Download EARSS in Ireland, 2007

Antimicrobial resistance
surveillance in Ireland
Results of invasive
Enterococcus faecium bacteraemia
surveillance (2009Q1-4)
**** Data as of 14/04/2010 ****
Ireland is a member of the European Antimicrobial Resistance
Surveillance System (EARSS)
EARSS E. faecium:
Objective and case definition
Objective:

To determine the proportions of E. faecium isolates from
blood that are resistant to 3 key antibiotic classes:
◦
Ampicillin
◦
High-level gentamicin
◦
Vancomycin
Case definition:

EARSS collects data on the first invasive isolate (from blood
only) of E. faecium per patient per quarter
Caveats in interpreting EARSS data

Care must be exercised when interpreting the raw
figures, i.e. increases in numbers of isolates, as the
numbers of laboratories reporting to EARSS has
increased over the years

EARSS 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 EARSS in Ireland, including quarterly and annual
reports, plus reference/ resource material on the
individual pathogens under surveillance, see:
http://www.ndsc.ie/hpsc/AZ/MicrobiologyAntimicrobialResistance/EuropeanAntimic
robialResistanceSurveillanceSystemEARSS/
Antibiotic codes and abbreviations:
AMP, Ampicillin
LNZ, Linezolid
TEC, Teicoplanin
HLG, High-Level Gentamicin
QDA, Quinupristin-Dalfopristin
VAN, Vancomycin
AMR, Antimicrobial Resistance
MDR, Multi-Drug Resistance
EFM, Enterococcus faecium
VREfm,Vancomycin-Resistant E. faecium
VSEfm,Vancomycin-Susceptible E. faecium
MDR, Multi-Drug Resistance
Numbers and resistance proportions of
E. faecium from bacteraemia, 2002-2009*
Time
period
2002
Number Number of
of labs
isolates %AMP-R* %VAN-R* %HLG-R*
21
85
88.9
11.1
16.7
%MDR*
3.7
2003
27
135
91.0
19.4
53.8
11.4
2004
40
187
95.7
23.2
58.0
18.5
2005
42
224
92.3
31.7
51.4
25.6
2006
42
265
93.9
37.1
44.3
25.6
2007
44
332
93.1
33.5
34.9
22.3
2008
42
406
95.1
35.7
28.4
16.2
2009**
44
397
92.9
39.1
38.3
26.7
2009Q1
44
118
91.5
38.1
30.6
22.5
2009Q2
44
111
93.6
34.2
38.0
23.1
2009Q3
44
74
91.9
37.8
42.0
26.1
2009Q4
44
94
94.4
48.9
43.6
36.8
* Not all isolates tested;
** Data for 2009 provisional up to the end of Q4
E. faecium bacteraemia resistance trends,
2002-2009*
21
27
40
41
42
44
42
44
44
44
44
44
100%
400
90%
350
80%
70%
300
60%
250
50%
200
40%
150
30%
100
20%
50
10%
0
0%
Time period
Total E. faecium
%AMP-R
%HLG-R
%VAN-R
* Data for 2009 provisional up to the end of Q4;
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
Number of isolates
450
Invasive MDR E. faecium trends, 2002-2009*
21
27
40
41
42
44
42
44
44
44
44
50%
45%
350
Number of isolates
44
40%
300
35%
250
30%
200
25%
150
20%
15%
100
10%
50
5%
0
0%
Time period
Total E. faecium tested for MDR
MDR
%MDR
* Data for 2009 provisional up to the end of Q4;
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
400
Numbers and proportions of VREfm
bacteraemia by hospital type, 2009Q1-4
Number of
isolates
VREfm
VSEfm
%VREfm
284
140
144
49.3%
Secondary
82
12
70
14.6%
Paediatric
14
0
10
0.0%
General (Private)
10
0
14
0.0%
Primary
5
0
5
0.0%
Radiotherapy/Oncology
2
0
2
0.0%
397
152
245
38.3%
Hospital Type
Specialist/Tertiary
