The Public Health Agency of Sweden
Updated 2 June 2022

Surveillance of antibacterial resistance

The Public Health Agency of Sweden is responsible for national monitoring of antibiotic resistance and sales of antibiotics in human medicine, with support from local and regional experts. Data is also communicated regularly to clinical microbiology laboratories, Strama groups, the healthcare sector, policy makers and the media.

Four types of antibiotic resistant bacteria are monitored according to the Communicable Diseases Act and epidemiological typing is carried out on all notifiable forms of resistance.

Sweden is actively working for a quality-assured methodology for surveillance of antibacterial resistance. Comparing the occurrence of antibiotic resistance between different regions over time requires that the clinical microbiology laboratories uses the same susceptibility breakpoints and Sweden has used those established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for many years.

Systems used in national surveillance

Svebar

A national IT system for early warnings and continuous resistance monitoring. The system automatically collects all culture results from participating clinical microbiology laboratories daily. Resistance monitoring in Sweden is mainly done on a voluntary basis and has good geographic coverage. The Public Health Agency of Sweden and the National Veterinary Institute analyse and compile national data on antibiotic sales and resistance in an annual report, SWEDRES/SVARM (published in English).

Annual report, SWEDRES/SVARM (Swedres-Svarm) (in Swedish)

SmiNet

Four types of antibiotic resistance in bacteria are included in the Swedish Communicable Diseases Act. These are Staphylococcus aureus resistant to methicillin (MRSA), Streptococcus pneumoniae with reduced susceptibility or resistance to penicillin (PNSP), Enterococcus faecalis and Enterococcus faecium resistant to vancomycin (VRE), and Enterobacterales (previously Enterobacteriaceae) with ESBL (including AmpC) or ESBLCARBA. However, ESBL and ESBL-CARBA are reported separately. SmiNet is a web-based programme that receives and manages notifications from treating physicians and laboratories. Resistance is reported on a daily basis and can be monitored continuously, unlike in EARS-Net and ResNet.

International surveillance

EARS-Net

European resistance monitoring of invasive infections, coordinated by ECDC, a programme that has an important role in informing about the occurrence and spread of antibiotic resistance in Europe. Sweden contributes with national resistance data from Svebar.

GLASS

In 2015, the World Health Organization, WHO, launched a global system for monitoring antibiotic resistance. It was named the Global Antimicrobial Resistance Surveillance System (GLASS).

Resistance data are collected from prioritized human bacterial pathogens isolated from clinical samples (blood, urine, feces and cervical and urethral samples).

Pathogens currently included in GLASS-AMR are: Acinetobacter spp., Escherichia coli, Klebsiella pneumoniae, Neisseria gonorrhoeae, Salmonella spp., Shigella spp., Staphylococcus aureus and Streptococcus pneumoniae.

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Swedish work on containment of antibiotic resistance