Transcript EARSS in Ireland, 2007 - Health Protection Surveillance Centre

Antimicrobial resistance
surveillance in Ireland
Results of invasive
Klebsiella pneumoniae infection
(blood/CSF) surveillance, 2009
**** Data as of 01/12/2010 ****
Ireland is a member of the European Antimicrobial Resistance
Surveillance Network (EARS-Net)
EARS-Net K. pneumoniae:
Objective and case definition
Objective:

To determine the proportions of K. pneumoniae isolates from
blood and/or CSF that are resistant to 4 key antibiotic
classes:
◦
Aminopenicillins (e.g. ampicillin)
◦
3rd Generation Cephalosporins (e.g. cefotaxime, ceftazidime)
◦
Fluoroquinolones (e.g. ciprofloxacin)
◦
Aminoglycosides (e.g. gentamicin, tobramycin, amikacin)
Case definition:

EARS-Net collects data on the first invasive isolate (from
blood/CSF) of K. pneumoniae 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:
AMK, Amikacin
CTX, Cefotaxime
CAZ, Ceftazidime
CIP, Ciprofloxacin
IPM, Imipenem
OFX, Ofloxacin
TOB, Tobramycin
AMP, Ampicillin
CPD, Cefpodoxime
CRO, Ceftriaxone
GEN, Gentamicin
MEM, Meropenem
TZP, Piperacillin-Tazobactam
3GC, 3rd-Generation Cephalosporin
AMR, Antimicrobial Resistance
KPN, K. pneumoniae
ESBL, Extended-Spectrum Beta-Lactamase
FQ-R, Fluoroquinolone-Resistant
FQ-S, Fluoroquinolone-Susceptible
MDR, Multi-Drug Resistance
Numbers and resistance proportions of
K. pneumoniae from invasive infection,
2006-2009
Time
period
2006
2007
2008
2009
2009Q1
2009Q2
2009Q3
2009Q4
Number Number of
%CIP/
%IPM/
of labs
isolates %AMP-R* %3GC-R* OFX-R* %GEN-R* MEM-R*
36
97.7
10.2
15.3
7.8
0.0
217
39
99.2
9.9
18.1
9.9
0.6
244
41
99.7
11.3
12.7
10.6
0.0
311
42
99.7
11.1
13.0
11.1
0.0
323
43
43
42
42
* Not all isolates tested
56
76
101
90
100.0
100.0
99.0
100.0
10.9
3.9
14.9
13.3
10.7
9.2
17.8
12.4
12.5
6.6
12.9
12.2
0.0
0.0
0.0
0.0
Proportions of ESBLs and MDR among
K. pneumoniae from invasive infection,
2006-2009
Year
2006
2007
2008
2009
2009Q1
2009Q2
2009Q3
2009Q4
Number Number of
of labs
isolates %3GC-R* %ESBL+* %MDR*
36
10.2
8.6
11.2
217
39
9.9
3.7
11.9
244
41
11.3
7.7
9.9
311
42
11.1
8.2
11.9
323
43
43
42
42
* Not all isolates tested
56
76
101
90
10.9
3.9
14.9
13.3
9.4
4.1
9.3
9.8
10.9
5.4
16.8
12.4
Invasive K. pneumoniae resistance trends,
2006-2009
350
39
41
42
42
42
43
43
Number of isolates
300
25%
250
20%
200
15%
150
10%
100
50
5%
0
0%
Time period
Total K. pneumoniae
%3GC-R
%CIP/OFX-R
%GEN-R
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
36
30%
Invasive K. pneumoniae resistance trends,
2006-2009: 3GCs and ESBLs
36
39
41
42
43
43
42
42
Number of isolates
300
30%
25%
250
20%
200
15%
150
10%
100
50
5%
0
0%
Time period
Total K. pneumoniae tested for ESBL
%ESBL-positive
Number of laboratories participating by year-end and quarter are indicated above the bars
%3GC-R
%Resistance
350
Invasive MDR K. pneumoniae trends,
2006-2009
350
36
39
41
42
43
43
42
42
25%
300
250
15%
200
150
10%
100
5%
50
0
0%
Time period
Total K. pneumoniae tested for MDR
MDR
%MDR
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
Number of isolates
20%
Numbers and proportions of fluoroquinolone
(FQ)-resistant invasive K. pneumoniae
infection by hospital type, 2009
