food microbiology division, nifds, mfds soohwan suh · • educations on animal and aqua farms for...

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


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


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 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


• Public educations (TV shows)

• Public educations (leaflets)

• Collection and dispose of unused drugs


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%


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%


Resistan

ce ra

te (%

) 국내산(n=159) 수입산(n=48)

Domestic (n=136) Imported (n=32)



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%


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%


Resistan

ce ra

te (%

)국내산(n=17) 수입산(n=37)

Domestic vs. Imported (y2017)

S. aureus

Beef

Pork

Chicken




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.

food microbiology division, nifds, mfds soohwan suh · • educations on animal and aqua farms for...

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