Download E. coli

Antimicrobial resistance
surveillance in Ireland
Results of invasive
Escherichia coli infection (blood/CSF)
surveillance, 2009
**** Data as of 01/12/2010 ****
Ireland is a member of the European Antimicrobial Resistance
Surveillance Network (EARS-Net)
EARS-Net E. coli:
Objective and case definition
Objective:

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 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/AZ/MicrobiologyAntimicrobialResistance/EuropeanAntimic
robialResistanceSurveillanceSystemEARSS/
Antibiotic codes and abbreviations:
AMK, Amikacin
CTX, Cefotaxime
CAZ, Ceftazidime
CIP, Ciprofloxacin
IPM, Imipenem
OFX, Ofloxacin
TOB, Tobramycin
AMP, Ampicillin
CPD, Cefpodoxime
CRO, Ceftriaxone
GEN, Gentamicin
MEM, Meropenem
TZP, Piperacillin-Tazobactam
3GC, 3rd-Generation Cephalosporin
AMR, Antimicrobial Resistance
ECO, Escherichia coli
ESBL, Extended-Spectrum Beta-Lactamase
FQREC, Fluoroquinolone-Resistant E. coli
FQSEC, Fluoroquinolone-Susceptible E. coli
MDR, Multi-Drug Resistance
Numbers and resistance proportions of E. coli
from invasive infection, 2002-2009
Time
period
2002
Number
of labs
21
Number of
isolates
741
%AMP-R*
62.2
%3GC-R*
3.0
%CIP-R*
5.4
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
* Not all isolates tested
%GEN/TOB/
%GEN-R*
AMK-R*
2.7
2.9
Proportions of ESBLs and MDR among E. coli
from invasive infection, 2002-2009
Time
period
2002
Number
of labs
21
Number of
isolates
741
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
* Not all isolates tested
%3GC-R* %ESBL+* %MDR*
3.0
1.2
2.4
Invasive E. coli resistance trends, 2002-2009
2500
21 27
40
41
44
42
42
44
44
44
44
30%
25%
2000
20%
1500
15%
1000
10%
500
%Resistance
Number of isolates
44
5%
0
0%
Time period
Total E. coli
%3GC-R
%CIP/OFX-R
%GEN-R
%GEN/AMK/TOB-R
Number of laboratories participating by year-end and quarter are indicated above the bars
Invasive E. coli resistance trends, 2002-2009:
3GCs and ESBLs
2500
21
27
40
41
20%
42
44
42
44
44
44
44 44
15%
1500
10%
1000
%Resistance
Number of isolates
2000
5%
500
0
0%
Time period
Total E. coli tested for ESBL
ESBL-positive
%ESBL-positive
Number of laboratories participating by year-end and quarter are indicated above the bars
%3GC-R
Invasive MDR E. coli trends, 2002-2009
21
27
40
41
42
44
42
44
44
44
44
Number of isolates
2000
44
20%
15%
1500
10%
1000
5%
500
0
0%
Time period
Total E. coli tested for MDR
MDR
%MDR
Number of laboratories participating by year-end and quarter are indicated above the bars
%Resistance
2500
Numbers and proportions of fluoroquinolone
(FQ)-resistant invasive E. coli infection by
hospital type, 2009
Number of
Hospital Type
isolates
Specialist/Tertiary
974
Secondary
750
Primary
147
General (Private)
100
Maternity
45
Paediatric
28
Other
13
Radiotherapy/Oncology
4
Orthopaedic
3
Total
2064
FQ-R
240
161
32
19
1
0
4
0
1
458
FQ-S
733
588
115
80
40
28
9
4
2
1599
%FQ-S
24.7%
21.5%
21.8%
19.2%
2.4%
0.0%
30.8%
0.0%
33.3%
22.3%
Numbers and proportions of MDR invasive
E. coli infection by hospital type, 2009
Number of
Hospital Type
isolates
Specialist/Tertiary
973
Secondary
751
Primary
147
General (Private)
100
Maternity
45
Paediatric
28
Other
13
Orthopaedic
4
Radiotherapy/Oncology
3
Total
2064
MDR
118
62
19
10
0
1
1
0
