Antimicrobial resistance Antimicrobial resistance surveillance in Irelandsurveillance in Ireland

Results of invasive Escherichia coli infection

(blood/CSF) surveillance, 2009**** Data as of 01/12/2010 ******** Data as of 01/12/2010 ****

Ireland is a member of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

EARS-Net EARS-Net E. coliE. coli::Objective and case definitionObjective and case definitionObjective:

To determine the proportions of E. coli 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 E. coli per patient per quarter

Caveats in interpreting EARS-Net dataCaveats 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/A-Z/MicrobiologyAntimicrobialResistance/

EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/

Antibiotic codes and abbreviations:Antibiotic codes and abbreviations:AMK, Amikacin AMP, Ampicillin CTX, Cefotaxime CPD, Cefpodoxime CAZ, Ceftazidime CRO, Ceftriaxone CIP, Ciprofloxacin GEN, GentamicinIPM, Imipenem MEM, MeropenemOFX, Ofloxacin TZP, Piperacillin-TazobactamTOB, Tobramycin 3GC, 3rd-Generation

Cephalosporin

AMR, Antimicrobial ResistanceECO, Escherichia coliESBL, Extended-Spectrum Beta-LactamaseFQREC, Fluoroquinolone-Resistant E. coliFQSEC, Fluoroquinolone-Susceptible E. coliMDR, Multi-Drug Resistance

Numbers and resistance proportions of Numbers and resistance proportions of E. coli E. coli from invasive infection, 2002-2009 from invasive infection, 2002-2009

* Not all isolates tested

Time period

Number of labs

Number of isolates %AMP-R* %3GC-R* %CIP-R* %GEN-R*

%GEN/TOB/AMK-R*

2002 21 741 62.2 3.0 5.4 2.7 2.9

2003 27 991 61.9 2.5 9.5 3.9 4.3

2004 40 1256 65.0 2.6 12.6 5.7 6.1

2005 42 1445 67.6 4.1 17.3 8.5 8.6

2006 42 1656 70.7 4.2 21.5 7.7 8.6

2007 44 1784 68.3 6.7 22.1 9.9 10.6

2008 42 1924 70.3 7.6 23.3 10.2 11.0

2009 43 2064 68.7 7.5 22.3 7.7 9.3

2009Q1 44 443 67.9 7.2 20.3 7.3 8.2

2009Q2 44 527 70.5 6.3 21.8 8.2 9.7

2009Q3 43 577 66.9 8.9 24.4 7.3 9.7

2009Q4 43 517 69.4 7.6 22.0 7.9 9.3

Proportions of ESBLs and MDR among Proportions of ESBLs and MDR among E. coli E. coli from invasive infection, 2002-2009 from invasive infection, 2002-2009

* Not all isolates tested

Time period

Number of labs

Number of isolates %3GC-R* %ESBL+* %MDR*

2002 21 741 3.0 1.2 2.4

2003 27 991 2.5 1.3 3.8

2004 40 1256 2.6 1.1 5.6

2005 42 1445 4.1 2.4 7.7

2006 42 1656 4.2 2.5 9.0

2007 44 1784 6.7 4.1 11.4

2008 42 1924 7.6 5.0 12.1

2009 43 2064 7.5 5.8 10.4

2009Q1 44 443 7.2 4.7 8.5

2009Q2 44 527 6.3 5.1 10.0

2009Q3 43 577 8.9 7.1 11.3

2009Q4 43 517 7.6 6.0 11.4

Invasive Invasive E. coli E. coli resistanceresistance trends, 2002-2009trends, 2002-2009

Number of laboratories participating by year-end and quarter are indicated above the bars

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Time periodTotal E. coli %3GC-R %CIP/OFX-R %GEN-R %GEN/AMK/TOB-R

27 424140 424421 44 4444 4444

Invasive Invasive E. coli E. coli resistanceresistance trends, 2002-2009: trends, 2002-2009: 3GCs and ESBLs3GCs and ESBLs

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Time periodTotal E. coli tested for ESBL ESBL-positive %ESBL-positive %3GC-R

27 424140 424421 44 44 44 4444

Invasive MDR Invasive MDR E. coli E. coli trends, 2002-2009trends, 2002-2009

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Time periodTotal E. coli tested for MDR MDR %MDR

27 424140 424421 44 4444 4444

Numbers and proportions of fluoroquinolone Numbers and proportions of fluoroquinolone (FQ)-resistant invasive (FQ)-resistant invasive E. coli E. coli infection by infection by hospital type, 2009hospital type, 2009

Hospital TypeNumber of

isolates FQ-R FQ-S %FQ-SSpecialist/Tertiary 974 240 733 24.7%Secondary 750 161 588 21.5%Primary 147 32 115 21.8%General (Private) 100 19 80 19.2%Maternity 45 1 40 2.4%Paediatric 28 0 28 0.0%Other 13 4 9 30.8%Radiotherapy/Oncology 4 0 4 0.0%Orthopaedic 3 1 2 33.3%Total 2064 458 1599 22.3%

Numbers and proportions of MDR invasive Numbers and proportions of MDR invasive E. coli E. coli infection by hospital type, 2009infection by hospital type, 2009

Hospital TypeNumber of

isolates MDR Non-MDR %MDRSpecialist/Tertiary 973 118 837 12.4%Secondary 751 62 681 8.3%Primary 147 19 128 12.9%General (Private) 100 10 88 10.2%Maternity 45 0 41 0.0%Paediatric 28 1 27 3.6%Other 13 1 12 7.7%Orthopaedic 4 0 4 0.0%Radiotherapy/Oncology 3 0 3 0.0%Total 2064 211 1821 10.4%

