Multisector Surveillance of Antibiotic Sales and Resistance
Monitoring sales of antibiotics and occurrence of resistant bacteria routinely and consistently makes it possible to analyse trends and identify changes that require quick action, as well as evaluate the effect of interventions.
Integrated analysis of data across sectors provides knowledge to help prevent the spread of antibiotic resistance from a One Health perspective. While various actors at regional and local levels perform surveillance, this page focuses primarily on national surveillance.
Surveillance of antibiotic sales
Swedish experience demonstrates that work for responsible antibiotic use should be carried out close to the prescriber in both the human and animal sectors. This requires data collection from and feedback to medical and veterinary hospitals, practices and pharmacies, as well as individual prescribers.
Data on sales and use of pharmacauticals in Sweden
The Swedish eHealth Agency maintains a database of pharmaceutical sales statistics, delivered by all authorised pharmacies. This includes data on sales for use in humans, to animal owners on prescription and to veterinarians for use in their own practice. In addition, the Swedish Board of Agriculture maintains a database of use of antibiotics for animals at farm level, reported by practicing veterinarians. Use of antibiotics in humans is primarily at the regional and local level.
Exploring Sweden’s Approach to Antibiotic Resistance in the Human Health Sector
Antibiotic use is related to both the emergence and the spread of resistance. Therefore it is important that antibiotics are used responsibly – only when needed and in the right way. The Public Health Agency of Sweden and the Swedish Veterinary Agency together publish antibiotic sales statistics in the annual report Swedres-Svarm (see below), including a comparative analysis of antibiotic sales in the animal and human sectors. In addition, statistics on sales of veterinary medicinal products, including antibiotics, are reported in Swedish by the Swedish Board of Agriculture. The Public Health Agency of Sweden continuously compiles, analyses and communicates the use of antibiotics in Sweden in humans to relevant stakeholders.
Below you find links to antibiotic sales statistics in Sweden.
Annual Swedres-Svarm reports (sva.se)
Antibiotic sales statistics in humans (in Swedish)
Antibiotic sales statistics in animals (sva.se) (in English)
Surveillance of antibiotic resistance in bacteria from humans
The Public Health Agency of Sweden is responsible for national monitoring of antibiotic resistance in humans, with support from local and regional experts. Monitoring results are also communicated regularly to clinical microbiology laboratories, Strama groups, the healthcare sector, policy makers and the media.
Notifiable antibiotic resistant bacteria
- Staphylococcus aureus resistant to methicillin (MRSA),
- Streptococcus pneumoniae with reduced susceptibility to penicillin (PNSP)
- Enterococcus faecalis and Enterococcus faecium resistant to vancomycin (VRE)
- Enterobacterales with ESBL (including AmpC) or ESBL-CARBA, reported separately
Data on resistance in bacteria from humans, including all culture results, are collected from clinical microbiology laboratories on a voluntary basis. In addition, four types of antibiotic resistant bacteria are included in 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. In 2024, a EUCAST Development Laboratory in Sweden has been appointed by the EU Commission to establish an EU reference laboratory (EURL) for antimicrobial resistance (AMR) together with two institutions in Denmark.
European Committee on Antimicrobial Susceptibility Testing (EUCAST (eucast.org)
Systems used in national antibiotic resistance surveillance in humans
Svebar
Svebar is a national surveillance system for early warnings and continuous resistance monitoring in humans. The system automatically collects all culture results, including data on antibiotic resistance testing, from participating clinical microbiology laboratories daily. Resistance monitoring in Sweden is mainly done on a voluntary basis and has good geographic coverage.
SmiNet
SmiNet is a system for reporting diseases according to the Swedish Communicable Diseases Act. Here, both treating physicians and laboratories report cases. Cases from diseases linked to notifiable antibiotic resistance are reported on a daily basis and are monitored continuously.
Surveillance of antibiotic resistance in bacteria from animals
The Swedish Veterinary Agency (SVA) monitors antibiotic resistance in bacteria from animals nationally through the programme Swedish Veterinary Antibiotic Resistance Monitoring (Svarm), which was started in 2000.
In the programme, antibiotic susceptibility of zoonotic bacteria (Salmonella and Campylobacter spp), specific animal pathogens, and commensal enteric bacteria (Escherichia coli and Enterococcus spp.) are monitored on a regular basis. In 2005, the SvarmPat programme was initiated to generate more data for Svarm on antibiotic resistance in pathogens from farm animals. Monitoring results are communicated via various channels and are discussed with relevant stakeholders.
Integrated national publications
The Public Health Agency of Sweden and the Swedish Veterinary Agency analyse and compile national data on antibiotic sales and resistance in an annual report, Swedres-Svarm (published in English).
Annual Swedres-Svarm reports (sva.se)
International surveillance
Swedish agencies contribute with antibiotic sales and resistance data to various international surveillance networks and collaborations.
In humans
ESAC-Net, a Europe-wide network coordinated by ECDC, monitors antimicrobial consumption from EU and EEA countries in reports and an interactive dashboard.
European Surveillance of Antimicrobial Consumption Network, ESAC-Net (ecdc.europa.eu)
EARS-Net, a Europe-wide network coordinated by ECDC, monitors resistance of invasive infections with reports and an interactive dashboard.
European Antimicrobial Resistance Surveillance Network (EARS-Net), EARS-Net (ecdc.europa.eu)
The Global Antimicrobial Resistance Surveillance System (GLASS), coordinated by the World Health Organization (WHO), monitors antibiotic resistance and consumption globally, publishing in annual reports and an interactive dashboard.
The Global Antimicrobial Resistance Surveillance System, GLASS (who.int)
In animals
An interactive database of how antimicrobial medicines are used in animals across the European Union and the final report (2022) of the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC).
European Surveillance of Veterinary Antimicrobial Consumption, ESVAC, 2009-2023 (ema.europa.eu)
The Antimicrobial sales and use (ASU) platform with all EU/EEA member states data on the sales and use of antimicrobial medicinal products in animals, starting in 2024 with data for 2023.
EMA, the Antimicrobial sales and use platform (ema.europa.eu)
The World Organisation for Animal Health (WOAH) report and interactive dashboard on the use of antimicrobials in animals, with global and regional trends.
World Organisation for Animal Health, WOAH ANIMUSE (amu.woah.org)
The Food and Agriculture Organization of the United Nations (FAO) is currently developing an International FAO Antimicrobial Resistance Monitoring (InFARM) System regarding antibiotic resistance in food and agriculture as well as use of antibiotics in crops.
The International FAO Food and Agriculture Organization (InFARM) System (fao.org)
Integrated international surveillance
The joint inter-agency antimicrobial consumption and resistance analysis (JIACRA) reports are published periodically by the EMA, ECDC and EFSA and analyse the relationship between the consuption of antimicrobials by humans and animals and the occurance of antimicrobial resistance.
The EFSA and the ECDC yearly summary report, storymaps and dashboards of antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food.