The National Reference Laboratory for Antimicrobial Resistance

The National Reference Laboratory for Antimicrobial Resistance is responsible for typing, resistance determination and advice on a range of resistant bacteria. The laboratory receives vancomycin and linezolid resistant enterococci (VRE and LRE), extended spectrum beta lactamase and carbapenemase producing organisms (ESBL and CPO), methicillin resistant Staphylococcus aureus (MRSA) as well as S. aureus bacteremia (SAB) isolates from the Departments of Clinical Microbiology (DCMs) for national surveillance, outbreak investigations and research.

Surveillance includes species identification, typing and characterization of the bacterial isolates. The laboratory takes an active part in infection detection with typing, epidemiological investigation and counseling.

Results of the surveillance are included in the advice of the national health authorities and in the European monitoring of MRSA, VRE, ESBL and CPO under the European Center for Disease Prevention and Control (ECDC). Since 2018, the laboratory has also monitored MRSA in domestic animals for the Danish Veterinary and Food Administration as well as ESBL-producing K. pneumoniae from blood infections.

The laboratory receives approx. 7,500 isolates per year for monitoring, where all VRE, LRE, ESBL-producing E. coli and CPO and approx. 1,000 MRSA isolates are whole genome sequenced.

The laboratory has a large collection of more than 100,000 characterized isolates. This collection dates back to 1957 and is an internationally unique resource for research.

Surveillance of the human consumption of antibiotics and the occurrence of antibiotic resistance is another important task carried out by the reference laboratory. The surveillance of antibiotic consumption in the primary sector (general practitioners, specialist doctors and dentists) is based on register data from e.g. the drug register and pharmacists' sales, while hospital consumption is compared to data on the number of patient admissions and their duration from The Danish National Patient Register (NPR). Monitoring of antibiotic resistance in humans is based on data reported to SSI from the country's clinical microbiology departments and data obtained at SSI reference laboratories.

Data from the National Reference Laboratory for Antimicrobial Resistance are collected and disseminated in the annual report DANMAP, in the “Annual reports on Staphylococcus aureus Bacteremia cases in Denmark”, and continually as individual test results to the DCMs and aggregated data available via “Overvågning i tal, grafer og kort” (SSI Danish homepage).