Transcript EARSS in Ireland, 2007

Antimicrobial resistance
surveillance in Ireland
Results of invasive
Pseudomonas aeruginosa infection
(blood/CSF) surveillance, 2009
**** Data as of 01/12/2010 ****
Ireland is a member of the European Antimicrobial Resistance
Surveillance Network (EARS-Net)
Antibiotic codes and abbreviations:
AMK, Amikacin
CAZ, Ceftazidime
GEN, Gentamicin
MEM, Meropenem
PIP, Piperacillin
TOB, Tobramycin
ATM, Aztreonam
CIP, Ciprofloxacin
IPM, Imipenem
OFX, Ofloxacin
TZP, Piperacillin-Tazobactam
AMR, Antimicrobial Resistance
PAE, Pseudomonas aeruginosa
MDR, Multi-Drug Resistance
EARS-Net P. aeruginosa:
Objective and case definition
Objective:

To determine the proportions of P. aeruginosa isolates from
blood or CSF that are resistant to piperacillin (+/tazobactam), ceftazidime, carbapenems (imipenem or
meropenem), fluoroquinolones (e.g. ciprofloxacin or
ofloxacin) and aminoglycosides (e.g. gentamicin)
Case definition:

EARS-Net collects data on the first invasive isolate (from
blood or CSF) of P. aeruginosa 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)
Numbers and resistance proportions of
P. aeruginosa from invasive infection,
2006-2009
Time
period
2006
Number Number of %PIP/
%IPM/ %CIP/
of labs isolates TZP-R* %CAZ-R* MEM-R* OFX-R* %GEN-R*
%MDR
36
128
9.4
10.6
11.8
18.0
9.5
9.5
2007
39
177
12.6
11.8
12.2
22.9
13.3
12.5
2008
41
199
10.8
8.7
9.3
21.8
9.0
11.1
2009
42
248
8.9
11.8
9.7
12.1
7.7
6.4
2009Q1
43
43
7.0
4.9
7.0
16.3
9.5
4.9
2009Q2
43
52
5.8
7.7
6.3
9.6
5.8
6.3
2009Q3
42
73
8.2
9.6
9.9
8.2
6.8
2.8
2009Q4
42
80
12.7
20.3
13.5
15.0
8.9
10.7
* Not all isolates tested
Invasive P. aeruginosa resistance trends (1),
2006-2009
Number of isolates
36
39
41
42
43
43
42
42
30%
250
25%
200
20%
150
15%
100
10%
50
5%
0
0%
Time period
Total P. aeruginosa
%PIP/TZP-R
%CAZ-R
%IPM/MEM-R
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
300
Invasive P. aeruginosa resistance trends (2),
2006-2009
300
36
39
42
41
43
43
42
42
35%
250
30%
200
25%
150
20%
15%
100
10%
50
5%
0
0%
Time period
Total P. aeruginosa
%CIP/OFX-R
%GEN-R
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
Number of isolates
40%
Numbers and proportions of MDR invasive
P. aeruginosa infection by hospital type, 2009
Number of
isolates
MDR
Non-MDR
%MDR
Specialist/Tertiary
145
10
130
7.1%
Secondary
58
3
48
5.9%
General (Private)
15
1
13
7.1%
Paediatric
15
1
14
6.7%
Primary
8
0
8
0.0%
Other
4
0
4
0.0%
Radiotherapy/Oncology
2
0
2
0.0%
Orthopaedic
1
0
1
0.0%
248
15
220
6.4%
Hospital Type
Total
Susceptibility data for invasive P. aeruginosa
isolates, 2009 (n=248)
Number of isolates
250
200
8.5%
11.8%
9.7% 12.1%
7.7%
8.1%
1.0%
150
5.8%
100
32.0%
50
0.0%
0
Antibiotic
Resistant
Susceptible
No data
Age and sex distribution of patients with
invasive P. aeruginosa infection in 2009
30
Number of isolates
25
20
15
10
5
0
Age Group
female
male
Age and sex-specific incidence rates of
invasive P. aeruginosa infection in 2009
80
70
60
ASIR
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 P. aeruginosa infection in 2009
PAE
n
248
n with age
248
Mean
60.7y
Median
67y (65-70y)
Mode
77y
Range
0-92y
Sex distribution of patients with invasive
P. aeruginosa infection in 2008
No. male
%male
No. female
%female
m/f ratio
z-test
P-value
PAE
140
56.5
108
43.5
1.30
2.05
0.04
In patients with laboratory-confirmed invasive P. aeruginosa infection in 2009,
males were approximately 1.3-times more likely to get an infection than
females (boderline significant, P=0.04).
Resistance profiles of P. aeruginosa isolates in
Profile
Number of isolates
2009 Resistance
Fully susceptible
172
P
2
3
8
M
9
C
12
G
5
P3
PM
4
1
PC
1
3M
1
3G
1
MC
1
CG
P3M*
P3C*
3MC*
3CG*
MCG*
P3MC*
P3MG*
P3CG*
3MCG*
P3MCG*
Not tested against all
Total
3
2
1
1
2
1
1
1
1
4
1
13
248
P, Piperacillins;
3, Ceftazidime;
M, Meroepenem;
C, Ciprofloxacin;
G, Gentamicin
* MDR, defined as
resistance to 3 or more
antibiotic classes
P. aeruginosa - distribution of piperacillin (e.g.
PIP or TZP) 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
P. aeruginosa - distribution of piperacillin (e.g.
PIP or TZP) resistance in EARSS countries in
2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
P. aeruginosa - distribution of ceftazidime
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
P. aeruginosa - distribution of ceftazidime
resistance in EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
P. aeruginosa - 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
P. aeruginosa - 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
P. aeruginosa - 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
P. aeruginosa - 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
P. aeruginosa - distribution of carbapenem
(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
P. aeruginosa - distribution of carbapenem
(e.g. MEM) resistance in EARSS countries in
2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009