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About this publication
Antimicrobial resistance is an emerging problem worldwide. It reduces the effectiveness of antimicrobial treatment of infectious diseases in humans and animals thereby leading to increased morbidity and mortality, as well as higher costs. It is well established that there is a strong association between the usage of antimicrobial agents and the occurrence of resistance. The selective pressure exerted following use of antimicrobial agents is a key issue in the epidemiology of resistance. In this report the term antimicrobial resistance is used synonymously with antibiotic resistance, although the term actually includes resistance in other microbes as well. Antimicrobial resistance can be disseminated through the spread of resistant pathogenic organisms themselves or by horizontal transfer of resistance genes from one type of organism to another. Such transfer is not limited to closely related organisms; it can also take place between organisms of different evolutionary origins and/or ecological niches. Thus, antimicrobial drug usage and resistance in one ecological compartment can have consequences for the occurrence of resistance in another compartment. When addressing antimicrobial resistance – the occurrences, causes, consequences and preventive measures – a holistic approach is needed, encompassing both data on usage and resistance in human and veterinary medicine, as well as organisms in the food production chain.
In response to the growing concern about antimicrobial resistance, the Norwegian Ministry of Health and Social Affairs issued a national action plan against antimicrobial resistance in March 2000. The importance of monitoring the human and animal health sectors as well as food production, was emphasised. The action plan recognised the need for ongoing surveillance as a fundamental component of the strategy. The NORM and NORM-VET
programmes were consequently established in order to provide and present data on the occurrence and distribution of antimicrobial resistance over time. The national action plan formally expired by the end of 2004. However, the need for continued surveillance of both resistance and antimicrobial usage was emphasised at subsequent consultations and an integrated national strategy for prevention of infections in the health service and antibiotic
resistance (2008-2012) was issued in the summer of 2008. A new national strategy (2015-2020) was launched by the Norwegian government in June 2015 including an explicit target of 30% reduction in antibiotic consumption in human medicine by 2020 compared to 2012. For food-producing terrestrial animals and companion animals the target was 10% and 30% reduction in the usage, respectively, by 2020, with 2013 as reference year. Additional specific targets in the food production chain are that livestock associated MRSA will not be established in the Norwegian pig population, and that ESBL in the poultry production will be reduced to a minimum. Also, the action plan states that the government will carry out mapping of reservoirs of antimicrobial resistant bacteria in humans, in food and in relevant animal populations and in sentinel environments. Due to the coronavirus pandemic, the expiry of this strategy has been postponed until 2022, but the government has initiated the process to develop a new framework for the coming years.
The NORM surveillance programme for antimicrobial resistance in human pathogens was established in 1999 and is coordinated by the Department of Microbiology and Infection Control at the University Hospital of North Norway in Tromsø. The NORM-VET monitoring
programme for antimicrobial resistance in animals, food and feed was established in 2000 and is coordinated by the Norwegian Veterinary Institute commissioned by the Norwegian Food Safety Authority. The NORM/NORMVET reports also present data on the usage of antimicrobial agents in humans and animals in Norway. The NORM and NORM-VET programmes are valuable tools for setting policies, assessing risks and evaluating interventions.
This report, which is the twenty-first annual joint report from NORM and NORM-VET, presents data on resistance and usage for 2021. The editors would like to thank all those
who contributed to data collection and the writing of this report, for excellent work.