Antimicrobial resistance II: Situation and strategies in Korea
Food Microbiology division, NIFDS, MFDS
Soohwan Suh
Contents
I. Status of antimicrobial-resistance management in South Korea
1. History of the national AMR management program
2. Major outcomes of national AMR programs
3. Future directions
II. Resistance rate in retail meats
1. Resistance in domestic and imported meats
Threats of antimicrobial-resistance
Livestock animals Human
Infection of AMRAntibiotic drugs
Threats of antimicrobial-resistance
Origins and channels of contaigion
Ministry of Health & Welfare (KCDC)
MAFR
A / M
inistry o
f Ocean
s and Fish
eries
Min
. Food &
Dru
g Safety
Resistant bacteria
MisuseMisuse
Resistant bacteria Antibiotics
Direct contact
Improper handling orcooking
Horticulture/farming/fishery products
Feces, fertilizers Feces, disposalof medicines
Local community
People
Environment
Food
Medical institutions
Spreading withinmedical institutions
Ministry of Environment
History of the national AMR management program
NVRQS (Ministry of agriculture ) Asia Pacific Foundation for Infectuous Disease(Samsung Medical Center)
◦ Monitoring of antimicrobial resistanceon the food-animals and meats
◦ Control of antimicrobial resistance inhospitals through integrated antimicrobialstewardship program
NFRDI Ministry of marine affairs and fisheries Drug resistance Division (KCDC)
◦ Monitoring of antimicrobial resistance foraquaculture and introduction of organicmarine production system
Korea Food and Drug Administration ◦ Surveillance of antimicrobial resistantpathogens in community
◦General management & budget allocation◦Development of network for integrated
antimicrobial resistance management◦Construction of information share portal ◦Management of expert committee for
antimicrobial resistance◦Public relation and education◦Invitation of Codex AMR TF◦Research for foodborne antimicrobial
resistant bacteria
Seoul National University / Korea UniversityEnterobacteria Division(KCDC)
8 Regional Research institute of public health and environment
◦ Risk analysis of critically importantveterinary antimicrobials
◦ Risk analysis of antimicrobial resistantbacteria
◦Establishment for national FoodNet forantimcirobial resistance
Korea consumer agency Yonsei University(21 University hospital)
◦ Antibiotic resistance monitoring for animalfarm environment and impact assessment
◦ Surveillance of antimicrobial resistantbacteria from animal farm environment
◦ Devising strategies to reduce antibioticresistance in clinical medicine
Korea consumer affairs institute /Yonsei University
Yonsei University / Culture collection of antimicrobial resistant microbes Kosin University
◦Survey for awareness of antimicrobial resistance◦ Evaluation of the effect of public relation and
contents development
◦Construction of Culture collection ofantimicrobial resistant microbes ◦ Analysis of antimicrobial resistance gene
National Antimicrobial-resistance Management Program(2003-2007)
National Antimicrobial-resistance Management Program(2008-2012)
Prime Minster’s Office
Mediation & evaluation of tasks of governmental
departments
Ministry of Health and Welfare
Revision of regulationsPublic relation & Education
Korea Food and Drug Administration
Invitation of CODEX TFAMR
Consumer education
Center for Disease Control & Prevention
Antimicrobial resistance management
Hospital infection management
Health Insurance Review & Assessment service
Monitoring antibiotics prescribing rate &
amount of hospitals
Ministry of Environment
Management of residual drugs in environment
Collection of used drugs in household
Ministry for Food, Agriculture, Forestry and
Fisheries(Livestock)
Trace system of antimicrobials for animal
Mandatory system of prescription for animalHACCP for livestock
Ministry for Food, Agriculture, Forestry and Fisheries(Aquaculture)
HACCP for aquacultureDiffusion of vaccine
Guideline of using antimicrobials
National Institute of Environmental
Research
Monitoring of residual drugs in
environment
Animal, plant & fisheries quarantine & inspection
agencyMonitoring of
antimicrobial resistant bacteria & amount of antimicrobials used
National Fisheries Research & Development
InstituteMonitoring of
antimicrobial resistant bacteria & amount of antimicrobials used
Hospital, Medical college, Academic societyRegional research institute of public health and env.
