EARS-Net data on antimicrobial
resistance in Ireland
Quarter 4 2016
20th June 2017
KEY POINTS, 2016 (General)
Escherichia coli
• The numbers of invasive E. coli infections have increased since 2004
• The proportion of ESBL-positive E. coli increased in 2016*
Staphylococcus aureus/ MRSA
• The number and proportion of MRSA bloodstream infections have decreased since 2006;
however, in contrast to this, the rate of MSSA BSIs is increasing
Klebsiella pneumoniae
• The numbers of invasive K. pneumoniae infections have increased over the last year
• The proportion of invasive multi-drug resistant K. pneumoniae (MDRKP; defined as ESBLpositivity and resistance to fluoroquinolones and aminoglycosides) infections decreased
in 2016*
• Carbapenem-resistance, particularly as a result of carbapenemase production, among
K. pneumoniae decreased in 2016*, but remains an important public health concern
Enterococcus faecium/ VREfm (vancomycin-resistant E. faecium)
• Ireland has had the highest proportion of VREfm in Europe since 2008
Pseudomonas aeruginosa
• The numbers of invasive P. aeruginosa infections have increased over the last year
• The proportion of multi-drug resistant P. aeruginosa has increased in 2016*
* 2016 data provisional to the end of Q4 only
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
KEY POINTS, 2016* (1)
Escherichia coli
• The numbers of invasive E. coli infections have increased since 2004
• The proportion of patients with invasive infections caused by E. coli producing extendedspectrum beta-lactamases (ESBLs) increased to 11.1%, the highest proportion to date
• The proportion of invasive infections caused by multi-drug resistant (MDR) E. coli
(displaying resistance to three or more antimicrobial classes) decreased slightly to 14.3%
Staphylococcus aureus/ MRSA
• The proportion of S. aureus bloodstream infections (BSIs) that were meticillin-resistant
(MRSA) decreased to14.7%, the lowest proportion to date
• In contrast to this, the rate of meticillin-susceptible S. aureus (MSSA) BSIs is increasing
*2016 data provisional to the end of Q4 only
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
KEY POINTS, 2016* (2)
Klebsiella pneumoniae
• The numbers of invasive K. pneumoniae infections increased by 17% on 2015
• The proportion of patients with invasive infections caused by multi-drug resistant
K. pneumoniae (MDRKP) decreased to 7.4%
• The proportion of patients with invasive infections caused by carbapenem-resistant
K. pneumoniae isolates decreased to 1.2%, but the overall trend has been increasing
and the emergence of carbapenemase-producing strains of K. pneumoniae in recent years
is worrying
Enterococcus faecium/ VREfm (vancomycin-resistant E. faecium)
• Since 2012, the proportion of E. faecium BSI that are vancomycin-resistant (i.e. VREfm)
has been over 40%
• Ireland has had the highest proportion of VREfm in Europe since 2008
Pseudomonas aeruginosa
• The numbers of invasive P. aeruginosa infections increased by 25% on 2015
• The proportion of patients with invasive infections caused by multi-drug resistant
P. aeruginosa increased to 13.2%, the highest proportion to date
*2016 data provisional to the end of Q4 only
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
EARS-Net case definition
EARS-Net collects antimicrobial resistance data on the first invasive
isolate (specimen types indicated below) per patient per quarter for
