The Swiss Antibiotic Resistance Report (SARR) is the national report on the antibiotic resistance situation in Switzerland. The report not only focuses on antibiotic consumption and resistance in human and veterinary medicine, but also on the impacts in the environment (One Health approach).
Antibiotic resistance occurs when bacteria become immune or less sensitive to antibiotics. Such resistant bacteria can make it more difficult or even impossible to treat infections. This is why the Swiss Antibiotic Resistance Strategy was launched in 2015. One part of the strategy involves monitoring antibiotic resistance and antibiotic consumption in humans, livestock and domestic animals, and in the environment. The results of this monitoring and surveillance have been published every two years since 2016 in the Swiss Antibiotic Resistance Report.
SARR 2022
Find out about the most important figures and results from the SARR 2022 here.
Interview with Andreas Kronenberg, Project Manager at the Swiss Centre for Antibiotic Resistance ANRESIS.
Antibiotic consumption
Every time antibiotics are used, resistant bacteria can develop. It is therefore crucial that these medicines are taken properly. The guiding principles are «as much as necessary, as little as possible» and «use wisely, take precisely». Surveillance of antibiotic use in human and veterinary medicine is therefore key.
Human medicine
In human medicine, antibiotic consumption significantly declined during the COVID-19 pandemic
In human medicine, total antibiotic consumption (in outpatient and inpatient settings) has fallen by 19% since 2019. The measures to tackle the COVID-19 pandemic, such as physical distancing and mask wearing, are likely to have played a significant part in this. Compared to other countries in Europe, Switzerland has one of the lowest levels of antibiotic consumption. In particular among the antibiotics that are critical to the development of antibiotic resistance (the Watch group), a decline of almost 40% has been achieved in the last 10 years. Their share of all antibiotic prescriptions fell in 2019 below the WHO target of 40% for the first time. Switzerland therefore remains one of the European countries with the lowest consumption.
Of the antibiotics consumed, 85% were used in outpatient settings, with the remaining 15% in hospitals. There are marked regional differences in Switzerland in terms of consumption: in the French- and Italian-speaking parts of the country, antibiotic consumption per inhabitant is above the national average, while in German-speaking Switzerland, it is below.
Antibiotic use in human medicine
y-axis: Defined daily doses per 1000 inhabitants per day
Show data table for the years 2002-2022
| AWaRe category "Access" | AWaRe category "Watch" | AWaRe category "Reserve" | |
|---|---|---|---|
|
|
|
|
|
| 2002 | 4.6 | 5.1 | 0.012 |
| 2003 | 5.0 | 5.2 | 0.013 |
| 2004 | 4.9 | 5.0 | 0.017 |
| 2005 | 5.0 | 5.5 | 0.019 |
| 2006 | 5.4 | 5.6 | 0.020 |
| 2007 | 5.5 | 5.7 | 0.020 |
| 2008 | 5.8 | 5.7 | 0.020 |
| 2009 | 5.8 | 5.6 | 0.024 |
| 2010 | 5.9 | 5.5 | 0.028 |
| 2011 | 6.0 | 5.4 | 0.030 |
| 2012 | 6.1 | 5.3 | 0.031 |
| 2013 | 6.4 | 5.3 | 0.031 |
| 2014 | 6.2 | 4.9 | 0.029 |
| 2015 | 6.3 | 4.8 | 0.037 |
| 2016 | 6.4 | 4.5 | 0.039 |
| 2017 | 6.2 | 4.3 | 0.041 |
| 2018 | 6.5 | 4.1 | 0.040 |
| 2019 | 6.6 | 3.9 | 0.040 |
| 2020 | 5.7 | 3.2 | 0.037 |
| 2021 | 5.6 | 2.9 | 0.033 |
| 2022 | 6.7 | 3.3 | 0.039 |
Source: SARR22, Data source: IQVIA™ Sales Data (Sell-In) from pharmaceutical industries (Arzneimittel) to public pharmacies, self-dispensing physicians and hospitals
Veterinary medicine
In veterinary medicine antibiotic consumption has further declined
Some 28 tonnes of antibiotics were used to treat animals in 2021 – a decline of around 6% compared with 2019. Since 2012, antibiotic use in veterinary medicine has been reduced by around half. In addition, the use of critically important antibiotics, which are particularly important in human medicine, continued to decline between 2019 and 2021, and has decreased by 46% since 2016. In domestic animals, antibiotic consumption has decreased by 19% in the last 10 years. Only 3% of the antibiotics used are exclusively authorised for domestic animals.
The rollout of the antibiotic consumption information system (IS ABV database) in 2019 means it is now possible to present detailed data on antibiotic use in animals. These data are provided by vets who have been required to electronically record all treatments and prescriptions of antibiotics for livestock and domestic animals since October 2019.