Management & surveillance on antibiotic resistanceManagement & surveillance on nosocomial infection
Clinical field Non-clinical field
Non‐clinical discussion bodies (2013~2016)
• Monitoring of antimicrobial‐resistance in each sector
after the end of “National Antibiotics‐resistance Safety Management Program”
Residues in the environmentand resistance
Resistance rate of imported or distributed food products
Resistance rate in clinical sector Resistance rate in farmingand fishery sectors
Antimicrobial-resistancemanagement
• Ministry of Health & Welfare
• Korea Center for Disease & Control
• HIRA
• Ministry of Food & Drug Safety (MFDS)
• National Institute of Food & Drug Safety
(NIFDS)
• MAFRA
• Animal and Plant Quarantine Agency
• Ministry of Oceans and Fisheries
• National Institute of Fisheries Science
• Ministry of Environment
• National Institute of
Environmental Research
Management of antibiotics-resistance
Non-clinical discussion bodies
National action plan of Korea (2016~)
• WHO presented a global action plan and urged national‐level actions (2015).
• Developed and implemented the National Action Plan on AMR
MoHW(Oversight)
KCDC
Dedicated departments
Antibiotics-resistanceadvisory committee
Good Antibiotics UsageCampaign HQ
MFDS (Non-human oversight)
MAFRA (animal oversight)
Ministry of Oceans and Fisheries
Ministry of Environment
Korea Institute of Drug Safety & Risk Management
Animal and PlantQuarantine Agency
National Institute ofFisheries Science
National Institute ofEnvironmentalResearch
Surveillance of
Antimicrobial drug usage
Research on Multi-
drug resistance
Interaction and translocation of
among Human-animal-
environment
Control and
treatment
One health approach to AMR
surveillance
One health approach fight AMR (2017~)
Ministry of Health & Welfare
Ministry of Agriculture,
Food & Rural Affiars
Ministry of Oceans & Fisheries
Ministry of Food & Drug
Safety
Ministry of Environment
Ministry of Science &
ICT
Major outcomesof national AMR
management programs
Major outcomes of National programs
• Ban of adding antimicrobials in animal feed (MAFRA, 2011)
• Provide government subsidies for organic live stock farms (2008)
• Expansion of HACCP certified farms
• Adoption of seafood traceability system
(Ministry of Oceans and Fisheries, 2008)
• Adoption of mandatory prescription by veterinarians (MAFRA, 2013)
• Public relation and education (2003~)
• Medicinal waste recovery system (MoE, 2010)
Major outcomes of National projects
Major outcomes of public relation & education
• Guidelines for public education
• Educations on animal and aqua farms for prudent use of antimicrobials
Major outcomes of public relation & education
• Public educations (TV shows)
• Public educations (leaflets)
• Collection and dispose of unused drugs
Major outcomes of public relation & education
Future directions• Establish and implement national antibiotics‐ resistance management action plan(2016~)
Vision
Reduce the use of antibiotics, use a proper amount, and prevent distribution of resistant bacteria
⇨ Protect the public from antibiotic‐resistance.
Target
[Human] ‐ Compared to 2015, by 2020 [Non‐human]
Reduce the volume of antibiotics usage by 20%
Reduce the volume of antibiotics prescription for upper airway
infection by 50%.
Reduce the volume of antibiotics prescription for respiratory
diseases by 20%.
