Transcript No Slide Title

Frequency of Occurrence of Bacterial Pathogens in Bacteremic Infections and Antimicrobial
Susceptibility From the SENTRY Surveillance Programme in Europe 2000
Conclusions: These data indicate that bacterial resistance to antimicrobials
used for therapy of bloodstream infections has reached worrisome levels at
many of the institutions surveyed in 2000. Given the large regional and local
variation of resistance rates across Europe, these average secular trends
should be interpreted with caution and compared to local data.
INTRODUCTION
The SENTRY program is a longitudinal surveillance program designed to
monitor the predominant pathogens and antimicrobial resistance patterns of
nosocomial and community acquired infections via an international network of
sentinel hospitals. We analyzed the SENTRY data from the year 2000, to
update the antimicrobial resistance rates in bloodstream isolates from a
network of European hospitals.
MATERIALS AND METHODS
During the year 2000, a total of 3087 bloodstream isolates from 18 European
hospitals were analyzed. These centers were distributed among 10 European
countries: 6 Mediterranean countries and 6 other countries (Table 1). Of these
centers, 11 (61%) had participated in the SENTRY program during 1997-98. As
part of the SENTRY program, European participating centers referred the first
20 clinically significant consecutive blood isolates of any species per month.
Only 1 isolate per patient was submitted. All strains were sent to the regional
monitor (RN Jones, University of Iowa, IA) for susceptibility testing to >20
antimicrobials and confirmation of organism identification. Antimicrobial
susceptibility testing of isolates was performed using a broth microdilution
method according to the National Committee for Clinical Laboratory Standards
(NCCLS) guidelines.
TABLE 3: Trends in proportion of isolates non
susceptible to broad spectrum antibiotics for selected
blood pathogens, 1997-2000 SENTRY Europe
FIGURES 2 - 7
M e d ite rra n e a n c o u n trie s
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
15
10
5
0
1997
1998
Escherichia coli
Coagulase-negative Staphylococus
Klebsiella pneumoniae
Enterobacter sp
Streptococcus pneumoniae
2000
year
Staphylococcus aureus
Pseudomonas aeruginosa
Enterococcus faecalis
Acinetobacter spp
Proteus mirabilis
4
5
6
7
8
9
10
O th e r c o u n trie s
11
12
13
14
15
16
17
18
0
20
4
N ° o f is o la te s
8
10
12
15
10
M IC < 2
M IC ≥ 2
14
s et al o si f o ° N
M IC ≥ 8
M IC < 8
20
6
30
Organism
and antibiotic
40
50
M IC < 2
M IC ≥ 2
80
Susceptibility to ciprofloxacin by center
1
FIGURE 2: Enterobacter sp
2
3
4
5
6
7
8
9
10
11
12
M e d ite rra n e a n c o u n trie s
0
Susceptibility to ciprofloxacin by center
2
1
2
3
4
5
6
7
8
9
10
13
14
15
16
17
FIGURE 4: Escherichia coli
18
O th e r c o u n trie s
Med iterran ean co u n tries
FIGURE 5: Klebsiella pneumoniae
O th er co u n tries
11
12
13
14
15
16
17
FIGURE 7: Staphylococcus aureus
18
Susceptibility to oxacillin by center
70
4
s et al o si f o ° N
M IC ≥ 2
M IC < 2
20
15
8
10
M IC ≤ 0.06
12
M IC 0.12 - 1
10
14
5
4
5
6
7
8
9
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
9
M e d ite rra n e a n c o u n trie s
10
11
12
13
14
15
16
17
18
O th e r c o u n trie s
TABLE 2: Susceptibility to 28 antimicrobials of top 5
gram-negative pathogens from bloodstream infection, Euro SENTRY 2000
Antimicrobial Agent
