EARSS in Ireland, 2007 - Health Protection Surveillance Centre

Report
Antimicrobial resistance
surveillance in Ireland
Results of invasive
enterococcal bacteraemia
surveillance, 2009
**** Data as of 01/12/2010 ****
Ireland is a member of the European Antimicrobial Resistance
Surveillance Network (EARS-Net)
EARS-Net Enterococci:
Objective and case definition
Objective:

To determine the proportions of enterococci, E. faecalis or
E. faecium, isolates from blood that are resistant to 3 key
antibiotic classes:
◦
Ampicillin
◦
High-level gentamicin
◦
Vancomycin
Case definition:

EARS-Net collects data on the first invasive isolate (from
blood only) of E. faecium per patient per quarter
Caveats in interpreting EARS-Net data

Care must be exercised when interpreting the raw
figures, i.e. increases in numbers of isolates, as the
numbers of laboratories reporting to EARS-Net has
increased over the years

EARS-Net data does not distinguish clinically significant
isolates from contaminants

If a resistant isolate is identified subsequent to a
susceptible one within the same quarter, then that
isolate is not counted (and similarly if susceptible
isolates is identified subsequent to resistant one)
For further information on antimicrobial resistance
and EARS-Net in Ireland, including quarterly and
annual reports, plus reference/ resource material on
the individual pathogens under surveillance, see:
http://www.hpsc.ie/hpsc/AZ/MicrobiologyAntimicrobialResistance/EuropeanAntimic
robialResistanceSurveillanceSystemEARSS/
Antibiotic codes and abbreviations:
AMP, Ampicillin
LNZ, Linezolid
TEC, Teicoplanin
HLG, High-Level Gentamicin
QDA, Quinupristin-Dalfopristin
VAN, Vancomycin
AMR, Antimicrobial Resistance
MDR, Multi-Drug Resistance
EFA, Enterococcus faecalis
EFM, Enterococcus faecium
VREfm,Vancomycin-Resistant E. faecium
VSEfm,Vancomycin-Susceptible E. faecium
MDR, Multi-Drug Resistance
Enterococcus faecalis
Numbers and resistance proportions of
E. faecalis from bacteraemia, 2002-2009
Time
period
2002
2003
2004
2005
2006
2007
2008
2009**
Number
of labs
21
27
40
42
42
44
42
43
2009Q1
2009Q2
2009Q3
2009Q4
44
44
43
43
* Not all isolates tested
Number of
isolates %AMP-R* %HLGR* %VAN-R*
168
8.1
38.5
2.4
218
5.1
33.9
1.4
242
0.8
41.3
1.3
290
3.5
44.4
2.5
294
4.5
42.4
3.7
281
2.2
37.2
2.8
301
0.7
30.5
7.7
289
2.1
36.7
0.7
52
69
74
94
5.8
0.0
1.4
2.1
33.3
30.8
44.3
36.8
0.0
0.0
0.0
2.2
E. faecalis bacteraemia resistance trends,
2002-2009
21
27
40
41
42
44
42
43
44
44
43
43
Number of isolates
300
60%
50%
250
40%
200
30%
150
20%
100
50
10%
0
0%
Time period
Total E. faecalis
%AMP-R
%HLG-R
%VAN-R
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
350
Numbers and proportions of E. faecalis
bacteraemia by hospital type, 2009
Specialist/Tertiary
145
Secondary
81
Paediatric
19
Primary
17
General (Private)
15
Maternity
8
Other
3
Radiotherapy/Oncology
1
Total
289
Susceptibility data for E. faecalis bacteraemia
isolates, 2009 (n=389)
300
2.1%
36.7%
0.7%
0.9%
Number of isolates
250
3.0%
200
150
100
95.5%
50
0
AMP
HLG
Resistant
VAN
TEC
Antibiotic
Susceptible
LNZ
No data
QDA
Resistance profiles of E. faecalis isolates in
2009
Resistance Profile
Fully susceptible
No. isolates
170
A
0
G
91
V
1
AG
6
AV
0
GV
1
Not tested against all
20
Total
?AST/ID: 1x AMP-S/QDA-S EFA
?AST/ID: 1x AMP-R/QDA-S EFA
289
A, Ampicillin; G, High-Level Gentamicin; V, Vancomycin
ID, Identification; AST, Antimicrobial Susceptibility Testing
Age and sex distribution of patients with
invasive E. faecalis infection in 2009
30
Number of isolates
25
20
15
10
5
0
Age Group
female
male
Age and sex-specific incidence rates of
E. faecalis bacteraemia in 2009
120
100
ASIR
80
60
40
20
0
Age Group
female
male
ASIR, Age-Specific Incidence Rate (per 100,000 population)
TOTAL
Mean, median, mode and range of ages of
patients with E. faecalis bacteraemia in 2009
EFA
n
289
n with age
289
Mean
Median
59.1y
66y (64-71y)
Mode
0y
Range
0-98y
Sex distribution of patients with E. faecalis
bacteraemia in 2009
EFA
No. male
177
%male
61.2
No. female
112
%female
38.8
m/f ratio
1.58
z-test
3.92
P-value
<0.0001
In patients with laboratory-confirmed invasive E. faecalis infection in 2009,
males were approximately 1.6-times more likely to get an infection than
females (highly significant, P<0.0001).
E. faecalis - distribution of high-level
gentamicin resistance in EARSS/EARS-Net
countries, 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
E. faecalis - distribution of high-level
gentamicin resistance in EARSS countries,
2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
E. faecalis - distribution of vancomycin
resistance in EARSS/EARS-Net countries,
2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