Reduce the resistance of Staphylococcus aureus against
methicillin by 20%
Increase the number of antibiotics items for prescription by
veterinarians by two folds
Chicken: Reduce the resistance to fluoro‐quinolone against
colon bacteria by 10%
CODEX ad hoc TF AMR
• The Codex ad hoc Intergovernmental Task Force on Antimicrobial Resistance (TFAMR) established in the Codex Alimentarius Commission (CAC) in 2006
• The 1st through 4th Codex TFAMR held in Korea (2007~2010)– Guidelines on risk assessment of foodborne antimicrobial resistance
• The 5th Codex TFAMR holding in Jeju, Korea in 2017– Revision of the Code of Practice to Minimize and Contain Antimicrobial Resistance
(CAC‐PCP 61‐2005)– Propose draft Guidelines on integrated surveillance of antimicrobial resistance
CODEX ad hoc TF AMR
CODEX
Resistance ratein retail meats
Domestic vs. Imported (y2017)
E. coli
Beef
Pork
Chicken
0,7% 0,0% 5,1% 1,5% 0,7%
20,6%
4,4% 0,0% 0,0% 2,9% 2,9% 5,1% 0,7%11,0% 4,4%
21,3%
6,3% 6,3% 6,3% 3,1% 3,1%
25,0%
12,5%0,0% 0,0% 3,1% 3,1% 6,3%
0,0%
12,5%
3,1%
15,6%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
AUG2 FOX CHL CIP GEN TET NAL MERO FEP COL SXT AMP TAZ FIS XNL STR
Resistan
ce ra
te (%
) 국내산(n=136) 수입산(n=32)
0,0% 0,0%
40,0%
6,0%16,0%
54,0%
30,0%
0,0% 0,0% 2,0%
32,0%
50,0%
0,0%
56,0%
4,0%
56,0%
6,7% 2,2%11,1%
4,4% 0,0%
42,2%
8,9%0,0% 0,0% 4,4%
22,2%31,1%
0,0%
31,1%
6,7%
24,4%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
AUG2 FOX CHL CIP GEN TET NAL MERO FEP COL SXT AMP TAZ FIS XNL STR
Resistan
ce ra
te (%
) 국내산(n=50) 수입산(n=45)
8,8% 8,8%
48,4%
67,3%
17,0%
73,0%
88,7%
0,0% 1,3% 0,6%
45,9%
83,6%
10,7%
71,1%
23,9%
64,8%
10,4% 12,5% 10,4%20,8%
10,4%
35,4%
50,0%
0,0% 2,1% 4,2%
27,1%
50,0%
8,3%
41,7%
25,0%
47,9%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
AUG2 FOX CHL CIP GEN TET NAL MERO FEP COL SXT AMP TAZ FIS XNL STR
Resistan
ce ra
te (%
) 국내산(n=159) 수입산(n=48)
Domestic (n=136) Imported (n=32)
Domestic (n=50) Imported (n=45)
Domestic (n=159) Imported (n=48)
CAZ
CAZ
CAZ
13,7% 15,7%
0,0% 0,0%
43,1%
2,0%7,8%
0,0% 0,0% 0,0% 2,0%
37,3%
15,7%
5,9%0,0% 0,0%
7,8%
29,3%
17,1%
0,0% 0,0%
36,6%
14,6%12,2%2,4% 0,0% 0,0%
4,9%
41,5%
2,4% 0,0% 0,0% 0,0% 0,0%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
CLI TET RIF FUS PEN CHL KAM SYN VAN GEN TMP ERY CIP FOX LZD MUP SMX
Res
ista
nce
rat
e (%
) 국내산(n=51) 수입산(n=41)
19,4%
51,6%
0,0%
12,9%
77,4%
29,0%
9,7% 6,5%0,0% 0,0%
12,9%19,4% 19,4%
6,5%0,0% 0,0%
6,5%17,3%
34,6%
0,0%5,8%
57,7%
5,8% 3,8% 5,8% 0,0% 1,9%9,6%
17,3%9,6% 15,4%
0,0% 0,0%
13,5%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
CLI TET RIF FUS PEN CHL KAM SYN VAN GEN TMP ERY CIP FOX LZD MUP SMX
Resistan
ce ra
te (%
) 국내산(n=31) 수입산(n=52)
0,0% 0,0% 0,0%
41,2%
82,4%
0,0%5,9%
0,0% 0,0% 0,0%5,9%
11,8%5,9% 5,9% 0,0% 0,0% 5,9%2,7%
18,9%
0,0%
10,8%
62,2%
