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. 2017 Feb 23;15(2):e04694.
doi: 10.2903/j.efsa.2017.4694. eCollection 2017 Feb.

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2015

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2015

European Food Safety Authority et al. EFSA J. .

Abstract

The data on antimicrobial resistance in zoonotic and indicator bacteria in 2015, submitted by 28 EU Member States (MSs), were jointly analysed by EFSA and ECDC. Resistance in zoonotic Salmonella and Campylobacter from humans, animals and food, and resistance in indicator Escherichia coli as well as meticillin-resistant Staphylococcus aureus in animals and food were addressed. 'Microbiological' resistance was assessed using epidemiological cut-off (ECOFF) values; for some countries, qualitative data on human isolates were interpreted in a way which corresponds closely to the ECOFF-defined 'microbiological' resistance. In Salmonella from humans, high proportions of isolates were resistant to ampicillin, sulfonamides and tetracyclines, whereas resistance to third-generation cephalosporins was low. In Salmonella and Escherichia coli isolates from fattening pigs and calves under one year of age, resistance to ampicillin, tetracyclines and sulfonamides was frequently detected, whereas resistance to third-generation cephalosporins was uncommon. For the first time, presumptive extended-spectrum beta-lactamase (ESBL)-/AmpC-/carbapenemase-production in Salmonella and Escherichia coli was monitored in humans (Salmonella), meat (pork and beef), fattening pigs and calves. Varying occurrence/prevalence rates of ESBL-/AmpC-producers were observed between countries, and carbapenemase-producing Escherichia coli were detected in single samples of pig meat and from fattening pigs from two MSs. Resistance to colistin was observed at low levels in Salmonella and Escherichia coli from fattening pigs and calves under one year of age and meat thereof. In Campylobacter from humans, high to extremely high proportions of isolates were resistant to ciprofloxacin and tetracyclines, particularly in C. coli. In a few countries, a third to half of C. coli in humans were resistant also to erythromycin, leaving few options for treatment of severe Campylobacter infections. High resistance to ciprofloxacin and tetracyclines was observed in C. coli isolates from fattening pigs, whereas much lower levels were recorded for erythromycin. Co-resistance to critically important antimicrobials in both human and animal isolates was generally uncommon.

Keywords: ESBL; antimicrobial resistance; indicator bacteria; zoonotic bacteria.

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Figures

Figure 1
Figure 1
Breakdown of serovars in Salmonella isolates from fattening pigs tested for antimicrobial susceptibility in the EU, 2015
Figure 2
Figure 2
Proportions of isolates fully susceptible, resistant to one to two classes of substances and multiresistant in the most commonly recovered Salmonella serovars in fattening pigs in the EU, 2015
  1. N: total number of isolates tested for susceptibility against the whole common antimicrobial.

Figure 3
Figure 3
Distribution of the occurrence of resistance to ciprofloxacin (CIP), erythromycin (ERY), gentamicin (GEN) and tetracyclines (TET) in C. coli from fattening pigs in seven reporting MSs in 2015, using ECOFFs
Figure 4
Figure 4
Distribution of MICs of erythromycin in C. coli from fattening pigs, 1005 isolates, 8 reporting countries, 2015
Figure 5
Figure 5
Distribution of the occurrence of resistance to ampicillin (AMP), ciprofloxacin (CIP), colistin (CST), cefotaxime (CTX) and tetracyclines (TET) in E. coli from fattening pigs in 27 MSs in 2015, using ECOFFs
Figure 6
Figure 6
Distribution of the occurrence of resistance to ampicillin (AMP), ciprofloxacin (CIP), colistin (CST), cefotaxime (CTX) and tetracyclines (TET) in E. coli from calves of less than one year of age in 10 MSs in 2015, using ECOFFs
Figure 7
Figure 7
Colistin resistance in E. coli from fattening pigs and calves under one year of age
Figure 8
Figure 8
Phenotypes inferred based on the resistance to the beta‐lactams included in Panel 2
  1. Presumptive ESBL‐producers include isolates exhibiting Phenotype 1 or 3.