0
211
Non-MDR
837
681
128
88
41
27
12
4
3
1821
%MDR
12.4%
8.3%
12.9%
10.2%
0.0%
3.6%
7.7%
0.0%
0.0%
10.4%
Susceptibility data for invasive E. coli isolates,
2009 (n=2064)
2500
Number of isolates
68.7%
7.5%
6.8%
2000
6.5%
22.3% 7.7%
9.3%
8.3%
0.1%
3.3%
1500
1000
11.3%
14.2%
12.3%
500
0
Resistant
Antibiotic
Susceptible
No data
A
ESBL
-ve
Resistance Profile
Fully susceptible
Number of
isolates
601
ESBL
+ve
Resistance profiles of E. coli isolates,
2009
601
903
842
C
31
31
G
4
4
A3
29
AC
219
205
AG
CG
34
32
A3C*
62
48
13
A3G*
7
3
3
ACG*
86
A3CG*
Not tested against all
56
32
51
1
5
31
2064
114
1864
3
Total
11
16
81
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
profiles of E. coli isolates, 2002-2009
1000
21
27 40
41
44
42
42
44
44
44
44
44
900
Number of isolates
800
700
600
500
400
300
200
100
0
Time period
Fully S
A
AC
A3C
ACG
Number of laboratories participating by year-end and quarter are indicated above the bars
A3CG
Trends in PROPORTIONS of main resistance
profiles of E. coli isolates, 2002-2009 (1)
60%
50%
% isolates
40%
30%
20%
10%
0%
Time period
Fully S
A
AC
A3C
ACG
A3CG
See next slide…………….
Trends in PROPORTIONS of main resistance
profiles of E. coli isolates, 2002-2009 (2)
14%
% isolates
12%
10%
8%
6%
4%
2%
0%
Time period
AC
A3C
ACG
A3CG
Age and sex distribution of patients with
invasive E. coli infection, 2009
250
Number of isolates
200
150
100
50
0
Age Group
female
male
Age and sex-specific incidence rates of
invasive E. coli infection, 2009
800
700
600
ASIR
500
400
300
200
100
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 invasive E. coli infection, 2009
Non-MDR
FQREC
FQSEC
MDR ECO
ECO
ECO
n
458
1599
211
1821
2064
n with age
458
1599
211
1821
2064
Mean
69.4y
63.7y
69.6y
64.6y
65.6y
Median
73y (71-75y) 70y (69-71y) 72y (70-75y) 71y (69-72y) 72y (71-73y)
Mode
77y
0y
77y
83y
83
Range
0-96y
0-97y
0-95y
0-97y
0-97y
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)
Sex distribution of patients with invasive
E. coli infection, 2009
No. male
%male
No. female
%female
m/f ratio
z-test
P-value
FQREC
253
55.2
205
44.8
1.23
2.26
0.024
FQSEC
667
41.7
932
58.3
0.72
-6.72
<0.0001
MDR ECO
116
55.0
95
45.0
1.22
1.45
0.15
Non-MDR
ECO
791
43.4
1030
56.6
0.77
-5.65
<0.0001
ECO
921
44.6
1143
55.4
0.81
-4.92
<0.0001
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. 1.25times 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.
E. coli - distribution of 3GC (e.g. CTX or CAZ)
resistance in EARSS/EARS-Net countries in
2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
E. coli - distribution of 3GC (e.g. CTX or CAZ)
resistance in EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
E. coli - distribution of fluoroquinolone (e.g.
CIP) resistance in EARSS/EARS-Net countries
in 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
E. coli - distribution of fluoroquinolone (e.g.
CIP) resistance in EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009
E. coli - distribution of aminoglycoside (e.g.
GEN) resistance in EARSS/EARS-Net
countries in 2009
Map downloaded from:
http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010
E. coli - distribution of aminoglycoside (e.g.
GEN) resistance in EARSS countries in 2008
Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009