E. faecalis - distribution of vancomycin
resistance in EARSS countries, 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
Enterococcus faecium
Numbers and resistance proportions of
E. faecium from bacteraemia, 2002-2009
Time
period
2002
Number Number of
of labs
isolates %AMP-R* %VAN-R* %HLG-R*
21
85
88.9
11.1
16.7
%MDR*
3.7
2003
27
135
91.0
19.4
53.8
11.4
2004
40
187
95.7
23.2
58.0
18.5
2005
42
224
92.3
31.7
51.4
25.6
2006
42
265
93.9
37.1
44.3
25.6
2007
44
332
93.1
33.5
34.9
22.3
2008
42
406
95.1
35.7
28.4
16.2
2009
43
397
92.9
39.1
38.3
26.7
2009Q1
44
118
91.5
38.1
30.6
22.5
2009Q2
44
111
93.6
34.2
38.0
23.1
2009Q3
43
74
91.9
37.8
42.0
26.1
2009Q4
43
94
94.4
48.9
43.6
36.8
* Not all isolates tested
E. faecium bacteraemia resistance trends,
2002-2009
21
27
40
41
42
44
42
44
44
44
44
44
100%
400
90%
350
80%
70%
300
60%
250
50%
200
40%
150
30%
100
20%
50
10%
0
0%
Time period
Total E. faecium
%AMP-R
%HLG-R
%VAN-R
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
Number of isolates
450
Invasive MDR E. faecium trends, 2002-2009
21
27
40
41
42
44
42
44
44
44
44
50%
45%
350
Number of isolates
44
40%
300
35%
250
30%
200
25%
150
20%
15%
100
10%
50
5%
0
0%
Time period
Total E. faecium tested for MDR
MDR
%MDR
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
400
Numbers and proportions of VREfm
bacteraemia by hospital type, 2009
Number of
isolates
VREfm
VSEfm
%VREfm
284
140
144
49.3%
Secondary
82
12
70
14.6%
Paediatric
14
0
10
0.0%
General (Private)
10
0
14
0.0%
Primary
5
0
5
0.0%
Radiotherapy/Oncology
2
0
2
0.0%
397
152
245
38.3%
Hospital Type
Specialist/Tertiary
Total
Numbers and proportions of MDR E. faecium
bacteraemia by hospital type, 2009
Number of
isolates
MDR
Non-MDR
%MDR
284
93
181
33.9%
Secondary
82
7
68
9.3%
Paediatric
14
0
11
0.0%
General (Private)
10
0
8
0.0%
Primary
5
0
5
0.0%
Radiotherapy/Oncology
2
0
2
0.0%
397
100
275
26.7%
Hospital Type
Specialist/Tertiary
Total
Susceptibility data for E. faecium bacteraemia
isolates, 2009 (n=397)
450
400
92.9%
39.1%
38.3%
5.2%
Number of isolates
350
39.5%
300
250
200
150
3.5%
100
50
0
AMP
HLG
Resistant
VAN
TEC
Antibiotic
Susceptible
LNZ
No data
QDA
Resistance profiles of E. faecium isolates in
2009
Resistance Profile
Fully susceptible
Number of isolates
23
A
160
G
1
V
2
AG
47
AV
42
GV
0
AGV*
Not tested against all
Total
100
22
397
A, Ampicillin; G, High-Level Gentamicin; V, Vancomycin
* Multi-drug resistant (defined as resistance to all 3 classes)
Trends in NUMBERS of main resistance
profiles of E. faecium isolates, 2002-2009
Number of isolates with resistance profile
200
21
27
40
41
42
44
42
43
44
44
180
160
140
120
100
80
60
40
20
0
A
Time period
AG
AV
AGV
Number of laboratories participating by year-end and quarter are indicated above the bars
43
43
Trends in PROPORTIONS of main resistance
profiles of E. faecium isolates, 2002-2009
% isolates with resistance profile
70%
60%
50%
40%
30%
20%
10%
0%
Time period
A
AG
AV
AGV
Age and sex distribution of patients with
invasive E. faecium infection in 2009
35
Number of isolates
30
25
20
15
10
5
0
Age Group
female male
Age and sex-specific incidence rates of
E. faecium bacteraemia in 2009
140
120
ASIR
100
80
60
40
20
0
Age Group
female
male
ASIR, Age-Specific Incidence Rate (per 100,000 population)
TOTAL
Mean, median, mode and range of ages of
patients with E. faecium bacteraemia in 2009
VREfm
VSEfm
MDR EFM
Non-MDR
EFM
n
152
245
100
275
397
n with age
152
245
100
275
397
58.8y
61.6y
59.0y
61.3y
60.5y
Mean
Median
EFM
63y (60-64y) 65y (62-70y) 60y (53-64y) 66y (62-71y) 66y (63-67y)
Mode
66y
0y
66y
59y
66y
Range
0-88y
0-92y
0-88y
0-92y
0-92y
Sex distribution of patients with E. faecium
bacteraemia in 2009
Non-MDR
MDR EFM
EFM
VREfm
VSEfm
94
132
61
155
226
61.8
53.9
61.0
56.4
56.9
58
113
39
120
171
%female
38.2
46.1
39.0
43.6
43.1
m/f ratio
1.62
1.17
1.56
1.29
1.32
z-test
3.01
1.22
2.26
2.13
2.79
0.003
0.22
0.024
0.033
0.005
No. male
%male
No. female
P-value
EFM
In patients with laboratory-confirmed invasive E. faecium infection in 2009,
males were approximately 1.3-times more likely to get an infection than
females (significant, P=0.005).
E. faecium - distribution of high-level
gentamicin resistance in EARSS/EARS-Net
countries, 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
E. faecium - distribution of high-level
gentamicin resistance in EARSS countries,
2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
E. faecium - distribution of vancomycin
resistance in EARSS/EARS-Net countries,
2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
E. faecium - distribution of vancomycin
resistance in EARSS countries, 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

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