  2. Presumptive AmpC‐producers include isolates exhibiting Phenotype 2 or 3.

Figure 9
Figure 9
Comparison of CBPs for non‐susceptibility (intermediate and resistant categories combined) and ECOFFs used to interpret MIC data reported for Salmonella spp. from humans, animals or food
Figure 10
Figure 10
Trends in resistance to ampicillin, ciprofloxacin/pefloxacin/nalidixic acid, cefotaxime and tetracycline in Salmonella Typhimurium from humans in 16 reporting countries, 2013–2015
  1. Statistically significant increasing trends over 3 years, as tested by logistic regression (p ≤ 0.05), were observed for ciprofloxacin in Hungary and Slovenia (↑), for ampicillin in Austria, France and Slovenia (↑) and for tetracyclines in Austria, France, Norway and Slovenia (↑). Statistically significant decreasing trends over 3 years were observed for ampicillin in Finland, Germany, Hungary, Luxembourg and Norway (↓) and for tetracyclines in Finland, Germany, Hungary, the Netherlands and Spain (↓). Only countries testing at least 10 isolates per year were included in the analysis.

Figure 11
Figure 11
Spatial distribution of (fluoro)quinolone resistance among S. Typhimurium from human cases in reporting countries in 2015
Figure 12
Figure 12
Spatial distribution of cefotaxime resistance among S. Typhimurium from human cases in reporting countries in 2015
Figure 13
Figure 13
Frequency distribution of Salmonella Typhimurium isolates from humans completely susceptible or resistant to one to nine antimicrobial classes in 2015
  1. N: total number of isolates tested for susceptibility against the whole common antimicrobial set for Salmonella; sus: susceptible to all antimicrobial classes of the common set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the common set for Salmonella.

Figure 14
Figure 14
Trends in resistance to ampicillin, ciprofloxacin/pefloxacin/nalidixic acid, cefotaxime and tetracycline in monophasic Salmonella Typhimurium 1,4,[5],12:i:‐ from humans in reporting countries, 2013–2015
  1. A statistically significant increasing trend over 3 years, as tested by logistic regression (p ≤ 0.05), was observed for ampicillin in Denmark (↑). Statistically significant decreasing trends over 3 years were observed for ampicillin, cefotaxime and tetracycline in Spain (↓). Only countries testing at least 10 isolates per year were included in the analysis.

Figure 15
Figure 15
Spatial distribution of (fluoro)quinolone resistance among monophasic S. Typhimurium 1,4,[5],12:i:‐ from human cases in reporting countries in 2015
Figure 16
Figure 16
Spatial distribution of cefotaxime resistance among monophasic S. Typhimurium 1,4,[5],12:i:‐ from human cases in reporting countries in 2015
Figure 17
Figure 17
Frequency distribution of monophasic Salmonella Typhimurium 1,4,[5],12:i:‐ isolates from humans completely susceptible or resistant to one to nine antimicrobial classes in 2015
  1. N: total number of isolates tested for susceptibility against the whole common antimicrobial set for Salmonella; sus: susceptible to all antimicrobial classes of the common set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the common set for Salmonella.

Figure 18
Figure 18
Frequency distribution of monophasic Salmonella Derby isolates from humans completely susceptible or resistant to one to nine antimicrobial classes in 2015
  1. N: total number of isolates tested for susceptibility against the whole common antimicrobial set for Salmonella; sus: susceptible to all antimicrobial classes of the common set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the common set for Salmonella.

Figure 19
Figure 19
Trends in ampicillin, cefotaxime, ciprofloxacin nalidixic acid and tetracycline resistance in tested Salmonella spp. isolates from meat from pigs in reporting MSs, 2009–2015, quantitative data
  1. A statistically significant trend for 5 or more years, as tested by a logistic regression model (p ≤ 0.05), was observed in Ireland (↓) for both ciprofloxacin and nalidixic acid, for ampicillin in Belgium (↓), Germany (↓) and Italy(↑), for cefotaxime in Belgium (↓), Germany (↑) and Italy (↑), in Germany (↓) for nalidixic acid, and in Belgium (↓) and Germany (↓) for tetracycline.

