Targeted interventions can significantly reduce the prevalence of antibiotic-resistant bacteria, according to 30 years of monitoring of antibiotic consumption and resistance through the DANMAP programme.
In 1995, Denmark became the first country in the world to establish integrated monitoring of antibiotic consumption and resistance across humans, animals and food.
In a world where antibiotic resistance remains a serious challenge, DANMAP surveillance provides an increasingly strong basis for identifying where action is needed.
DANMAP is a collaboration between the National Food Institute at DTU and Statens Serum Institut (SSI) and is celebrating its 30th anniversary this year.
They collect and compare data from humans, animals and food for three decades.
The anniversary also provides an opportunity to consider how monitoring should develop in the coming years. This includes integrating new data sources and strengthening the One Health approach, in which the health of humans, animals and the environment is considered as interconnected.
“We strive to become even better at collecting and understanding data across humans, animals and food. This will help us preserve antibiotics as an effective treatment for bacterial infections in animals and humans and, in turn, protect the health of both animals and the public,” says Sofia Ribeiro Duarte, Senior Researcher at the National Food Institute at DTU.
“At the same time, we will systematically monitor whether Denmark is moving in the right direction in relation to the targets set out in the national action plans on antibiotic resistance published in recent years.”
In addition to strengthening the One Health approach, data need to be interpreted more systematically across different sources.
“We have built up a 30-year record that becomes more valuable over time. Since 2018, we have been working to link health data with genetic analyses to enable faster detection and monitoring of outbreaks. We will continue to develop this work, but we also want to develop systems that link antibiotic consumption with resistance data, both within and across sectors,” says Ute Wolff Sönksen, Senior Physician at Statens Serum Institut.
Part of this work involves making findings and data more accessible and easier to understand. DANMAP Explorer already provides digital access to more than 25 years of historical resistance data from animals and food. The ambition is to make data even more accessible in the future, so that changes can be detected earlier and information from different areas can be more easily considered in context.
A current example of how data can be used across sectors can be found in hospitals.
Researchers are monitoring, among other things, CPO bacteria. These bacteria produce enzymes that can make them resistant to carbapenems, antibiotics that are used, among other things, to treat serious infections in humans.
In 2024, 166 new patients were linked to CPO outbreaks in Denmark. Using whole-genome sequencing — a detailed analysis of the bacteria’s genetic material — researchers can compare bacteria from different patients and hospitals. Cases that initially appear to be unrelated may turn out to be part of the same outbreak.
“DANMAP is an important part of Denmark’s preparedness against antibiotic resistance. As the healthcare system and routes of infection or food production change, surveillance must evolve with the risks. The next major resistance challenge may well look different from the one that led to the establishment of DANMAP,” says Ute Wolff Sönksen.
Monitoring of CPO therefore also continues in the animal and food sectors, as CPO bacteria have been detected in food abroad in recent years.
“When we find resistant bacteria in humans, one important question is whether they can be linked to livestock, meat sold in supermarkets or completely different sources. By comparing data from humans, animals and food, we can get closer to the answer and, consequently, identify where interventions are most effective,” says Sofia Ribeiro Duarte of the National Food Institute at DTU.
Since 2014, DANMAP has systematically investigated whether CPO bacteria are present in animals and food in Denmark. So far, they have not been detected.
A concrete example of the value of DANMAP can be found in Danish chicken production.
In 2011, cephalosporin-resistant E. coli bacteria were detected in 44% of samples of Danish chicken meat, even though cephalosporins had not been used in Danish broiler production for at least ten years.
Studies indicated, among other things, that the bacteria may have entered Denmark through imported breeding animals. After the use of the antibiotics in question was stopped further up the international breeding chain, the incidence fell significantly. In 2024, E. coli bacteria with similar resistance characteristics were found in only 2% of samples of Danish chicken meat.
