Since publishing the editorial note on antimicrobial resistance (Eurosurveillance 1997; 2(3): 21-2) we have received replies from Austria, Belgium, Greece, and Italy. Austria does not monitor antimicrobial resistance. The National Institute for Veterinary Research in Belgium studies salmonellas isolated from sick and healthy vector animals, animal foods, and some food for human consumption. The institute sent us a report which gives details of the evolution of the main serovars serotyped from 1992 to 1996 from poultry, pigs, and cattle, and data on antimicrobial resistance (1).

Greece monitors antimicrobial resistance in isolates from humans, and occasionally in isolates from livestock, food, and animals. A research programme to detect resistance genes, particularly against the Beta-lactam antibiotics, has been in operation for seven years organised by the Athens University and the National School of Public Health, (National Reference Centre for Salmonellae and Shigellae) (2). Human and animal strains of Salmonella enteritidis resistant to ampicillin were examined and found that 34 of 39 strains shared the same plasmid (3). Other research has demonstrated the transfer of epidemic R plasmid from S. enteritidis to Escherichia coli (4).

In Italy no single institution monitors resistance in humans, animals, in cattle and in food. Veterinarians in Italy routinely collect clinical isolates from livestock to be tested for screening, diagnostic, and therapeutic purposes. Tests for antimicrobial resistance are included. This is coordinated by the Veterinary Public Health Institute (Istituto Zooprofilattico) and the information is available only at the regional level; data are neither collected routinely nor collated nationally.

Several projects in Italy monitor aspects of antimicrobial resistance in humans for limited periods of time. A surveillance system to monitor multidrug resistant strains of Mycobacterium tuberculosis was set up in 1995, based on an existing network of infectious disease units (5), and coordinated by the infectious disease clinic of the University of Bari. Participating centres collect strains and supply information in a standard format. The Italian Surveillance Group for Antimicrobial Resistance, coordinated by the Institute of Microbiology of the University of Verona, links many important Italian hospital laboratories that take part voluntarily in the network, which has recently yielded interesting results (6).

Italy's Istituto Superiore di Sanità Laboratory of Microbiology monitors vancomycin resistance in Enterococcus spp. (VRE) strains of animal origin and is evaluating the relationship of vancomycin resistance with the use of avoparcin as an additive in animal feed and the possible role of animal resistant strains in human infections. The prevalence of VRE will be measured in the intestinal tract of animals and meats, mainly those eaten raw or poorly cooked. VRE strains from animals, meat, and the environment will be compared using molecular typing techniques with VRE isolated from humans.

References

1. Pohl P, Imberechts H, Stockmans A, Marin M. Serovars of Belgian Salmonella isolates during the years 1992, 1993, 1994, 1995 and 1996. Evolution among poultry, pigs and bovines 1983-1996. Antimicrobial resistance. National Institute for Veterinary Research. Belgium 1997.

2. Tassios PT, Markogiannakis A, Vatopoulos AC, Katsanikou E, Velonakis EN, et al. Molecular epidemiology of antibiotic resistance of Salmonella enteritidis during a 7-year period in Greece. J Clin Microbiol 1997; 35(6) (in press)

3. Tassios PT, Vatopoulos AC, Mainas E, Gennimata D, Papadakis J et al. Molecular analysis of ampicillin-resistant sporadic Salmonella typhi and Salmonella paratyphi clinical isolates. Clinical Microbiology and Infection (in press)

4. Balis E, Vatopoulos AC, Kanelopoulou M, Mainas E, Hatzoudis G, Kontogianni V et al. Indications of in vivo transfer of an epidemic R plasmid from Salmonella enteritidis to Escherichia coli of the normal human gut flora. J Clin Microbiol 1996; 34: 977-9.

5. Angarano G, Carbonara S, Costa D, Italian Tuberculosis Drug Resistance Study Group. Drug resistance of tuberculosis in HIV-infected Italian population. Microbiologica 1995; 18: 69-72.

6. Cornaglia G, Ligozzi M, Mazzariol A, Valentini M, Orefici G, Italian Surveillance Group for Antimicrobial Resistance, Fontana R. Rapid increase of resistance to erythromycin and clindamycin in Streptococcus pyogenes in Italy, 1993-1995. Emerging Infectious Diseases 1996; 2: 339-42.