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Antimicrobial resistance surveillance in Ireland. Results of invasive Pseudomonas aeruginosa infection (blood/CSF) surveillance, 2009 **** Data as of 01/12/2010 ****. - PowerPoint PPT Presentation
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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
0%
5%
10%
15%
20%
25%
30%
0
50
100
150
200
250
300
%Re
sist
ance
Num
ber o
f iso
late
s
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
0%
5%
10%
15%
20%
25%
30%
35%
40%
0
50
100
150
200
250
300
%Re
sist
ance
Num
ber o
f iso
late
s
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)
0
50
100
150
200
250
Num
ber o
f iso
late
s
AntibioticResistant Susceptible No data
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
0
5
10
15
20
25
30N
umbe
r of i
sola
tes
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)
0
10
20
30
40
50
60
70
80A
SIR
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
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 ceftazidime - distribution of ceftazidime resistance in EARSS countries in 2008resistance in EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
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
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 fluoroquinolone - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS countries in (e.g. CIP) 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 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
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 aminoglycoside - distribution of aminoglycoside (e.g. GEN) resistance in EARSS countries in (e.g. GEN) resistance in EARSS countries in 2008 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
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
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010