This information was published for the first time in the SARR 2022 report. Due to a lack of comparison data, it is not yet possible to study the evolution of prescribing practice in animals. Such analyses will be conducted in the next few years.
In 2020, 23 tonnes (rounded) of antibiotics were used to treat livestock and 1.7 tonnes (rounded) to treat domestic animals. In proportional terms, most of the antibiotics used in livestock were for cattle and the majority of antibiotics used in domestic animals were for horses (chart).
Antibiotic resistance
If the bacteria that cause an infection are resistant to certain antibiotics, the infection becomes difficult or even impossible to treat. The data collected on humans since 2004 and on animals since 2006 reveal a mixed picture: while antibiotic resistance has significantly increased in some bacteria, it has remained stable or decreased in others. Resistance rates have stabilised in recent years.
Human medicine
In human medicine resistance rates have stabilised
Based on modelling, we can estimate the number of deaths and the disease burden caused by infections with resistant pathogens. It is estimated that some 300 people die from resistant infections every year in Switzerland. Relative to the size of its population, Switzerland is therefore less affected by infections caused by resistant bacteria than France or Italy, but is more affected than the Netherlands and Scandinavian countries.
On the whole, resistance rates have stabilised in human medicine. The rate of invasive infections (e.g. sepsis) caused by resistant bacteria has significantly decreased in the last 15 years for some pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA), for which resistance rates have halved. The resistance rates against fluoroquinolones and third-/fourth-generation cephalosporins in E. coli and Klebsiella pneumoniae, which rose considerably between 2004 and 2015, have fortunately stabilised in the last five years. The resistance of these bacteria to carbapenems (carbapenemase-producing Enterobacterales (CPE)) pose a particular threat to public health, which is why they have been subject to mandatory notification since 2016. The number of reported cases has risen steadily since, although consumption is low compared with neighbouring countries.
Multi-resistant microorganisms in invasive isolates
y-axis: Proportion of antibiotic resistance in %
Show data table for the years 2004-2023
| FQR-E.coli: Escherichia coli resistant to fluoroquinolones | ESCR-E.coli: Escherichia coli resistant to broad spectrum cephalosporins | ESCR-KP: Klebsiella pneumoniae resistant to broad spectrum cephalosporins | PNSP: Penicillin-resistant Streptococcus pneumonia | MRSA: Methicillin-resistant Staphylococcocus aureus | VRE: Vancomycin-resistant enterococci (Enterococcus faecalis and Enterococcus faecium) | |
|---|---|---|---|---|---|---|
|
|
|
|
|
|
|
|
| 2004 | 10.6 % | 0.9 % | 1.3 % | 9.4 % | 12.9 % | 0.9 % |
| 2005 | 11.1 % | 1.6 % | 2.5 % | 7.7 % | 9.9 % | 1.3 % |
| 2006 | 12.0 % | 2.6 % | 1.7 % | 7.1 % | 10.0 % | 0.3 % |
| 2007 | 16.2 % | 2.6 % | 3.8 % | 11.2 % | 10.6 % | 0.3 % |
| 2008 | 15.7 % | 4.1 % | 2.9 % | 8.7 % | 10.1 % | 1.8 % |
| 2009 | 16.1 % | 4.6 % | 4.0 % | 7.5 % | 9.3 % | 1.5 % |
| 2010 | 19.1 % | 5.7 % | 5.0 % | 6.6 % | 8.5 % | 0.8 % |
| 2011 | 18.2 % | 6.9 % | 6.6 % | 5.6 % | 7.9 % | 0.9 % |
| 2012 | 18.3 % | 9.5 % | 6.1 % | 7.2 % | 6.7 % | 0.3 % |
| 2013 | 18.7 % | 8.5 % | 8.7 % | 5.9 % | 5.5 % | 0.4 % |
| 2014 | 19.0 % | 9.7 % | 9.9 % | 7.6 % | 5.7 % | 0.3 % |
| 2015 | 20.5 % | 11.0 % | 8.9 % | 5.7 % | 4.4 % | 0.4 % |
| 2016 | 18.6 % | 10.4 % | 7.9 % | 6.4 % | 4.6 % | 0.6 % |
| 2017 | 20.3 % | 10.6 % | 7.1 % | 6.5 % | 4.3 % | 1.1 % |
| 2018 | 20.5 % | 11.7 % | 9.3 % | 6.5 % | 4.9 % | 1.7 % |
| 2019 | 18.8 % | 11.6 % | 8.3 % | 6.5 % | 3.5 % | 0.6 % |
| 2020 | 18.7 % | 10.8 % | 7.7 % | 5.9 % | 4.6 % | 1.1 % |
| 2021 | 18.0 % | 10.9 % | 8.9 % | 6.7 % | 4.5 % | 0.7 % |
| 2022 | 17.4 % | 11.5 % | 10.9 % | 4.8 % | 3.7 % | 1.2 % |
| 2023 | 20.8 % | 13.0 % | 11.1 % | 6.8 % | 4.2 % | 0.8 % |
Source: SARR22, Data: ANRESIS
Veterinary medicine
Indicator bacteria collected from healthy animals show a mixed picture regarding antibiotic resistance
The monitoring of antibiotic resistance in indicator bacteria from healthy slaughter animals is designed to provide information on the type of resistance found in intestinal bacteria of animal origin. These bacteria do not usually cause disease themselves, but can pass on resistance to other bacteria, including those that can cause disease in humans. Every time antibiotics are used in animals, it can result in selective pressure, giving rise to resistant bacteria in the intestinal flora of the animals concerned. Consequently, E. coli as indicator bacteria are a useful instrument with which to observe changes in resistance and to track the spread of resistance.