eight key pathogens (arranged in order of frequency reported):
•
Escherichia coli (blood or CSF)
•
Staphylococcus aureus (blood only)
•
Enterococcus faecium (blood only)
•
Klebsiella pneumoniae (blood or CSF)
•
Streptococcus pneumoniae (blood or CSF)
•
Enterococcus faecalis (blood only)
•
Pseudomonas aeruginosa (blood or CSF)
•
Acinetobacter spp. (blood or CSF)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Data collected by EARS-Net
• Routinely-generated data from laboratories on key antibiotics for eight
pathogens under surveillance
– Qualitative, i.e. RIS data (interpretations only)
– Quantitative, i.e. MIC/Etest results in mg/l*
*especially important for pneumococci
• Reference laboratory data
– Serotypes on pneumococci
– Confirmation on K. pneumoniae/E. coli isolates that are
carbapenemase-producing CRE
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Data Management
• Nationally
o Data stored in WHONET format (a freeware from WHO, which is
versatile for collecting, storing and analysing AMR data) and in an
Access database at HPSC
• Locally
o WHONET files*
o LIMS files*, that can be translated to WHONET via BacLink software
o Excel template*
o Isolate Record Forms
*all electronic files should be encrypted before being sent to HPSC by email
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Participation in EARS-Net
Between 2007 and 2014, all laboratories (n=39) and acute hospitals (n=58)
participated in EARS-Net resulting in 100% coverage of the Irish population
In 2015 and 2016, a number of laboratories suspended their participation due to
resource issues:
• Midland Regional Hospital Portlaoise between Q2 and Q3 2015 and from Q3
2016 onwards
• Cavan General Hospital from Q4 2016 onwards
• Midland Regional Hospital Tullamore between Q2 and Q3 2015
• Letterkenny General Hospital between Q3 and Q4 2015
The overall population coverage by EARS-Net was estimated to be ~97% in
2015 and ~99% in Q1-4 2016
Note: estimated population coverage by EARS-Net in other EU/EEA
countries varies considerably from <20% to 100%
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Data Management
EUCAST vs CLSI (situation as of Q1 2016)
• 34 labs have now adopted EUCAST guidelines = 93% of all isolates
• 5 labs still using CLSI
Data collection (in Q1 2016)
• WHONET – 22 labs – representing 86% of data
• LIMS file – 2 labs – 5% of data
• Excel – 3 labs – 4% of data
• Paper forms – 11 labs – 5% of data
• No data – 2 labs
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Escherichia coli
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Escherichia coli invasive infections
Time period Total E. coli %AMP-R %3GC-R %ESBL+ve %FQ-R %GEN-R
%AG-R
%MDR
2010
2170
68.4%
8.0%
6.1%
23.6%
9.4%
11.9%
11.8%
2011
2210
71.9%
9.1%
7.5%
23.8%
8.7%
12.4%
13.2%
2012
2450
69.6%
10.3%
8.8%
25.2%
9.7%
12.8%
13.6%
2013
2530
70.9%
12.3%
10.5%
25.3%
9.8%
12.9%
14.6%
2014
2015†
2771
69.9%
12.0%
10.2%
26.2%
11.2%
14.5%
15.0%
Extrapolated:
2697 2796 66.7%
12.5%
10.6%
24.4%
11.0%
14.5%
14.5%
2016†
3057
12.3%
11.1%
24.1%
10.2%
13.2%
14.3%
3108
68.4%
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using data for
the same time period in the previous year
AMP, Ampicillin; 3GC, 3rd-generation cephalosporins; FQ, fluoroquinolones; GEN, gentamicin; AG, aminoglycosides; MDR, multi-drug resistance
Key messages:
• The numbers of invasive E. coli infections have increased since 2004