Figure 20
Figure 20
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobial classes in Salmonella spp. from carcases of fattening pigs in reporting countries in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set of antimicrobials for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 21
Figure 21
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobial classes in Salmonella Derby from carcases of fattening pigs in reporting countries in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Sallmonella sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 22
Figure 22
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobial classes in monophasic Salmonella Typhimurium from carcases of fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 23
Figure 23
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobial classes in Salmonella Typhimurium from carcases of fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised sef of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 24
Figure 24
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobial classes in Salmonella Rissen from carcases of fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 25
Figure 25
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobial classes in Salmonella Infantis from carcases of fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised sef of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 26
Figure 26
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobial classes in Salmonella spp. from carcases of bovines under one year of age in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised sef of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 27
Figure 27
Trends in ampicillin, cefotaxime, ciprofloxacin nalidixic acid and tetracycline resistance in tested Salmonella spp. isolates from meat from bovine animals in reporting MSs, 2009–2015, quantitative data
  1. A statistically significant trend for 5 or more years, as tested by a logistic regression model (p ≤ 0.05), was observed in the Germany (↓) for ampicillin.

Figure 28
Figure 28
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobials classes in Salmonella spp. from fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 29
Figure 29
Spatial distribution of ciprofloxacin resistance among Salmonella spp. from fattening pigs in countries reporting MIC data in 2015
Figure 30
Figure 30
Spatial distribution of cefotaxime resistance among Salmonella spp. fattening pigs reporting MIC data in 2015
Figure 31
Figure 31
Trends in ampicillin, cefotaxime, ciprofloxacin nalidixic acid and tetracycline resistance in tested Salmonella spp. isolates from pigs in reporting MSs, 2009–2015, quantitative data
  1. A statistically significant trend for 5 or more years, as tested by a logistic regression model (p ≤ 0.05), was observed in the Italy (↓) for both ciprofloxacin and nalidixic acid, for ampicillin in the Netherlands(↑), for ciprofloxacin in Estonia(↑), for cefotaxime in Italy (↑), and for tetracycline in Italy (↓) and the Netherlands (↑).

Figure 32
Figure 32
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobials classes in Salmonella Derby from fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 33
Figure 33
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobials classes in monophasic Salmonella Typhimurium from fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 34
Figure 34
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobials classes in Salmonella Typhimurium from fattening pigs in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 35
Figure 35
Frequency distribution of completely susceptible isolates and resistant isolates to one to nine antimicrobials classes in Salmonella spp. from calves under one year of age in MSs in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Salmonella; sus: susceptible to all antimicrobial classes of the harmonised set for Salmonella; res1–res9: resistance to one up to nine antimicrobial classes of the harmonised set for Salmonella.

Figure 36
Figure 36
Spatial distribution of ciprofloxacin resistance among Salmonella spp. from calves under one year of age in countries reporting MIC data in 2015
Figure 37
Figure 37
Spatial distribution of cefotaxime resistance among Salmonella spp. from calves under one year of age in countries reporting MIC data in 2015
Figure 38
Figure 38
Tigecycline resistance in Salmonella spp. from fattening pigs, calves under one year of age and meat from these animals
Figure 39
Figure 39
Colistin resistance in Salmonella spp. from fattening pigs, calves under one year of age and meat from these animals
Figure 40
Figure 40
Comparison of clinical breakpoints (CBPs) and epidemiological cut‐off values (ECOFFs) used to interpret MIC data reported for Campylobacter spp. from humans, animals or food
Figure 41
Figure 41
Trends in ciprofloxacin, erythromycin and tetracycline resistance in Campylobacter coli from humans in reporting countries, 2013–2015
  1. Statistically significant increasing trends over 3 years, as tested by logistic regression (p ≤ 0.05), were observed for ciprofloxacin in Austria and Slovenia (↑). Statistically significant decreasing trends over 3 years were observed for erythromycin in France and Malta (↓). Only countries testing at least 10 isolates per year were included in the analysis.

Figure 42
Figure 42
Spatial distribution of ciprofloxacin resistance among Campylobacter coli from human cases in reporting countries in 2015
Figure 43
Figure 43
Spatial distribution of erythromycin resistance among Campylobacter coli from human cases in reporting countries in 2015
Figure 44
Figure 44
Frequency distribution of Campylobacter coli isolates from humans completely susceptible or resistant to one to four antimicrobial classes in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Campylobacter; sus: susceptible to all antimicrobial classes of the harmonised set for Campylobacter; res1‐res4: resistance to one up to four antimicrobial classes of the harmonised set for Campylobacter.