Hospital Type
Specialist/Tertiary
Secondary
General (Private)
Primary
Paediatric
Maternity
Other
Radiotherapy/Oncology
Total
Number of
isolates
187
75
27
13
7
6
6
2
323
FQ-R
29
8
2
2
0
0
1
0
42
FQ-S
157
67
25
11
7
6
5
2
280
%FQ-R
15.6%
10.7%
7.4%
15.4%
0.0%
0.0%
16.7%
0.0%
13.0%
Numbers and proportions of MDR invasive
K. pneumoniae infection by hospital type, 2009
Hospital Type
Specialist/Tertiary
Secondary
General (Private)
Primary
Paediatric
Maternity
Radiotherapy/Oncology
Other
Total
Number of
isolates
187
75
27
13
7
6
6
2
323
MDR
25
5
2
2
0
3
1
0
38
Non-MDR
158
70
25
11
7
3
5
2
281
%MDR
13.7%
6.7%
7.4%
15.4%
0.0%
50.0%
16.7%
0.0%
11.9%
Susceptibility data for invasive K. pneumoniae
isolates, 2009 (n=323)
350
99.7%
11.2%
11.4%
Number of isolates
300
10.0%
11.1%
0.0% 13.0% 11.1%
0.3%
10.7%
250
200
150
6.3%
100
11.3%
1.6%
50
0
Resistant
Antibiotic
Susceptible
No data
ESBL
-ve
Resistance Profile
Fully susceptible
A
3
C
G
A3
AC
AG
CG
A3C*
A3G*
Number of
isolates
1
259
0
0
0
8
10
3
0
6
6
ESBL
+ve
Resistance profiles of K. pneumoniae isolates,
2009
1
246
4
3
10
3
3
5
2
1
ACG*
10
A3CG*
Not tested against all
16
4
13
2
4
323
25
280
Total
8
A, Ampicillin; 3, 3GC; C, Ciprofloxacin; G, Gentamicin
* Multi-drug resistant (defined as resistance to 3 or more classes)
Age and sex distribution of patients with
invasive K. pneumoniae infection, 2009
25
Number of isolates
20
15
10
5
0
Age Group
female
male
Age and sex-specific incidence rates of
invasive K. pneumoniae infection, 2009
100
90
80
70
ASIR
60
50
40
30
20
10
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 invasive K. pneumoniae
infection, 2009
n
n with age
Mean
Median
Mode
Range
KPN
323
323
60.7y
65y (62-68y)
0y
0-94y
Sex distribution of patients with invasive
K. pneumoniae infection, 2009
No. male
%male
No. female
%female
m/f ratio
z-test
P-value
KPN
182
56.3
141
43.7
1.29
2.30
0.021
In patients with laboratory-confirmed invasive K. pneumoniae infection in
2009, males were approximately 1.3-times more likely to get an infection
than females (significant, P=0.021).
K. pneumoniae - distribution of 3GC (e.g. CTX
or CAZ) resistance in EARSS/EARS-Net
countries in 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
K. pneumoniae - distribution of 3GC (e.g. CTX
or CAZ) resistance in EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
K. pneumoniae - distribution of
fluoroquinolone (e.g. CIP) resistance in
EARSS/EARS-Net countries in 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
K. pneumoniae - distribution of
fluoroquinolone (e.g. CIP) resistance in
EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
K. pneumoniae - distribution of
aminoglycoside (e.g. GEN) resistance in
EARSS/EARS-Net countries in 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
K. pneumoniae - distribution of
aminoglycoside (e.g. GEN) resistance in
EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
K. pneumoniae - distribution of carbapenems
(e.g. MEM) resistance in EARSS/EARS-Net
countries in 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
K. pneumoniae - distribution of
carbapenems (e.g. MEM) resistance in
EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009