Ampicillin
Piperacillin
Ticarcillin
Amoxicillin/clavulanate
Piperacillin/tazobactam
Ticarcillin/clavulanate
Cefazolin
Cefuroxime
Cefoxitin
Ceftazidime
Ceftriaxone
Cefepime
Aztreonam
Imipenem
Meropenem
Gentamicin
Tobramycin
Amikacin
Isepamicin
Nalidixic acid
Ciprofloxacin
Levofloxacin
Gatifloxacin
BMSQ
SBQ265805
Nitrofurantoin
Trimethoprim-sulfamethoxazole
Tetracycline
NA - Not applicable
E. coli
P. aeruginosa
K. pneumoniae
Chi-square
by year, p value
1998
2000
P. aeruginosa
Piperacillin
Ciprofloxacin
Ceftazidime
Cefepime
Imipenem
Meropenem
(n=257)
13
22
12
17
8
9
(n=248)
23
29
20
17
20
14
(n=187)
26
29
28
31
22
21
<0,001
0.14
<0,001
<0,001
<0,0001
<0,01
E. coli
Ceftazidime
Cefepime
Ciprofloxacin
Meropenem
(n=963)
1
0
6
0
(n=954)
2
1
10
0
(n=649)
3
1
14
0
0.18
<0,01
<0,0001
_
Enterobacter species
Ceftazidime
Cefepime
Ciprofloxacin
Meropenem
(n=178)
17
3
11
0
(n=199)
35
4
17
0
(n=137)
34
4
13
0
<0,001
0.8
0.2
_
K. pneumoniae
Ceftazidime (MIC >1 mg/l)
Ceftazidime (MIC > 8 mg/l)
Cefepime
Ciprofloxacin
Meropenem
(n=204)
14
13
7
4
0
(n=250)
28
26
8
6
0
(n=213)
33
24
12
12
0
<0,0001
<0,01
0.12
<0,01
_
Acinetobacter species
Ceftazidime
Cefepime
Ciprofloxacin
Meropenem
(n=111)
46
38
52
24
(n=138)
50
36
47
20
(n=100)
71
65
73
32
<0,001
<0,0001
<0,001
0.11
S. aureus
Oxacillin
(n=931)
22
(n=759)
26
(n=589)
30
<0,01
CNS
Oxacillin
Teicoplanin
(n=811)
69
0.1
(n=841)
77
3
(n=428)
78
6
<0,001
<0,0001
Enterococcus species
Vancomycin
Teicoplanin
(n=338)
4
4
(n=280)
4
4
(n=232)
6
2
0.46
0.4
S. peumoniae
Penicillin (MIC 0.1-1mg/l)
Penicillin (MIC >1 mg/l)
(n=105)
4
28
(n=112)
8
31
(n=105)
11
27
0.07
0.73
30
0
FIGURE 6: Streptococcus pneumoniae
18
O th e r c o u n trie s
40
10
Susceptibility to penicillin by center
3
50
20
M IC > 2
16
2
M IC ≥ 4
M IC < 4
60
6
N ° o f is o la te s
30
25
Susceptibility to ciprofloxacin by center
0
% of non susceptibles isolates by years
1997
60
70
5
16
TABLE 1: List of the participating
centers in Euro SENTRY 2000
20
3
10
2
M e d ite rra n e a n c o u n trie s
FIGURE 1: Top 10 isolated blood pathogens from
1997 through 2000, Euro SENTRY
2
25
1
Country
France
Greece
Israel
Spain
Spain
Spain
Turkey
Turkey
Italy
Italy
Italy
Belgium
Switzerland
Germany
Germany
Sweden
Poland
UK
1
Susceptibility to imipenem by center
18
0
Center
CHU de Lille
National University of Athens Medical School
The Chaim Sheba Medical Center
University Hospital Virgen de la Macarena
Hospital de Bellvitge
Hospital Ramon y Cajal
Hacettepe Universitesi Tip Fakultesi
Marmara Universitesi Tip Fakultesi
Universita degli Studi di Genova
Universita degli Studi di Catania
Policlinico Agostino Germelli
Hopital Erasme-Université Libre de Bruxelles
Unité de Bacteriologie CHU Lausanne
Heinrich-Heine Universitat
J.-W.-Goethe Universitat
University Hospital, Linkoping
Sera and Vaccines Central Research Lab
St Thomas Hospital
M e d ite rra n e a n c o u n trie s
FIGURE 3: Pseudomonas aeruginosa
O th e r c o u n trie s
0
s et al o si f o ° N
Figure 1 shows the 10 most frequently isolated blood pathogens in these hospitals
from 1997 through 2000. These species represent about 85% of blood isolates
during the year 2000. E. coli, S. aureus, coagulase negative staphylococci (CNS),
K. pneumoniae and P. aeruginosa, were the 5 most frequent pathogens. Of these
bloodstream isolates, 47 % were from nosocomial bacteremia and 23% were from
patients admitted to intensive care units.