Figure 45
Figure 45
Trends in ciprofloxacin, erythromycin and tetracycline resistance in Campylobacter jejuni from humans in reporting countries, 2013–2015
  1. Statistically significant increasing trends over 3 years, as tested by logistic regression (p ≤ 0.05), were observed for ciprofloxacin in Austria, Estonia, France, the Netherlands and Slovakia (↑), for erythromycin in Slovakia (↑) and for tetracycline in Austria, Estonia, Italy, the Netherlands and Slovakia (↑). Statistically significant decreasing trends over 3 years were observed for erythromycin in Luxembourg and Malta (↓). Only countries testing at least 10 isolates per year were included in the analysis.

Figure 46
Figure 46
Spatial distribution of ciprofloxacin resistance among Campylobacter jejuni from human cases in reporting countries in 2015
Figure 47
Figure 47
Spatial distribution of erythromycin resistance among Campylobacter jejuni from human cases in reporting countries in 2015
Figure 48
Figure 48
Frequency distribution of Campylobacter jejuni isolates from humans completely susceptible or resistant to one to four antimicrobial classes in 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Campylobacter; sus: susceptible to all antimicrobial classes of the harmonised set for Campylobacter; res1‐res4: resistance to one up to four antimicrobial classes of the harmonised set for Campylobacter.

Figure 49
Figure 49
Spatial distribution of ciprofloxacin resistance in C. coli from fattening pigs in reporting countries in 2015, using harmonised ECOFFs
Figure 50
Figure 50
Spatial distribution of erythromycin resistance in Ccoli from fattening pigs in reporting countries in 2015, using harmonised ECOFFs
Figure 51
Figure 51
Distribution of MICs of erythromycin in C.‐coli from fattening pigs ‐ 1,005 isolates, 8 countries, 2015
Figure 52
Figure 52
Trends in ciprofloxacin (CIP), erythromycin (ERY), nalidixic acid (NAL), streptomycin (STR) and tetracycline (TET) resistance in Campylobacter coli from fattening pigs in reporting countries, 2009–2015, using harmonised ECOFFs
  1. Statistical significance of temporal trends over 5 or more years was assessed by using a logistic regression model (p ≤ 0.05).

  2. Statistically significant increasing trends were observed for ciprofloxacin in France (↑) and Switzerland (↑), and for streptomycin and tetracycline in Switzerland (↑).

  3. Statistically significant decreasing trends were observed for erythromycin and streptomycin in the Netherlands (↓).

Figure 53
Figure 53
Frequency distribution of C. coli isolates completely susceptible and resistant to one to four antimicrobials, in fattening pigs in the reporting countries, 2015, using harmonised ECOFFs
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Campylobacter; sus: susceptible to all antimicrobial classes of the harmonised set for Campylobacter; res1–res4: resistance to one up to four antimicrobial classes of the harmonised set for Campylobacter.

Figure 54
Figure 54
Distribution of MICs of tigecycline in indicator E. coli from fattening pigs and calves under one year of age, 2015
Figure 55
Figure 55
Spatial distribution of ciprofloxacin resistance among indicator E. coli from fattening pigs in reporting countries in 2015, using harmonised ECOFF
Figure 56
Figure 56
Spatial distribution of cefotaxime resistance among indicator E. coli from fattening pigs in reporting countries in 2015, using harmonised ECOFF
Figure 57
Figure 57
Trends in ampicillin (AMP), cefotaxime (CTX), ciprofloxacin (CIP), nalidixic acid (NAL) and tetracyclines (TET) resistance in indicator E. coli from fattening pigs in reporting countries, 2009–2015, using harmonised ECOFFs
  1. Statistically significance of trends over four/five or more years was tested by a logistic regression model (p ≤ 0.05). Statistically significant increasing trends were observed for ampicillin in Denmark (↑) and Spain (↑), as well as for ciprofloxacin in Poland (↑) and Spain (↑). Statistically significant decreasing trends were observed for ampicillin in Belgium (↓) and the Netherlands (↓), for tetracycline in Austria (↓), Belgium (↓), France (↓) and the Netherlands (↓), as well as for cefotaxime, ciprofloxacin and nalidixic acid in Belgium (↓) and the Netherlands (↓).

