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Antimicrobial resistance surveillance in Europe PDF

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SURVEILLANCE REPORT Antimicrobial resistance surveillance in Europe 2009 www.ecdc.europa.eu Antimicrobial resistance surveillance in Europe Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) 2009 Antimicrobial resistance surveillance in Europe 2009 SURVEILLANCE REPORT Suggested citation for full report: European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2009. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2010. Cover picture © istockphoto ISBN 978-92-9193-227-6 doi 10.2900/35994 © European Centre for Disease Prevention and Control, 2010. Reproduction is authorised, provided the source is acknowledged. ii SURVEILLANCE REPORT Antimicrobial resistance surveillance in Europe 2009 Contents Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Countries participating in EARS-Net 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix National institutions/organisations participating in EARS-Net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 2 Escherichia coli and Staphylococcus aureus: bad news and good news. Analysis of data from laboratories reporting continuously from 2002 to 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 2.1 Methods of analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 2.2 Limitations of the analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 2.3 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 3 External Quality Assessment Exercise (EQA) 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 3.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 3.2. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 3.3 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 4 EARS-Net laboratory/hospital denominator data 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.2 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.3 Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.4 Population coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.5 Hospital denominator information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.6 Hospital characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.7 Laboratory denominator information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.8 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 5 Antimicrobial resistance in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 5.1 Streptococcus pneumoniae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 5.2 Staphylococcus aureus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 5.3 Enterococci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 5.4 Escherichia coli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 5.5 Klebsiella pneumoniae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 5.6 Pseudomonas aeruginosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 Annex 1: Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Annex 2: Country summary sheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 iii Antimicrobial resistance surveillance in Europe 2009 SURVEILLANCE REPORT List of tables 2.1: Average numbers of Escherichia coli and Staphylococcus aureus isolates per country reported yearly from 2002 to 2009 by laboratories participating continuously in EARSS/EARS-Net during this time interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 3.1: Escherichia coli (9448): Minimum inhibitory concentration (MIC) and intended results reported by reference laboratories and the overall concordance of the participating laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3.2: Klebsiella pneumoniae (9449): Minimal inhibitory concentration (MIC) and intended results reported by the reference laboratories and the overall concordance of the participating laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3.3: Streptococcus pneumoniae (9450): Minimum inhibitory concentration (MIC) and intended results reported by the reference laboratories and the overall concordance of the participating laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3.4: Pseudomonas aeruginosa (9451): Minimum inhibitory concentration (MIC) and intended results reported by the reference laboratories and the overall concordance of the participating laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.5: Pseudomonas aeruginosa (9452): Minimum inhibitory concentration (MIC) and intended results reported by the reference laboratories and the overall concordance of the participating laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.6: Staphylococcus aureus (9453): Minimum inhibitory concentration (MIC) and intended results reported by the reference laboratories and the overall concordance of the participating laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 4.1: Hospital denominator data for 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 4.2: Hospital characteristics for 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 4.3: Laboratory denominator information for 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 5.1: Number of invasive S. pneumoniae isolates and proportion of penicillin-non-susceptible (PNSP), penicillin-resistant (PRSP), macrolide non-susceptible (MNSP), single penicillin (PEN), single macrolides (MACR) and dual non-susceptible (DUAL) isolates, including 95% confidence intervals (95% CI), reported per country in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 5.2: Distribution of single penicillin, single macrolides and dual penicillin-macrolides non-susceptibility, among the most common serogroups reported per country in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 5.3: Number of invasive S. aureus isolates and proportion resistant to meticillin (MRSA) and rifampin (RIF), including 95% confidence intervals (95% CI), reported per country in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 5.4: Number of invasive E. faecalis and E. faecium isolates and proportion of high-level aminoglycoside-resistant E. faecalis and vancomycin-resistant E. faecium (%R), including 95% confidence intervals (95% CI), reported per country in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 