• ESBL-positive E. coli increased to 11.1% in 2016, which is the highest proportion
(%) to date
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
3500
30%
3000
25%
2500
20%
2000
15%
1500
%Resistance
Number of isolates
Trends in E. coli invasive infections showing percentage resistance to
fluoroquinolones, aminoglycosides and 3rd-generation cephalosporins
10%
1000
500
5%
0
0%
Year
Total E. coli
%FQREC
%GEN-R
%GEN/TOB/AMK-R
%3GC-R
† 2015 and 2016 incomplete data from 3 and 2 laboratories, respectively
FQREC, fluoroquinolone (e.g. ciprofloxacin)-resistant E. coli; GEN, gentamicin, TOB, tobramycin; AMK, amikacin (GEN, TOB and AMK are aminoglycosides);
3GC, 3rd-generation cephalosporins (e.g. cefotaxime, ceftazidime)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
3500
16%
3000
14%
12%
2500
10%
2000
8%
1500
6%
1000
4%
500
2%
0
0%
Total E. coli
Year
%3GC-R
%ESBL+ve
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
3GC, 3rd-generation cephalosporins (e.g. cefotaxime, ceftazidime); ESBL, extended-spectrum beta-lactamase
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
%3GC-R/ESBL+ve
Number of isolates
Trends in E. coli invasive infections showing percentage 3GC-resistance
and ESBL-positivity
Distribution of 3rd-generation cephalosporin resistant E. coli
in EARS-Net countries in 2014
IE rank (2014; 11.6%):
13th of 29 countries
Median = 11.3%
Trends
12 countries
1 country
Map downloaded from ECDC’s TESSy database on 21/10/2015:
http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in E. coli invasive infections with percentage
multi-drug resistance
3500
18%
16%
3000
2500
12%
2000
10%
1500
8%
%MDR ECO
Number of isolates
14%
6%
1000
4%
500
2%
0
0%
Total E. coli tested for MDR
Year
MDR ECO
%MDR
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
MDR, multidrug resistance (defined as resistance to 3 or more classes of antibiotics OR a confirmed carbapenemase producer)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Carbapenase-producing carbapenem-resistant
enterobacteriaceae (CRE)
Total E. coli
Time period Total E. coli tested for CBP
CBP-S
ECO
CBP-R
ECO
%CBP-R
ECO
Carbapenemases detected
2011
2210
2190
2190
0
0.0%
None
2012
2450
2433
2431
2
0.1%
Not CPE
2013
2530
2524
2522
2
0.1%
Not CPE
2014
2015†
2771 Extrapolated:
2770
2768
2
0.1%
1x NDM; 1x Not CPE
2697
2796
2678
2672
6
0.2%
1x NDM; 1x OXA-48; 4x Not CPE
2016†
3057
3108
3047
3042
5
0.2%
1x NDM; 4x Not CPE
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using data
for the same time period in the previous year
CBP, carbapenem; CPE, carbapenemase-producing enterobacteriaceae
Key message:
4 confirmed carbapenemase-producing E. coli isolates from invasive infections reported
to date: three NDM (one each in 2014, 2015 and 2016) and one OXA-48 (in 2015)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Staphylococcus aureus
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Staphylococcus aureus bloodstream infections
Year Total S. aureus
MSSA
MRSA %MRSA
2010
1251
946
305
24.4%
2011
1095
832
263
24.0%
2012
1060
818
242
22.8%
2013
1094
872
222
20.3%
2014
2015†
1117
900
217
19.4%
Extrapolated:
1082 1117
883
199
18.4%
2016†
1168
996
172
14.7%
1183
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using data for the
same time period in the previous year
Key messages:
• The proportion of S. aureus bloodstream infections that was meticillin-resistant (i.e.