The antimicrobial susceptibility of the most common Gram-negative isolates is
shown in table 2. As compared to blood isolates from European SENTRY centers
in 1997-1998, resistance rates to first line antimicrobials appeared to increase for
a number of leading pathogens (Table3): ciprofloxacin resistance in E.coli, oxacillin
resistance in S.aureus, K.pneumoniae decreased susceptibility to ceftazidime and
resistance to ceftazidime, imipenem, ciprofloxacin in P.aeruginosa and
Acinetobacter sp. The same trend was noted for teicoplanin-resistant CNS.
Figures 2 to 7 illustrate the inter-center variation in the frequency of isolates by
species and proportion of resistant strains for selected pathogens and
antimicrobials. Some resistant pathogens such P. aeruginosa resistant to imipenem
were significantly more prevalent in Mediterranean countries (p<0.01) than in
centers from Central or Northern European countries. Similar differences were
shown for penicillin resistant S. pneumoniae (p<0.001).
N ° o f is o la t e s
Background: To update the antimicrobial resistance rates in bloodstream
isolates from a network of European hospitals.
Methods: In the first 9 months of 2000, 18 University Hospitals from 10
European countries referred 3087 blood isolates for in vitro testing against
>20 antimicrobials.
Results: Of these isolates, 47% were considered from nosocomial bacteremia
and 23% were from patients admitted to intensive care units. The 5 most
frequent pathogens were E. coli, S. aureus, coag.-neg. staphylococci, K.
pneumoniae and P. aeruginosa. As compared to blood isolates from 25
European SENTRY centers in 1997-98, resistance rates to first line
antimicrobials appeared to increase for a number of leading pathogens but
also showed large variation by center and by region. The mean (inter-center
range) proportion of ciprofloxacin non-susceptible strains in E.coli was 14%
(0-42) (vs 8% in 1997-98); oxacillin resistance in S.aureus was 31% (0-67)
(vs 24% in 1997-98); ceftazidime decreased susceptibility (MIC  2 µg/ml) in
K.pneumoniae was 33% (0-64) (vs 17% in 1997-98); in P.aeruginosa, the
proportion of strains non-susceptible to ceftazidime was 28% (1-60) (vs 16% in
1997-98), imipenem 22% (0-71) (vs 15% in 1997-98) and ciprofloxacin 29%
(0-67) (vs 25% in 1997-98). The prevalence of glycopeptide resistant
enteroccci remained stably low in 2000: E. faecium, 8% (vs 11%, 1997-98)
and E.faecalis, 1% (vs 1% in 1997-98).
RESULTS
% of isolates
ABSTRACT
Dr. H.Rodriguez Villalobos
ULB- Hopital Erasme Microbiology Dpt,
808 route de Lennik, 1070 Brussels, Belgium
Phone: (+32) 2 555 45 18, Fax: (+32) 2 555 31 10
Email:[email protected]
H.Rodriguez-Villalobos1, M.J. Struelens1, R.Jones2, European SENTRY participants.