The resistance rates of E. coli in the intestines of broiler chickens, fattening pigs and veal calves evolved differently between 2019 and 2021. While resistance fell in broiler chickens, rates remained more or less stable in fattening pigs and veal calves.
Proportion of resistant E. coli in broilers
Proportion of resistant E. coli from healthy slaughter animals
Show data table for the years 2006-2022
| Ampicillin | Chloramphenicol | Ciprofloxacin | Gentamicin | Nalidixic acid | Sulfamethoxazole | Tetracycline | Trimethoprim | |
|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|
|
|
|
| 2006 | 48.4% | 25.9% | 4.7% | 5.6% | 3.6% | 64.2% | 56.5% | - |
| 2007 | - | - | - | - | - | - | - | - |
| 2008 | 2.5% | 1.2% | 3.8% | 1.2% | 1.2% | 7.5% | 6.2% | 7.5% |
| 2009 | 6.8% | 0.8% | 1.5% | 0 | 0.8% | 15.9% | 16.7% | 4.5% |
| 2010 | 39.1% | 17.4% | 4.3% | 5.4% | 3.3% | 55.4% | 51.1% | 20.7% |
| 2011 | 17.7% | 11.6% | 4.3% | 3.7% | 3.7% | 35.4% | 36.6% | 11.0% |
| 2012 | 14.4% | 3.7% | 3.2% | 5.9% | 3.2% | 26.2% | 24.6% | 11.2% |
| 2013 | 27.3% | 9.7% | 7.4% | 3.4% | 7.4% | 46.0% | 38.1% | 22.2% |
| 2014 | - | - | - | - | - | - | - | - |
| 2015 | 36.8% | 11.6% | 6.8% | 5.8% | 6.3% | 41.6% | 40.5% | 15.8% |
| 2016 | - | - | - | - | - | - | - | - |
| 2017 | 38.7% | 9.8% | 3.6% | 4.6% | 3.6% | 46.9% | 41.2% | 19.1% |
| 2018 | - | - | - | - | - | - | - | - |
| 2019 | 26.1% | 7.0% | 4.5% | 4.0% | 4.0% | 31.2% | 36.2% | 13.1% |
| 2020 | - | - | - | - | - | - | - | - |
| 2021 | 26.1% | 7.2% | 0.6% | 6.7% | 0.6% | 27.2% | 28.3% | 12.2% |
| 2022 | - | - | - | - | - | - | - | - |
| Ampicillin | Chloramphenicol | Ciprofloxacin | Gentamicin | Nalidixic acid | Sulfamethoxazole | Tetracycline | Trimethoprim |
Source: SARR22
Environment
New methods allow a better understanding of the spread of antibiotic resistance
Drug-resistant bacteria can spread between humans and animals, just like non-resistant bacteria, and use many different and complex routes of transmission (see figure). As part of the National Research Programme on antimicrobial resistance (NRP 72), various projects looked at the spread of new forms of resistance using next-generation sequencing (NGS). Among other things, researchers found a high colonisation with resistant pathogens in travellers returning from certain locations. They also detected transmission of resistant pathogens from patients discharged from hospital to their relatives, and between staff working in veterinary clinics and the animals treated there. To determine the part played by these routes of transmission more accurately, NGS would need to be systematically expanded. The aim of sequencing must be to gain relevant insights for the control of resistant pathogens and to utilise these for targeted action within the framework of the StAR.
Causes and transmission paths of antibiotic-resistant bacteria
✕
Documents
Links
Media
Last modification 24.10.2023
Contact
Strategy on Antibiotic Resistance
c/o Federal Office of Public Health FOPH
Schwarzenburgstrasse 157
3003 Bern
Switzerland
- Tel.
- +41 58 463 87 06