MRSA) decreased to 14.7% in 2016, the lowest proportion to date
• The numbers and proportion of MRSA bloodstream infections have been decreasing
since 2006
• The numbers of MSSA bloodstream infections have been increasing since 2012
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in S. aureus bloodstream infections showing %MRSA
1600
50%
1400
45%
40%
35%
1000
30%
800
25%
600
20%
%MRSA
Number of isolates
1200
15%
400
10%
200
5%
0
0%
Year
Total S. aureus
MRSA
%MRSA
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Distribution of MRSA in EARS-Net countries in 2014
IE rank: 12/29 (19.4%)
Median = 13.1%
Map downloaded from ECDC’s TESSy database on 21/10/2015:
http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
2014 trends
2 countries
8 countries
Distribution of MRSA in EARS-Net countries in 2014
Romania
Portugal
Malta
Greece
Cyprus
Italy
Slovakia
Hungary
Spain
Croatia
Bulgaria
Ireland
France
Belgium
Slovenia
Czech Republic
Luxembourg
Germany
United Kingdom
Latvia
Lithuania
Austria
Iceland
Estonia
Finland
Denmark
Sweden
Norway
Netherlands
0%
10%
20%
30%
40%
50%
60%
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in S. aureus bloodstream infections (rates)
Bed Days
Used
MRSA
(BDU)
rate*
1600
MSSA
rate*
0.30
1400
1323
553
770
41.8%
3,722,601
0.147
0.199
1424
592
832
41.6%
3,808,937
0.152
0.208
1412
592
820
41.9%
3,908,502
0.148
0.206
1393
536
857
38.5%
3,922,083
0.135
0.213
1303
439
864
33.7%
3,896,689
0.110
0.216
1309
355
954
27.1%
3,945,656
0.089
0.237
1251
305
946
24.4%
3,909,425
0.078
0.238
1095
263
832
24.0%
3,931,241
0.066
0.208
1060
242
818
22.8%
3,871,187
0.060
0.213
1094
222
872
20.3%
3,903,494
0.056
0.219
200
1117
217
900
19.4%
3,875,933
0.055
0.227
0
1082
199
883
18.4%
3,856,140
0.050
0.223
1168
172
996
14.7%
3,945,878
0.043
0.245
0.25
1200
0.20
1000
800
0.15
600
0.10
400
0.05
Rate per 1,000 bed days used
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015†
2016†
MRSA MSSA
N
N
%MRSA
Number of isolates
Year
SAU
N
0.00
* Rate per 1,000 bed days used;
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs)
Year
MRSA
MSSA
MRSA rate
MSSA rate
Key message: In 2016, the %MRSA and MRSA rate were the lowest, while the MSSA
rate was the highest reported to date
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
For S. aureus/MRSA data by acute hospital in Ireland, please click
here
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Klebsiella pneumoniae
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Klebsiella pneumoniae invasive infections
Time period Total KPN
%3GC-R
%ESBL+ve %FQ-R %GEN-R
%AG-R
%CRKP
%MDRKP
2010
326
10.2%
5.1%
10.5%
6.8%
7.1%
0.0%
2.2%
2011
312
8.0%
5.6%
13.2%
7.4%
8.3%
1.9%
4.6%
2012
345
11.9%
8.8%
11.9%
9.6%
9.9%
0.3%
5.3%
2013
326
21.2%
18.4%
20.9%
16.9%
17.8%
1.2%
12.3%
2014
2015†
358Extrapolated:13.1%
11.0%
17.3%
12.6%
13.2%
1.1%
8.2%
401
404
17.5%
13.3%
21.6%
17.0%
18.0%
2.2%
9.8%
2016†
469
476
16.8%
12.9%
16.6%
11.5%
12.6%
1.1%
7.1%
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using data for the
same time period in the previous year
Key messages:
• The highest number of invasive K. pneumoniae infections were reported in 2016, an
increase of 17% on 2015
• ESBL-positivity and resistance to fluoroquinolones and aminoglycosides increased
dramatically between 2012 and 2013 corresponding with the rise of multi-drug
resistant K. pneumoniae (MDRKP): the proportion of MDRKP among invasive
K. pneumoniae infections decreased to 7.1% in 2016*
• Carbapenem-resistance among K. pneumoniae, particularly as a result of
carbapenemase production (see later slide), has emerged
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in K. pneumoniae invasive infections showing percentage resistance