Total
Numbers and proportions of MDR E. faecium
bacteraemia by hospital type, 2009Q1-4
Number of
isolates
MDR
Non-MDR
%MDR
284
93
181
33.9%
Secondary
82
7
68
9.3%
Paediatric
14
0
11
0.0%
General (Private)
10
0
8
0.0%
Primary
5
0
5
0.0%
Radiotherapy/Oncology
2
0
2
0.0%
397
100
275
26.7%
Hospital Type
Specialist/Tertiary
Total
Susceptibility data for E. faecium bacteraemia
isolates, 2009 (n=397)
450
400
92.9%
39.1%
38.3%
5.2%
Number of isolates
350
39.5%
300
250
200
150
3.5%
100
50
0
AMP
HLG
Resistant
VAN
TEC
Antibiotic
Susceptible
LNZ
No data
QDA
Resistance profiles of E. faecium isolates in
2009Q1-4
Resistance Profile
Fully susceptible
Number of isolates
23
A
160
G
1
V
2
AG
47
AV
42
GV
0
AGV*
Not tested against all
Total
100
22
397
A, Ampicillin; G, High-Level Gentamicin; V, Vancomycin
* Multi-drug resistant (defined as resistance to all 3 classes)
Trends in NUMBERS of main resistance
profiles of E. faecium isolates, 2002-2009*
21
Number of isolates with resistance profile
200
27
40
41
42
44
42
44
44
44
180
160
140
120
100
80
60
40
20
0
A
* Data for 2009 provisional up to the end of Q4
Time period
AG
AV
AGV
44
44
Trends in PROPORTIONS of main resistance
profiles of E. faecium isolates, 2002-2009*
% isolates with resistance profile
70%
60%
50%
40%
30%
20%
10%
0%
Time period
A
* Data for 2009 provisional up to the end of Q4
AG
AV
AGV
Age and sex distribution of patients with
invasive E. faecium infection in 2008
40
Number of isolates
35
30
25
20
15
10
5
0
Age Group
female male
Age and sex-specific incidence rates of
E. faecium bacteraemia in 2008
100
90
80
70
ASIR
60
50
40
30
20
10
0
Age Group
female
male
ASIR, Age-Specific Incidence Rate (per 100,000 population)
TOTAL
Mean, median, mode and range of ages of
patients with E. faecium bacteraemia in 2008
VREfm
VSEfm
MDR EFM
Non-MDR
EFM
n
145
261
61
240
406
n with age
145
261
61
240
406
60.1y
60.0y
58.9y
61.4y
60.0y
Mean
Median
EFM
63y (60-64y) 65y (62-70y) 60y (53-64y) 66y (62-71y) 64y (62-65y)
Mode
63y
74y
52y
74y
71y
Range
0-89y
0-98y
0-87y
0-98y
0-98y
Sex distribution of patients with E. faecium
bacteraemia in 2008
Non-MDR
EFM
MDR EFM
VREfm
VSEfm
80
149
65
178
229
55.2
57.1
44.8
56.3
56.4
65
112
80
138
177
%female
44.8
42.9
55.2
43.7
43.6
m/f ratio
1.23
1.33
0.81
1.29
1.29
z-test
1.25
2.31
1.17
2.27
2.60
P-value
0.21
0.021
0.24
0.023
0.009
No. male
%male
No. female
EFM
In patients with laboratory-confirmed invasive E. faecium infection in 2008,
males were approximately 1.3-times more likely to get an infection than
females (significant, P=0.009).
E. faecium - distribution of high-level gentamicin
resistance in EARSS countries, 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
E. faecium - distribution of high-level gentamicin
resistance in EARSS countries, 2007
Map downloaded from http://www.rivm.nl/earss/database/ on 28/08/2008
E. faecium - distribution of vancomycin
resistance in EARSS countries, 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
E. faecium - distribution of vancomycin
resistance in EARSS countries, 2007
Map downloaded from http://www.rivm.nl/earss/database/ on 28/08/2008