestock also contribute to the development of resistance.

Antimicrobial drug consumption monitored at European level

Antimicrobial drug consumption is monitored in the EU under the coordination of the European Centre for Disease Prevention and Control (ECDC). EU/EEA/EFTA countries report annual data on antibacterial, antifungal and antiviral drugs. They form the joint ESAC-Net surveillance network.

The surveillance of consumption is based on national sales and medical reimbursement statistics. Data are collected separately from hospitals and outpatient care. Indicator figures proportional to the population are used in making comparisons.

The so-called “defined daily dose” (DDD), or the average adult daily dose for adults, allows making comparisons of different dosage forms and medicine consumption in proportion to the population: For example, DDD/1,000 inhabitants/day.

Information about antimicrobial drug consumption from reports

ECDC publishes an annual summary report and maintains a database used to review antimicrobial drug consumption by country, region and drug group. The database includes data from 1997 onwards.
Annual reports and protocols on antimicrobial consumption

In addition, ECDC, the European Food Safety Authority (EFSA) and the European Medicines Agency (EMA) have published joint reports on antimicrobial drug consumption and antimicrobial resistance reported in humans and animals. The reports are based on follow-up data collected in the period 2011–2015. Finland participates in ESAC-Net surveillance.
The European Union summary report on antimicrobial resistance

In November 2018, the first national report was published, presenting an overview of Finland's antimicrobial drug consumption in the period 2010–2017 by region.

The prevalence of antimicrobial drug use has also been charted at the national level in connection with prevalence studies concerning treatment-related infections.
Video: Monitoring of antimicrobial drug consumption and regional reporting (YouTube, in Finnish)