to fluoroquinolones, aminoglycosides and 3rd-generation cephalosporins
500
30%
450
Number of isolates
350
20%
300
250
15%
200
%Resistance
25%
400
10%
150
100
5%
50
0
0%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015† 2016†
Total KPN
%3GC-R
Year
%CIP/OFX-R
%GEN/TOB/AMK-R
%GEN-R
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
3GC, 3rd-generation cephalosporins (e.g. cefotaxime, ceftazidime); CIP, ciprofloxacin; OFX, ofloxacin (CIP and OFX are fluoroquinolones); GEN, gentamicin,
TOB, tobramycin; AMK, amikacin (GEN, TOB and AMK are aminoglycosides)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in K. pneumoniae invasive infections with
percentage 3GC-resistance and ESBL-positivity
30%
500
450
Number of isolates
350
20%
300
15%
250
200
10%
150
100
%3GC-R/ESBL+ve
25%
400
5%
50
0%
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015† 2016†
Year
Total KPN
%3GC-R
%ESBL+ve
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Distribution of 3rd-generation cephalosporin resistant
K. pneumoniae in EARS-Net countries in 2014
IE rank: 21/29 (13.0%)
Median = 30.7%
2014 trends
11 countries
5 countries
Map downloaded from ECDC’s TESSy database on 21/10/2015:
http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Carbapenemase-producing K. pneumoniae
Total K. pneumoniae
Time period
tested for CBP
CBP-R KPN
%CBP-R
Carbapenemases detected
2010
308
0
0.0%
None
2011
310
6
1.9%
3x OXA-48; 1x KPC; 1x not CPE
2012
345
1
0.3%
None
2013
326
4
1.2%
2x OXA-48; 2x not CPE
2014
358
4
1.1%
1x OXA-48; 1x KPC; 2x not CPE
2015
401
9
2.2%
6x OXA-48; 1x KPC; 2x not CPE
2016*
467
5
1.1%
3x KPC; 1x OXA-48; 1x not CPE
Extrapolated:
404
476
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using data for
the same time period in the previous year
CBP, carbapenem; CPE, carbapenemase-producing enterobacteriaceae
Key messages:
• In 2016*, the number and proportion of carbapenem-resistant K. pneumoniae
decreased but remains an important public health concern
• In 2016*, there were 4 confirmed carbapenemase-producing K. pneumoniae from
invasive infections compared to 7 in 2015 and just 2 each in 2014 and 2013
• Of 19 confirmed carbapenemases to date, 13 were OXA-48 and 6 were KPC
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in carbapenemase-producing K. pneumoniae
500
4%
450
3%
350
300
250
2%
200
150
%CBP-R
Number of isolates
400
1%
100
50
0
0%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015† 2016†
Year
Total K. pneumoniae tested for CBP
CBP-R KPN
%CBP-R
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively;
CBP, carbapenem
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Distribution of carbapenem-resistant K. pneumoniae in
EARS-Net countries in 2014
IE rank: 23/28 (0.6%)
Median = 1.3%
Map downloaded from ECDC’s TESSy database on 21/10/2015:
http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
2014 trends
7 countries
1 country
500
18%
450
16%
400
14%
350
12%
300
10%
250
8%
200
%MDRKP
Number of isolates
Trends in K. pneumoniae invasive infections with
percentage multi-drug resistance (MDRKP)
6%
150
100
4%
50
2%
0
0%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015† 2016†
Year
Total KPN tested for MDRKP
MDRKP
%MDRKP
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
MDRKP, multi-drug resistance K. pneumoniae (defined as simultaneously ESBL-positive and non-susceptible to ciprofloxacin and gentamicin AND/OR a
confirmed carbapenemase producer)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Distribution of multi-drug resistant (MDR) K. pneumoniae in
EARS-Net countries in 2014
2008 data
downloaded from
TESSy, 31/03/2016