2,7% 0,0% 2,7% 0,0% 0,0%2,7%
18,9%
2,7% 5,4% 0,0% 2,7%
10,8%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
CLI TET RIF FUS PEN CHL KAM SYN VAN GEN TMP ERY CIP FOX LZD MUP SMX
Resistan
ce ra
te (%
)국내산(n=17) 수입산(n=37)
Domestic vs. Imported (y2017)
S. aureus
Beef
Pork
Chicken
Domestic (n=17) Imported (n=37)
Domestic (n=31) Imported (n=52)
Domestic (n=51) Imported (n=41)
Resistance in E. coli (domestic beef)
0,0
20,0
40,0
60,0
80,0
100,0
2003(9)
2004(9)
2005(13)
2006(25)
2008(7)
2009(12)
2010(24)
2011(16)
2012(23)
2013(38)
2014(29)
2015(29)
2016(42)
2017(136)
내성
률(%
)Res
ista
nce
rat
e (%
)
Resistance in E. coli (domestic pork)
0,0
20,0
40,0
60,0
80,0
100,0
2003
(3)
2004
(9)
2005
(16)
2006
(9)
2008
(5)
2009
(15)
2010
(22)
2011
(15)
2012
(11)
2013
(27)
2014
(14)
2015
(21)
2016
(9)
2017
(50)
Ris
ista
nce
rate
(%
)
Resistance in E. coli (domestic chicken)
0,0
20,0
40,0
60,0
80,0
100,0
2003(7)
2004(24)
2005(24)
2006(35)
2008(23)
2009(20)
2010(39)
2011(27)
2012(27)
2013(47)
2014(34)
2015(43)
2016(37)
2017(159)
Resistan
ce ra
te (%
)
Resistance in S. aureus (domestic beef)
0
20
40
60
80
100
2005(11)
2006(28)
2008(6)
2009(10)
2010(20)
2011(8)
2012(8)
2013(7)
2014(9)
2015(15)
2016(10)
2017(17)
Resistan
ce ra
te (%
)
0
20
40
60
80
100
2005(15)
2006(19)
2008(3)
2009(7)
2010(19)
2011(16)
2012(16)
2013(14)
2014(14)
2015(9)
2016(7)
2017(31)
Resistan
ce ra
te (%
)
Resistance in S. aureus (domestic pork)
Resistance in S. aureus (domestic chicken)
0
20
40
60
80
100
2005(20)
2006(33)
2008(27)
2009(13)
2010(25)
2011(28)
2012(22)
2013(27)
2014(21)
2015(28)
2016(17)
2017(51)
Resistan
ce ra
te (%
)
Monitoring outcome reporting
◼ Published integrated, non‐clinical national antibiotics usage and resistance statistics
report (livestock, farm products, and fishery products)
◼ Published via the website (www.mfds.go.kr)
Conclusion
Korean government tried to slow down the spread of resistance by “national antimicrobial-resistance management program” started since 2003.
National Action Plan on Antimicrobial Residence in accordance with WHO’s global action plan propositions since 2016 engaged in clinical and non-clinical national programs as part of the ONE-HEALTH approach
Major outcomes of last 15 yrs of National AMR management Programs include banning addition of antibiotics to animal feeds and introduction of mandatory prescription by vets.
Due to the ban on mixing in the feed, which resulted in a significant reduction in the usage of tetracycline, it turned out that the resistance against this drug reduced significantly.
MFDS (NIFDS) is planning to continue its role of AMR management, including overseeing non-clinical areas such as livestock, fishery, environment, and foods, to reduce the AMR and ensure proper use of antibiotics.
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