Hôpital Erasme -Université Libre de Bruxelles, Brussels, Belgium.1 The Jones Group North Liberty,IA.2
Poster #77
Enterobacter sp
Acinetobacter sp
MIC 50
MIC 90
%S
MIC 50
MIC 90
%S
MIC 50
MIC 90
%S
MIC 50
MIC 90
%S
MIC 50
MIC 90
%S
>16
8
128
4
1
8
2
4
4
0.12
0.25
0.12
0.12
0.12
0.06
1
0,5
2
1
4
0.25
0.03
0.03
0.03
0.03
32
0.5
4
>16
>128
>128
16
4
64
16
8
8
0.5
0.25
0.12
0.25
0.12
0.06
2
2
4
2
>32
>2
4
4
>4
4
32
2
>8
48
53
48
80
96
73
87
93
94
97
97
99
96
100
100
93
93
99
NA
77
86
87
NA
NA
NA
94
100
62
NA
16
64
>16
8
64
>16
>16
>32
4
>32
4
8
1
0.5
2
0.5
4
4
>32
0.25
1
1
2
0.5
NA
NA
>8
NA
>128
>128
>16
>64
>128
>16
>16
>32
>16
>32
>16
>16
>8
>8
>8
>16
>32
32
>32
>2
>4
>4
>4
>4
NA
NA
>8
NA
74
59
1
79
64
0
0
0
72
11
68
40
78
79
69
72
80
NA
0
71
71
NA
NA
NA
NA
NA
1
>16
8
>128
4
2
4
2
4
2
0.25
0.25
0.12
0.12
0.12
0.06
1
0.5
1
0.5
4
0.25
0.03
0.03
0.12
0.03
32
0.5
4
>16
>128
>128
>16
>64
>128
>16
>16
8
>16
>32
16
>16
0.25
0.06
>8
>16
32
4
>32
>2
2
2
>4
2
>64
2
>8
5
54
4
68
77
62
63
64
90
76
74
88
75
100
99
73
70
88
NA
79
88
90
NA
NA
NA
65
100
78
>16
4
8
>16
4
8
>16
16
>32
0.25
0.25
0.12
0.25
0.25
0.06
1
0.5
1
1
4
0.25
0.03
0.03
0.12
0.03
32
0.5
4
>16
>128
>128
>16
>64
>128
>16
>16
>32
>16
>32
4
>16
1
0.12
8
16
4
2
>32
>2
>4
>4
>4
4
64
2
8
7
60
55
5
71
57
6
48
5
66
68
96
64
100
100
88
80
91
NA
78
87
88
NA
NA
NA
64
100
85
NA
>128
>128
>16
>64
128
>16
>16
>32
>16
>32
16
>16
1
2
>8
16
>32
>32
>32
>2
4
4
>4
4
>64
2
>8
NA
>128
>128
>16
>64
>128
>16
>16
>32
>16
>32
>16
>16
>8
>8
>8
>16
>32
>32
>32
>2
>4
>4
>4
>4
>64
2
>8
NA
21
21
18
27
24
1
10
7
29
21
35
6
69
68
24
41
39
NA
26
27
34
NA
NA
NA
0
100
31
CONCLUSIONS
1. The distribution of most frequent bloodstream pathogens was similar in
2000 as compared with 1997-98.
2. A trend toward increased resistance to first line antimicrobials over the
period 1997-2000 was seen with several leading pathogens, including
community acquired pathogens (E.coli, S. pneumoniae) and nosocomial
pathogens (K. pneumoniae, P. aeruginosa, Acinetobacter sp).
3. These average secular trends should be interpreted with caution
because of large inter-center variation in resistance rates and change in
the cohort of SENTRY participants during this period.
4. These European-wide trends underline the magnitude of antimicrobial
resistance in many participating hospitals. Monitoring of local data is
essential for guiding therapeutic strategies.
A156-25