Antimicrobial resistance surveillance in Ireland

Antimicrobial resistance Antimicrobial resistance surveillance in Irelandsurveillance in Ireland

Results of invasive Pseudomonas aeruginosa

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)

Antibiotic codes and abbreviations:Antibiotic codes and abbreviations:

AMK, Amikacin ATM, AztreonamCAZ, Ceftazidime CIP, CiprofloxacinGEN, Gentamicin IPM, Imipenem MEM, Meropenem OFX, Ofloxacin PIP, Piperacillin TZP, Piperacillin-

TazobactamTOB, Tobramycin

AMR, Antimicrobial ResistancePAE, Pseudomonas aeruginosaMDR, Multi-Drug Resistance

EARS-Net EARS-Net P. aeruginosaP. aeruginosa::Objective and case definitionObjective 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 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)

Numbers and resistance proportions of Numbers and resistance proportions of P. aeruginosa P. aeruginosa from invasive infection, from invasive infection, 2006-2009 2006-2009

* Not all isolates tested

Time period

Number of labs

Number of isolates

%PIP/ TZP-R* %CAZ-R*

%IPM/ MEM-R*

%CIP/ OFX-R* %GEN-R* %MDR

2006 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

Invasive Invasive P. aeruginosaP. aeruginosa resistanceresistance trends (1), trends (1), 2006-20092006-2009

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

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Time periodTotal P. aeruginosa %PIP/TZP-R %CAZ-R %IPM/MEM-R

413936 42 43 42 4243

Invasive Invasive P. aeruginosaP. aeruginosa resistanceresistance trends (2), trends (2), 2006-20092006-2009

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

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Time periodTotal P. aeruginosa %CIP/OFX-R %GEN-R

36 424139 42 43 4243

Numbers and proportions of MDR invasive Numbers and proportions of MDR invasive P. aeruginosa P. aeruginosa infection by hospital type, 2009infection by hospital type, 2009

Hospital TypeNumber 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%

Total 248 15 220 6.4%

Susceptibility data for invasive Susceptibility data for invasive P. aeruginosa P. aeruginosa isolates, 2009 (n=248)isolates, 2009 (n=248)

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8.5% 11.8% 9.7% 12.1% 7.7%

1.0%

5.8%

8.1%

32.0%

0.0%

Age and sex distribution of patients with Age and sex distribution of patients with invasive invasive P. aeruginosa P. aeruginosa infection in 2009infection in 2009

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Age Groupfemale male

Age and sex-specific incidence rates of Age and sex-specific incidence rates of invasive invasive P. aeruginosa P. aeruginosa infection in 2009infection in 2009

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

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Age Group

female male TOTAL

Mean, median, mode and range of ages of patients Mean, median, mode and range of ages of patients with invasive with invasive P. aeruginosa P. aeruginosa infection in 2009infection in 2009

PAEn 248n with age 248Mean 60.7yMedian 67y (65-70y)Mode 77yRange 0-92y

Sex distribution of patients with invasive Sex distribution of patients with invasive P. aeruginosa P. aeruginosa infection in 2008infection in 2008

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).

PAENo. male 140%male 56.5No. female 108%female 43.5m/f ratio 1.30z-test 2.05P-value 0.04

Resistance profiles of Resistance profiles of P. aeruginosa P. aeruginosa isolates in isolates in 20092009

P, Piperacillins; 3, Ceftazidime; M, Meroepenem; C, Ciprofloxacin; G, Gentamicin

* MDR, defined as resistance to 3 or more antibiotic classes

Resistance Profile Number of isolates

Fully susceptible 172

P 2

3 8

M 9

C 12

G 5

P3 4PM 1

PC 1

3M 1

3G 1

MC 1

CG 3P3M* 2P3C* 13MC* 13CG* 2MCG* 1P3MC* 1P3MG* 1P3CG* 13MCG* 4P3MCG* 1Not tested against all 13Total 248

P. aeruginosa P. aeruginosa - distribution of piperacillin (e.g. - distribution of piperacillin (e.g. PIP or TZP) resistance in EARSS/EARS-Net PIP or TZP) resistance in EARSS/EARS-Net countries in 2009countries in 2009

Map downloaded from:

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

P. aeruginosa P. aeruginosa - distribution of piperacillin (e.g. - distribution of piperacillin (e.g. PIP or TZP) resistance in EARSS countries in PIP or TZP) resistance in EARSS countries in 20082008

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

P. aeruginosa P. aeruginosa - distribution of ceftazidime - distribution of ceftazidime resistance in EARSS/EARS-Net countries in resistance in EARSS/EARS-Net countries in 20092009



P. aeruginosa P. aeruginosa - distribution of ceftazidime - distribution of ceftazidime resistance in EARSS countries in 2008resistance in EARSS countries in 2008


P. aeruginosa P. aeruginosa - distribution of fluoroquinolone - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS/EARS-Net (e.g. CIP) resistance in EARSS/EARS-Net countries in 2009countries in 2009



P. aeruginosa P. aeruginosa - distribution of fluoroquinolone - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS countries in (e.g. CIP) resistance in EARSS countries in 20082008


P. aeruginosa P. aeruginosa - distribution of aminoglycoside - distribution of aminoglycoside (e.g. GEN) resistance in EARSS/EARS-Net (e.g. GEN) resistance in EARSS/EARS-Net countries in 2009 countries in 2009



P. aeruginosa P. aeruginosa - distribution of aminoglycoside - distribution of aminoglycoside (e.g. GEN) resistance in EARSS countries in (e.g. GEN) resistance in EARSS countries in 2008 2008


P. aeruginosa P. aeruginosa - distribution of carbapenem - distribution of carbapenem (e.g. MEM) resistance in EARSS/EARS-Net (e.g. MEM) resistance in EARSS/EARS-Net countries in 2009countries in 2009



P. aeruginosa P. aeruginosa - distribution of carbapenem - distribution of carbapenem (e.g. MEM) resistance in EARSS countries in (e.g. MEM) resistance in EARSS countries in 20082008


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Antimicrobial resistance surveillance in Ireland