IE rank: 20/29 (7.3%)
Median = 16.7%
Note: MDR defined here as
combined resistance to
3GCs, fluoroquinolones
and aminoglycosides
Map downloaded from ECDC’s TESSy database on 21/10/2015:
http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
2014 trends
6 countries
3 countries
Enterococcus faecium
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Enterococcus faecium bloodstream infections
Total E. faecium
Time period Total E. faecium tested for VAN
VSEfm
VREfm %VREfm
2010
392
392
238
154
39.3%
2011
364
364
228
136
37.4%
2012
392
392
214
178
45.4%
2013
409
408
232
176
43.1%
2014
2015†
405
405
219
186
45.9%
421
Extrapolated:
426
419
228
191
45.6%
2016†
431
437
430
239
191
44.4%
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using
data for the same time period in the previous year
Key messages:
• Since 2012, the proportion of VREfm bloodstream infections has been over 40%
• Ireland has the highest proportion of VREfm in Europe
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in E. faecium bloodstream infections showing %VRE
500
60%
450
50%
350
40%
300
250
30%
200
20%
150
100
10%
50
0
0%
VREfm
Year
VSEfm
%VREfm
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
VRE, vancomycin-resistant enterococcus; VREfm, vancomycin-resistant E. faecium; VSEfm, vancomycin-susceptible E. faecium
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
%VREfm
Number of isolates
400
Distribution of vancomycin-resistant E. faecium (VREfm) in
EARS-Net countries in 2014
IE rank: 1/29 (45.1%)
Median = 4.5%
2014 trends
8 countries
3 countries
Map downloaded from ECDC’s TESSy database on 21/10/2015:
http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Pseudomonas aeruginosa
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
P. aeruginosa invasive infections
Time period Total PAE %PIP/TZP-R %CAZ-R %IMP/MEM-R %FQ-R %GEN-R %AG-R
%MDR
2010
221
10.0%
9.2%
8.3%
13.2%
8.7%
8.6%
6.5%
2011
184
2.8%
8.2%
12.0%
12.6%
6.5%
6.5%
4.0%
2012
219
17.4%
15.2%
19.4%
20.6%
11.9%
11.9%
13.0%
2013
207
15.7%
10.7%
13.1%
15.0%
11.6%
11.6%
9.4%
8.9%
11.6%
13.7%
4.9%
5.5%
6.7%
2014
2015†
182Extrapolated: 16.5%
201
207
14.0%
8.5%
16.4%
13.5%
3.5%
7.0%
7.5%
2016†
250
251
17.2%
13.2%
13.2%
16.4%
11.2%
12.4%
13.2%
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using data for the
same time period in the previous year
Key message:
• In 2016, the numbers of P. aeruginosa infections increased by 25%
• Resistance to piperacillin/tazobactam, ceftazidime, fluoroquinolones and
aminoglycosides increased, while carbapenem (e.g. meropenem) resistance
decreased
• MDR P. aeruginosa increased
MDR, Multi-drug resistant (defined as resistance to three or more of the 5 required antibiotics/antibiotic classes: piperacillintazobactam; ceftazidime; carbapenems; fluoroquinolones; aminoglycosides)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
30%
300
35%
250
25%
250
30%
200
20%
150
15%
20%
150
15%
100
100
10%
50
5%
50
0%
0
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015† 2016†
25%
200
10%
5%
0%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015† 2016†
Year
Total PAE
%PIP/TZP-R
Year
%CAZ-R
%IPM/MEM-R
Total PAE
%GEN/TOB/AMK-R
%CIP/OFX-R
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
PIP, piperacillin; TZP, piperacillin/tazobactam; CAZ, ceftazidime; IPM, imipenem; MEM, meropenem (IPM and MEM are carbapenems); CIP, ciprofloxacin;
OFX, ofloxacin (CIP and OFX are fluoroquinolones); GEN, gentamicin; TOB, tobramycin and AMK, amikacin (GEN, TOB and AMK are aminoglycosides)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
%Resistance
Number of isolates
300
%Resistance
Number of isolates
