Antibiotic resistance occurs when bacteria become resistant or less responsive to antibiotics. These resistant bacteria can make treatment longer or even impossible. It is therefore important that the evolution of antibiotic consumption in humans, livestock, domestic animals and the environment is monitored. The results of this surveillance are published every two years in the Swiss Antibiotic Resistance Report.
Antibiotic consumption in Switzerland is stable or in decline
According to the Swiss Antibiotic Resistance Report 2020 (SARR 2020 for short), antibiotic consumption in human medicine is stable, in both inpatient and outpatient settings. There are significant regional differences, however. In the French- and Italian-speaking parts of the country, antibiotic consumption per capita is above average, and in German-speaking Switzerland it is below the national average.
The report also shows that antibiotic use continues to decline in veterinary medicine. There was a year-on-year decrease of around 7 % in 2019, and the total volume of antibiotics used has more than halved in the last ten years. In addition, consumption of ‘critically-important antibiotics‘, which are used as a last resort in human medicine, has also decreased by more than half since 2016.
Measures for the environment
After antibiotics have been taken, they are partially excreted by humans and animals and this is how they end up in wastewater and soil. Since 2016, sewage treatment plants have therefore been upgraded to include additional treatment steps. This will significantly reduce the quantity of antibiotics that end up in the environment through waste water.
Antibiotic resistance in Switzerland
Relative to the size of its population, Switzerland is less affected by infections caused by resistant bacteria than France, Italy or the UK, but more so than the Netherlands and Scandinavian countries. The data collected on humans since 2004 and on animals since 2006 reveal a mixed picture: while resistance has significantly increased in some bacteria, it has remained stable or decreased in others.
Resistance in human medicine
The rate of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) continues to decline in human medicine. Nevertheless, the rate of MRSA infections in wounds and abscesses in outpatient settings has increased.
The resistance of bacteria that cause food-borne infections is falling in Switzerland. There were virtually no cases of Methicillin-resistant Staphylococcus aureus (MRSA) in raw Swiss pork, beef and poultry in the period under review.
Carbapenem resistance is increasing
Carbapenems are important antibiotics in human medicine as they are used as a last resort when no other antibiotic can be used to treat a patient. In veterinary medicine, carbapenems are not permitted for use in livestock and can only be used in domestic animals in exceptional cases.
Since 1 January 2016, cases of carbapenemase-producing Enterobacterales (CPE) have had to be reported to the Federal Office of Public Health (FOPH). As is the case in most European countries, this emerging form of resistance is still rare. The number of CPEs has risen sharply, although there has been no increase in the consumption of carbapenems in human medicine for six years.
No cases of CPE in livestock have been detected in Switzerland to date. However, CPE was recently detected in domestic animals (cats and dogs) and veterinary staff at a veterinary clinic. This highlights the importance of close collaboration between human and veterinary medicine, or what is known as the ‘One Health’ approach.