Susceptibility data for invasive Susceptibility data for invasive E. coli E. coli isolates, isolates, 2009 (n=2064)2009 (n=2064)

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AntibioticResistant Susceptible No data

68.7%

11.3%

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22.3% 7.7%

3.3%

9.3%

14.2%

Resistance profiles of Resistance profiles of E. coli E. coli isolates, isolates, 20092009

Resistance ProfileNumber of

isolates ES

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Fully susceptible 601 601

A 903 842

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C 31 31

G 4 4

A3 29 11 16

AC 219 205

AG 34 32

CG

A3C* 62 48 13

A3G* 7 3 3

ACG* 86 81

A3CG* 56 51 5

Not tested against all 32 1 31

Total 2064 114 1864

A, Ampicillin; 3, 3GC; C, Ciprofloxacin; G, Gentamicin (+/-tobramcyin

or amikacin)* Multi-drug resistant (defined as resistance to 3 or more classes)

Trends in NUMBERS of main resistance Trends in NUMBERS of main resistance profiles of profiles of E. coli E. coli isolates, 2002-2009isolates, 2002-2009

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Time periodFully S A AC A3C ACG A3CG

27 424140 424421 44 4444 4444

Number of laboratories participating by year-end and quarter are indicated above the bars

Trends in PROPORTIONS of main resistance Trends in PROPORTIONS of main resistance profiles of profiles of E. coli E. coli isolates, 2002-2009 (1)isolates, 2002-2009 (1)

See next slide…………….

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Trends in PROPORTIONS of main resistance Trends in PROPORTIONS of main resistance profiles of profiles of E. coli E. coli isolates, 2002-2009 (2)isolates, 2002-2009 (2)

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Age and sex distribution of patients with Age and sex distribution of patients with invasive invasive E. coli E. coli infection, 2009infection, 2009

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Age Groupfemale male

Age and sex-specific incidence rates of Age and sex-specific incidence rates of invasive invasive E. coli E. coli infection, 2009infection, 2009

ASIR, Age-Specific Incidence Rate (per 100,000 population)

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female male TOTAL

Mean, median, mode and range of ages of Mean, median, mode and range of ages of patients with invasive patients with invasive E. coli E. coli infection, 2009infection, 2009

The difference in the mean age of patients with invasive infections due to FQREC and FQSEC is highly significant (F-statistic=28.47; P<0.0001)The difference in the mean age of patients with invasive infections due to MDR and non-MDR E. coli is highly significant (F-statistic=16.84; P<0.0001)

FQREC FQSEC MDR ECONon-MDR

ECO ECOn 458 1599 211 1821 2064n with age 458 1599 211 1821 2064Mean 69.4y 63.7y 69.6y 64.6y 65.6yMedian 73y (71-75y) 70y (69-71y) 72y (70-75y) 71y (69-72y) 72y (71-73y)Mode 77y 0y 77y 83y 83Range 0-96y 0-97y 0-95y 0-97y 0-97y

Sex distribution of patients with invasive Sex distribution of patients with invasive E. coli E. coli infection, 2009infection, 2009

In patients with laboratory-confirmed invasive E. coli infection in 2009, females were approximately 1.25-times more likely to get an infection than males (highly significant, P<0.0001). However, males were approx. 1.25-times more likely to get an infection with FQREC (significant, P=0.024) and 1.2-times more likely to get an infection with MDR E. coli (not significant, P=0.15) than females.

FQREC FQSEC MDR ECONon-MDR

ECO ECONo. male 253 667 116 791 921%male 55.2 41.7 55.0 43.4 44.6No. female 205 932 95 1030 1143%female 44.8 58.3 45.0 56.6 55.4m/f ratio 1.23 0.72 1.22 0.77 0.81z-test 2.26 -6.72 1.45 -5.65 -4.92P-value 0.024 <0.0001 0.15 <0.0001 <0.0001

E. coliE. coli - distribution of 3GC (e.g. CTX or CAZ) - distribution of 3GC (e.g. CTX or CAZ) resistance in resistance in EARSS/EARS-NetEARSS/EARS-Net countries in countries in 20092009

Map downloaded from:

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

E. coliE. coli - distribution of 3GC (e.g. CTX or CAZ) - distribution of 3GC (e.g. CTX or CAZ) resistance in EARSS countries in 2008resistance in EARSS countries in 2008

Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

E. coliE. coli - distribution of fluoroquinolone (e.g. - distribution of fluoroquinolone (e.g. CIP) resistance in CIP) resistance in EARSS/EARS-NetEARSS/EARS-Net countries countries in 2009in 2009

Map downloaded from:

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

E. coliE. coli - distribution of fluoroquinolone (e.g. - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS countries in 2008CIP) resistance in EARSS countries in 2008

Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

E. coliE. coli - distribution of aminoglycoside (e.g. - distribution of aminoglycoside (e.g. GEN) resistance in GEN) resistance in EARSS/EARS-NetEARSS/EARS-Net countries in 2009 countries in 2009

Map downloaded from:

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

E. coliE. coli - distribution of aminoglycoside (e.g. - distribution of aminoglycoside (e.g. GEN) resistance in EARSS countries in 2008 GEN) resistance in EARSS countries in 2008

Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009