Trends in P. aeruginosa invasive infections showing percentage resistance to
mandatory antibiotics/antibiotic classes (according to EARS-Net protocol)
Trends in P. aeruginosa invasive infections with
percentage multi-drug resistance (MDR)
300
20%
18%
16%
14%
200
12%
150
10%
8%
100
%MDR
Number of isolates
250
6%
4%
50
2%
0
0%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015† 2016†
Year
Total P. aeruginosa tested for MDR
MDR
%MDR
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
MDR, multi-drug resistance defined as resistance to three or more of the 5 required antibiotics/antibiotic classes (piperacillin-tazobactam; ceftazidime;
carbapenems; fluoroquinolones; aminoglycosides)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Streptococcus pneumoniae
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Streptococcus pneumoniae invasive infections
Time period Total S. pneumoniae
PSSP
PNSP
I
R
NS ND %PNSP
2010
314
256
57
40
15
2
1
18.2%
2011
327
262
64
44
20
0
1
19.6%
2012
321
258
63
48
15
0
0
19.6%
2013
311
245
64
56
8
0
2
20.7%
2014
2015†
331
272
56
48
8
0
3
17.1%
249
53
52
1
0
2
17.5%
2016†
365
304
60
60
0
0
1
16.5%
304
Extrapolated:
313
365
† Incomplete reporting for 2015 (from 3 labs) and 2016 (from 2 labs): extrapolated figures in 2015 and 2016 account for missing data using data for
the missing labs from same time period in the previous year
PSSP, penicillin-susceptible S. pneumoniae; PNSP, penicillin-non-susceptible S. pneumoniae; I, intermediate-level resistance; R, high-level
resistance; NS, non-susceptible; ND, not determined
Key messages:
• Numbers of cases increased by 20% to the highest level since 2008 when PCV7
was introduced to the vaccination schedule
• The proportion of invasive infections due to PNSP decreased to 16.5% in 2016
• The numbers that are HLR decreased since 2011
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Trends in S. pneumoniae bloodstream infections showing %PNSP
PCV7 introduced Sept ‘08
500
PCV13 introduced Dec ‘10
30%
450
25%
350
20%
300
250
15%
200
10%
150
100
5%
50
0
0%
Year
Total S. pneumoniae
PNSP
%I
%HLR
%PNSP
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
PNSP, penicillin-non-susceptible S. pneumoniae; I, intermediate; HLR, high-level resistant
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
%PNSP
Number of isolates
400
Distribution of penicillin-non-susceptible S. pneumoniae
(PNSP) in EARS-Net countries in 2014
IE rank: 8/28 (17.7%)
Median = 8.9%
CAUTION: Different
interpretive criteria
mean some countries
on this map might not
be comparable (see
next slide – in particular
differences between
scenarios A and B/C)
Map downloaded from ECDC’s TESSy database on 21/10/2015:
http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx
Effect of different interpretive criteria to categorise penicillin
susceptibility results in pneumococci
Penicillin MIC distribution:
Penicillin MIC distribution:
Latest CLSI non-meningitis breakpoints
25
25
Number of isolates
S, ≤2mg/L; I, 4mg/L; R, ≥8mg/L
15
10
Latest CLSI meningitis breakpoints (same as
EUCAST meningitis bps)
S, ≤0.06mg/L; R, ≥0.12mg/L
15
10
25
C
ND*
.004
.006
<=.008
.008
.012
.016
.023
<=.031
.032
.047
<=.06
.064
.094
.125
.19
.25
.38
.5
.75
1
1.5
2
3
4
6
6
4
3
2
1
1.5
.5
.38
.75
Penicillin MIC distribution:
Latest CLSI oral (=old) breakpoints
(similar to EUCAST non-meningitis bps)
ND
20
Number of isolates
Our current
strategy (in
line with most
European
countries)
.25
.19
.125
.094
.064
.032
<=.06
Penicillin MIC (mg/L)
I
R
S
Penicillin MIC (mg/L)
R
CLSI: S, ≤0.06mg/L; I, 0.12-1mg/L; R, ≥2mg/L
(EUCAST: S, ≤0.06mg/L; I, 0.12-2mg/L; R, ≥4mg/L)
15
10
5
0
ND*
.004
.006
<=.008
.008
.012
.016
.023
<=.031
.032
.047