Figure 58
Figure 58
Frequency distribution of E. coli isolates completely susceptible and resistant to 1–11 classes of antimicrobials in fattening pigs in reporting countries, 2015, using harmonised ECOFFs
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Escherichia coli; sus: susceptible to all antimicrobial classes of the harmonised set for Escherichia coli; res1–res9: resistance to one up to eleven antimicrobial classes of the harmonised set for Escherichia coli.

Figure 59
Figure 59
Spatial distribution of full susceptibility to the panel of antimicrobials tested among indicator E. coli from fattening pigs in reporting countries, 2015, using harmonised ECOFFs
Figure 60
Figure 60
Spatial distribution of ciprofloxacin resistance among indicator E. coli from calves under one year of age in reporting countries in 2015, using harmonised ECOFF
Figure 61
Figure 61
Spatial distribution of cefotaxime resistance among indicator E. coli from calves under one year of age in reporting countries in 2015, using harmonised ECOFF
Figure 62
Figure 62
Trends in ampicillin (AMP), cefotaxime (CTX), ciprofloxacin (CIP), nalidixic acid (NAL) and tetracyclines (TET) resistance in indicator Escherichia coli from cattle in reporting countries, 2009–2015, using harmonised ECOFFs
  1. Statistically significant decreasing trends over four/five or more years, as tested by a logistic regression model (p ≤ 05), Statistically significant increasing trends over five or more years were observed for ampicillin and tetracycline in Austria (↑) and Denmark (↑), for ampicillin, ciprofloxacin, nalidixic acid and cefotaxime in Switzerland (↑) and for cefotaxime in Poland (↑). Statistically significant decreasing trends were observed for ampicillin, ciprofloxacin, cefotaxime, nalidixic acid and tetracycline in Belgium (↓) and the Netherlands (↓), and for ampicillin in Poland (↓).

Figure 63
Figure 63
Frequency distribution of E. coli isolates completely susceptible and resistant to 1–11 classes of antimicrobials in calves under one year of age in reporting countries, 2015
  1. N: total number of isolates tested for susceptibility against the whole harmonised set of antimicrobials for Escherichia coli; sus: susceptible to all antimicrobial classes of the harmonised set for Escherichia coli; res1‐res9: resistance to one up to eleven antimicrobial classes of the harmonised set for Escherichia coli.

Figure 64
Figure 64
Spatial distribution of full susceptibility to the mandatory panel of antimicrobials tested among indicator E. coli from calves under one year of age in reporting countries in 2015, using harmonised ECOFFs
Figure 65
Figure 65
Distribution of MICs of colistin in indicator E. coli from fattening pigs and calves under one year of age, 2015
Figure 66
Figure 66
Prevalence of presumptive ESBL‐ (a) and AmpC‐ (b) producing E. coli isolates from meat from pigs collected within the specific ESBL‐/AmpC‐/carbapenemase‐producing monitoring and subjected to supplementary testing or molecular typing confirmation in 2015
Figure 67
Figure 67
Prevalence of presumptive ESBL‐ (a)/AmpC‐ (b) producing E. coli isolates from meat from bovine animals collected within the specific ESBL‐/AmpC‐/carbapenemase‐producing monitoring and subjected to supplementary testing in 2015
Figure 68
Figure 68
Prevalence of presumptive ESBL‐ (a) and AmpC‐ (b) producing E. coli isolates from fattening pigs collected within the specific ESBL‐/AmpC‐/carbapenemase‐producing monitoring and subjected to supplementary testing in 2015
Figure 69
Figure 69
Prevalence of presumptive ESBL‐ (a) and AmpC‐ (b) producing E. coli isolates from calves of less than one year of age collected within the specific ESBL‐/AmpC‐/carbapenemase‐producing monitoring and subjected to supplementary testing or molecular typing confirmation in 2015

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