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Antimicrobial Agents and Chemotherapy, November 1998, p. 3049-3049, Vol. 42, No. 11
0066-4804/98/$00.00+0
LETTERS TO THE EDITOR
Historical Yearly Usage of Glycopeptides for Animals and
Humans: The American-European Paradox Revisited
 |
LETTER |
Kirst et al. (5) in their letter on clinical use of
vancomycin in the United States and major European countries state that
"although it is well recognized that vancomycin resistance is more
prevalent in the United States than in Europe, it has not been
explained why avoparcin usage fails to correlate with the different
epidemiologies of resistance between the two continents; avoparcin was
never approved for use in animals in the United States, in contrast to
its broad use as a growth-promoting agent in Europe."
I do not agree that vancomycin resistance is more prevalent in the
United States than in Europe. In Europe, vancomycin-resistant Enterococcus faecium (VRE) is highly prevalent in the
community (livestock, food, and humans) (8). In contrast, a
zero prevalence has been found in healthy humans and in livestock in
the United States (3, 7).
The frequent occurrence of VRE in the community correlates well with
the use of large amounts of the glycopeptide avoparcin as a
growth-promoting agent in livestock in Europe. A direct relationship between avoparcin usage and occurrence of VRE in livestock has been
shown (1, 2). In Denmark, with a population of 5.2 million
inhabitants, 24 kg of active vancomycin was used for humans in
1994. In comparison, 24,000 kg of active avoparcin was used for swine
and broilers the same year. Thus, the amounts of active avoparcin used
for livestock in Denmark in 1994 exceeded the
total clinical use of vancomycin in the United States and in Europe in
1994 (Table 1)! Data on total use of avoparcin in Europe is unfortunately not available.
Avoparcin was never approved for animals in the United States due to
its carcinogenic effect (6). This correlates well with the
absence of VRE in healthy humans and livestock in the United States.
The incidence of human infections with VRE is higher in the United
States relative to Europe. This correlates with a high usage of
vancomycin in hospitals in the United States and a lower usage in
Europe (5).
The most likely sources of VRE in European hospitals are
community sources (6, 8). The primary sources of VRE
in hospitals in the United States are not known. I propose that likely
sources of VRE in the United States are travel, tourists, and imported food. With a high consumption of vancomycin in hospitals, even rare
introductions of VRE may lead to a high incidence of infection because
of the extreme tenacity of this organism and its capability of causing
nosocomial outbreaks (4, 6).
Considering the huge community reservoir, the incidence of VRE
infection in Europe would probably surpass that in the United States
were the use vancomycin to reach similar levels. Using last-resort
antibiotics as growth promoters appears to present an unacceptable
public health risk.
We need data on antibiotic consumption to understand the epidemiology
of antibiotic-resistant bacteria. I therefore welcome the initiative of
Kirst et al. (5). To my mind, monitoring of antibiotic
resistance in bacteria and consumption of antibiotics must go hand in hand.
| |
FOOTNOTES |
Ed. Note: The authors of the original letter did not
feel that a response was necessary.
| |
REFERENCES |
| 1.
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McDonald, C. L.,
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Vancomycin-resistant enterococci outside the health care setting: prevalence, sources and public health implications.
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Welton, L. A.,
L. A. Thal,
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S. Donabedien,
J. McMahon,
J. W. Chow, and M. J. Zervos.
1998.
Antimicrobial resistance in enterococci isolated from turkey flocks fed virginiamycin.
Antimicrob. Agents Chemother.
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Witte, W.
1998.
Medical consequences of antibiotic use in agriculture.
Science
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|
| | | | |
Henrik Caspar Wegener
Danish Zoonosis Centre
Danish Veterinary Laboratory
Bülowsvej 27
DK-1790 Copenhagen V
Denmark
|
Antimicrobial Agents and Chemotherapy, November 1998, p. 3049-3049, Vol. 42, No. 11
0066-4804/98/$00.00+0
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