<=.06
.064
.094
.125
.19
.25
.38
.5
.75
1
1.5
2
3
4
6
S
.023
.016
.012
.008
0
.006
0
<=.008
5
ND*
5
.004
Number of isolates
B
20
20
<=.031
A
S
Penicillin MIC (mg/L)
I
R
ND
ND
Pneumococcal serotypes, Q1-4 2016
• 93% (341/365) pneumococcal isolates were serotyped
• From patients aged ≥65 years (the target population for the PPV23 vaccine),
71% of isolates (131 of 184) were serotypes that are included in the PPV23
vaccine
• From patients aged <2 years (the target population for the PCV13 vaccine),
three (of 20 isolates) were serotypes covered by the vaccine and 17 were
non-vaccine serotypes
• The most common serotypes identified were 8† and 12F† (n=39 each), 3*†
(n=30), 19A*† (n=27), 22F† (n=25), 33F† (n=23), 9N† (n=19), 15A (n=14)
and 24F (n=11) representing 66% of all isolates typed
*PCV13 serotypes; † PPV23 serotypes
Serotyping data courtesy of the Irish Pneumococcal Reference Laboratory
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Other pathogens
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Enterococcus faecalis
• 296 isolates (2015, 294 isolates)
• 1% of isolates with resistance to vancomycin
Acinetobacter spp.
• 69 isolates (2015, 87 isolates)
• No isolates were MDR, defined as resistance to fluoroquinolones,
aminoglycosides and carbapenems [In 2015, 2 isolates (3%) were
MDR]
• MDR Acinetobacter is a major problem in Southern European
countries including:
– Spain (2014, 56%)
– Italy (2014, 87%)
– Greece (2014, 87%)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Acknowledgements
• All microbiology laboratories for their continued support for EARSNet and for providing data for this report
• EARS-Net Steering Group
• Microbiology team at HPSC
• Irish Pneumococcal Reference Laboratory
• National Carbapenemase Producing Enterobacteriaceae Reference
Laboratory Service (CPEaRLS)
• EARS-Net at ECDC, Stockholm, Sweden for providing the
European data and maps
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Additional slides
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Summary of resistance trends
(selected drug/bug combinations)
50%
Quinolone-Resistant
E. coli
45%
CephalosporinResistant E. coli
Proportion resistance
40%
35%
ESBL-producing E. coli
30%
Multiple-Resistant
E. coli
25%
20%
Vancomycin-Resistant
Enterococcus faecium
15%
10%
Meticillin-Resistant
Staph. aureus
5%
Penicillin-Resistant
Strep. pneumoniae
0%
Year
Erythromycin-Resistant
S. pneumoniae
† 2015 and 2016 data incomplete from 3 and 2 laboratories representing 97% and 99% population coverage, respectively
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Monitoring trends over time: changing epidemiology
Number of isolates reported
3500
3000
2500
2000
1500
1000
500
0
Year
eco
sau
† 2015 and 2016 data are for projected totals (assuming 100% coverage by laboratories)
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016
Pneumococcal serotypes, 2015
• 90% (273/304) pneumococcal isolates were serotyped
• From patients aged ≥65 years the target population for the PPV23 vaccine),
69% of isolates (105 of 157) were serotypes that are included in the PPV23
vaccine
• From patients aged <2 years (the target population for the PCV13 vaccine),
3 of 12 isolates were serotypes covered by the vaccine, i.e. 9 were nonvaccine serotypes
• The most common serotypes identified were 8† (n=28), 19A* † (n=27), 12F †
(n=23), 7F* † (n=22), 3* † (n=21), 22F † (n=17), 15A (n=14), 9N † (n=13),
24F (n=12) and 35B (n=11) representing 69% of all isolates typed
*PCV13 serotypes; † PPV23 serotypes
Serotyping data courtesy of the Irish Pneumococcal Reference Laboratory
EARS-Net data on Antimicrobial Resistance in Ireland, Q1-4 2016