5.5: Number of invasive E. coli isolates and proportion aminopenicillins, third-generation cephalosporins, fluoroquinolones, aminoglycosides and multiresistance (%R), including 95% confidence intervals (95% CI), reported per country in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 5.6: Number of invasive E. coli isolates resistant to third-generation cephalosporins (CREC) and proportion of ESBL positive among these isolates, as ascertained by the participating laboratories in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 5.7: Overall resistance and resistance combinations among invasive Escherichia coli isolates tested against aminopenicillins, fluoroquinolones, third-generation cephalosporins and aminoglycosides (n= 42 898) in Europe, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 5.8: Number of invasive K. pneumoniae isolates and proportion of fluoroquinolones, third-generation cephalosporins, aminoglycosides and multiresistance (%R), including 95% confidence intervals (95% CI), reported per country in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5.9: Number of invasive K. pneumoniae isolates resistant to third-generation cephalosporins (CRKP) and proportion of ESBL positive among these isolates, as ascertained by the participating laboratories in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5.10: Overall resistance and resistance combinations among invasive Klebsiella pneumoniae isolates tested against fluoroquinolones, third-generation cephalosporins and aminoglycosides (n= 10 952) in Europe, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 5.11: Number of invasive P. aeruginosa isolates and proportion of piperacillin±tazobactam, fluoroquinolones, ceftazidime, aminoglycosides, carbapenems and multiresistance (%R), including 95% confidence intervals (95% CI), reported per country in 2009 . . . . . . . . . .68 5.12: Overall resistance and resistance combinations among invasive Pseudomonas aeruginosa isolates tested against at least three antibiotic classes among piperacillin±tazobactam, ceftazidime, fluoroquinolones, aminoglycosides and carbapenems (n= 8 376) in Europe, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 List of figures 2.1: Yearly number of bloodstream infections caused by Escherichia coli and Staphylococcus aureus. EARSS/EARS-Net 2002–2009 (22 countries/198 laboratories) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 2.2: Proportion of third-generation cephalosporin-resistant Escherichia coli (CREC) and meticillin-resistant Staphylococcus aureus (MRSA). EARSS/EARS-Net 2002–2009 (22 countries/198 laboratories) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 2.3: Combined resistance (R) of Escherichia coli to aminopenicillins, third-generation cephalosporins, fluoroquinolones and aminoglycosides. EARSS/EARS-Net 2002–2009 (22 countries/198 laboratories) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 3.1: Proportion of participating laboratories returning reports per country, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 3.2: Adherence to guidelines: number of laboratories per country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 4.1: Number of laboratories and hospitals reporting AMR and/or denominator data in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 iv SURVEILLANCE REPORT Antimicrobial resistance surveillance in Europe 2009 4.2: Proportion of small, medium and large hospitals per country, based on the number of beds, for all hospital reporting both antimicrobial resistance data and denominator data in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 5.1: Streptococcus pneumoniae: proportion of invasive isolates non-susceptible to penicillin (PNSP) in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5.2: Streptococcus pneumoniae: proportion of invasive isolates non-susceptible to macrolides in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 5.3: Streptococcus pneumoniae: proportion of invasive isolates with dual non-susceptibility to penicillin and macrolides in 2009 . . . . . . . . . . . . . . . .22 5.4: Streptococcus pneumoniae: trend of penicillin non-susceptibility by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 5.5: Streptococcus pneumoniae: trend of macrolides non-susceptibility by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 5.6: Streptococcus pneumoniae: trend of dual non-susceptibility (penicillin and macrolides) by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 5.7: Distribution of serogroups and the resistance profile of S. pneumoniae isolates per serogroup in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 5.8: Staphylococcus aureus: proportion of invasive isolates resistant to meticillin (MRSA) in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 5.9: Staphylococcus aureus: trend of meticillin-resistance (MRSA) by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 5.10: Enterococcus faecalis: proportion of invasive isolates with high-level resistance to aminoglycosides in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 5.11: Enterococcus faecalis: trends of high-level aminoglycoside resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 5.12: Enterococcus faecium: proportion of invasive isolates resistant to vancomycin in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 5.13: Enterococcus faecium: trends of vancomycin resistance by country 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 5.14: Escherichia coli: proportion of third-generation cephalosporin resistance in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 5.15: Escherichia coli: proportion of invasive isolates with resistance to fluoroquinolones in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 5.16: Escherichia coli: proportion of invasive isolates with resistance to aminoglycosides in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 5.17: Escherichia coli: trends of aminopenicillin resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 5.18: Escherichia coli: trends of third-generation cephalosporin resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 5.19: Escherichia coli: trends of fluoroquinolone resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 5.20: Escherichia coli: trends of aminoglycoside resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 5.21: Escherichia coli: trends of combined resistance (resistant to fluoroquinolones, third-generation cephalosporins and aminoglycosides) by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 5.22: Klebsiella pneumoniae: proportion of invasive isolates resistant to third-generation cephalosporins in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 5.23: Klebsiella pneumoniae: proportion of invasive isolates resistant to fluoroquinolones in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 5.24: Klebsiella pneumoniae: proportion of invasive isolates resistant to aminoglycosides in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 5.25: Klebsiella pneumoniae: proportion of invasive isolates resistant to carbapenems in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 5.26: Klebsiella pneumoniae: trend of third-generation cephalosporins resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5.27: Klebsiella pneumoniae: trend of fluoroquinolones resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 5.28: Klebsiella pneumoniae: trend of aminoglycosides resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 5.29: Klebsiella pneumoniae: trend of multiresistance (third-generation cephalosporins, fluoroquinolones and aminoglycosides) by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 5.30: Pseudomonas aeruginosa: proportion of invasive isolates resistant to piperacillin±tazobactam in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.31: Pseudomonas aeruginosa: proportion of invasive isolates resistant to ceftazidime in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.32: Pseudomonas aeruginosa: proportion of invasive isolates resistant to fluoroquinolones in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 5.33: Pseudomonas aeruginosa: proportion of invasive isolates resistant to aminoglycosides in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 5.34: Pseudomonas aeruginosa: proportion of invasive isolates resistant to carbapenems in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.35: Pseudomonas aeruginosa: trend of piperacillin±tazobactam resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 5.36: Pseudomonas aeruginosa: trend of ceftazidime resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 5.37: Pseudomonas aeruginosa: trend of fluoroquinolones resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 5.38: Pseudomonas aeruginosa: trend of aminoglycosides resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 5.39: Pseudomonas aeruginosa: trend of carbapenems resistance by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 5.40: Pseudomonas aeruginosa: trend of multiresistance (R to three or more antibiotic classes among piperacillin±tazobactam, ceftazidime, fluoroquinolones, aminoglycosides and carbapenems) by country, 2006–2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 v SURVEILLANCE REPORT Antimicrobial resistance surveillance in Europe 2009 Abbreviations and acronyms AMR Antimicrobial resistance KPC Klebsiella pneumoniae carbapenemase AmpC Ampicillinase C MIC Minimum inhibitory concentration ARMed Antibiotic resistance surveillance and MLS Macrolide, lincosamide and streptogramin control in the Mediterranean region MNSP Macrolide non-susceptible S. pneumoniae AST Antimicrobial susceptibility testing MRSA Meticillin-resistant Staphylococcus aureus BSAC British Society for Antimicrobial NDM-1 New Delhi metallo-beta-lactamase 1 Chemotherapy NRL National reference laboratories BSI Bloodstream infections NWGA Norwegian Working Group on CC Clonal complex Antimicrobials CMY Cephamycinase OXA Oxacillinase gene CLSI Clinical and Laboratory Standards Institute PBP Penicillin-binding protein CREC Third-generation cephalosporin-resistant PCV Pneumococcal conjugate vaccine E. coli PNSP Penicillin-non-susceptible Streptococcus CRKP Third-generation cephalosporin-resistant pneumoniae K. pneumoniae PRSP Penicillin-resistant Streptococcus CSF Cerebrospinal fluid pneumoniae DCFP Data Check and Feedback Programme RNA Ribonucleic acid DEFS Data Entry & Feedback Software SeqNet European Network of Laboratories for DG SANCO Directorate-General for Health and Sequence Based Typing of Microbial Consumer Protection Pathogens DIN Deutsche Industrie Norm (German) SFM Comité de l’Antibiogramme de la Société Française de Microbiologie (French) DNA Deoxyribonucleic acid SIR Sensitive, intermediate, resistant EARSS European Antimicrobial Resistance Surveillance System SHV Sulfhydryl-variable extended-spectrum beta-lactamase gene EARS-Net European Antimicrobial Resistance Surveillance Network Spa-typing S. aureus protein A-gene sequence typing ECDC European Centre for Disease Prevention SRGA Swedish Reference Group for Antibiotics and Control TESSy The European Surveillance System (at ENSP Erythromycin non-susceptible ECDC) Streptococcus pneumoniae TEM Temoneira extended-spectrum beta- EU European Union lactamase gene EQA External quality assessment UK NEQAS United Kingdom National External Quality Assessment Scheme for Microbiology ESAC European Surveillance of Antimicrobial Consumption VISA Vancomycin-intermediate Staphylococcus aureus ESBL Extended-spectrum beta-lactamase VIM Verona integron-encoded ESCMID European Society of Clinical Microbiology metallo-beta-lactamase and Infectious Diseases VRE Vancomycin-resistant enterococci ESGARS ESCMID Study Group for Antimicrobial Resistance Surveillance VREF Vancomycin-resistant Enterococcus faecalis EUCAST European Committee on Antimicrobial VRSA Vancomycin-resistant Staphylococcus Susceptibility Testing aureus FREC Fluoroquinolone-resistant E. coli WHO World Health Organization GISA Glycopeptide intermediate-resistant WHONET WHO microbiology laboratory database Staphylococcus aureus software GRC Commissie Richtlijnen Gevoeligheidsbepalingen (Dutch) ICU Intensive care unit IMP Imipenemase vii

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Antimicrobial resistance surveillance in Europe Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) 2009
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