Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016

Publisher Copyright: © 2019 European Centre for Disease Prevention and Control (ECDC). All rights reserved.Background: Antibiotic resistance, either intrinsic or acquired, is a major obstacle for treating bacterial infections. Aim: Our objective was to compare the countryspecific species distribution of the four Gram-negative species Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species and the proportions of selected acquired resistance traits within these species. Method: We used data reported for 2016 to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 countries in the European Union and European Economic Area. Results: The country-specific species distribution varied considerably. While E. coli accounted for 31.9% to 81.0% (median: 69.0%) of all reported isolates, the two most common intrinsically resistant species P. aeruginosa and Acinetobacterspp. combined (PSEACI) accounted for 5.5% to 39.2% of isolates (median: 10.1%). Similarly, large national differences were noted for the percentages of acquired non-susceptibility to third-generation cephalosporins, carbapenems and fluoroquinolones. There was a strong positive rank correlation between the countryspecific percentages of PSEACI and the percentages of non-susceptibility to the above antibiotics in all four species (rho > 0.75 for 10 of the 11 pairs of variables tested). Conclusion: Countries with the highest proportion of P. aeruginosa and Acinetobacter spp. were also those where the rates of acquired non-susceptibility in all four studied species were highest. The differences are probably related to national differences in antibiotic consumption and infection prevention and control routines.Peer reviewe

Decreasing and stabilising trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae in segmented regression analysis, European Union/European Economic Area, 2001 to 2018

The authors acknowledge the work performed by the staff of the participating clinical microbiology laboratories and of the national healthcare services that provided data to ESAC-Net and EARS-Net. Germán Peñalva was supported by El Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001) ‐ co‐financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014‐2020, and received a grant from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) for a three-month study visit at ECDC during which the analysis was performed. Publisher Copyright: © 2019 European Centre for Disease Prevention and Control (ECDC). All rights reserved.Investments to reduce the spread of antimicrobial resistance (AMR) in the European Union have been made, including efforts to strengthen prudent antimicrobial use. Using segmented regression, we report decreasing and stabilising trends in data reported to the European Surveillance of Antimicrobial Consumption Network and stabilising trends in data reported to the European Antimicrobial Resistance Surveillance Network. Our results could be an early indication of the effect of prioritising AMR on the public health agenda.Peer reviewe

Large increase in bloodstream infections with carbapenem-resistant Acinetobacter species during the first 2 years of the COVID-19 pandemic, EU/EEA, 2020 and 2021

EARS-Net Study Group (Portugal: Manuela Caniça).EARS-Net Study Group participants: Reinhild Strauss, Karl Mertens, Stefana Sabtcheva, Arjana Tambic Andrasevic, Panagiota Maikanti, Helena Žemličková, Henrik Hasman, Marina Ivanova, Kati Räisänen, Sylvie Maugat, Ines Noll, Kassiani Mellou, Ákos Tóth, Kristján Orri Helgason, Stephen Murchan, Giulia Errico, Ieva Voita, Esther Walser-Domjan, Jolanta Miciulevičienė, Monique Perrin, Elizabeth Anne Scicluna, Sjoukje Hs Woudt, Ørjan Samuelsen, Dorota Żabicka, Manuela Caniça, Gabriel Adrian Popescu, Eva Schréterová, Helena Ribič, Maria Belén Aracil García, Hanna Billström.Bloodstream infections (BSIs) with Acinetobacter species commonly have poor outcomes, especially in intensive care unit (ICU) patients [1]. Acinetobacter spp. is intrinsically resistant to many antimicrobials, and additional acquired resistance further complicates the treatment of serious infections in already vulnerable patient groups. Recent data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) show a large and statistically significant increase in reports of Acinetobacter spp. BSIs in the European Union (EU) and European Economic Area (EEA) during the period from 2017 to 2021 [2]. Most of this increase occurred in 2020 and 2021, the first years of the coronavirus disease (COVID-19) pandemic. Here we further explore this trend in a subset of data from laboratories that continuously reported data during that period.info:eu-repo/semantics/publishedVersio

An increase in erythromycin resistance in methicillin-susceptible Staphylococcus aureus from blood correlates with the use of macrolide/lincosamide/streptogramin antibiotics. EARS-Net Spain (2004–2020)

Objectives: To describe and analyse erythromycin resistance trends in blood isolates of Staphylococcus aureus (EARS-Net Spain, 2004–2020) and the association of these trends with the consumption of macrolide, lincosamide, and streptogramin B (MLSB) antibiotics. To assess molecular changes that could be involved in erythromycin resistance trends by whole genome analysis of representative isolates. Materials and methods: We collected antibiotic susceptibility data for all firstblood S. aureus isolates in patients from 47 Spanish hospitals according to EARS-Net criteria. MLSB antibiotic consumption was obtained from the Spanish Agency for Medicines and Medical Devices (2008–2020). We sequenced 137 representative isolates for core genome multilocus sequence typing, resistome and virulome analysis. Results: For the 36,612 invasive S. aureus isolates, methicillin resistance decreased from 26.4% in 2004 to 22.4% in 2020. Erythromycin resistance in methicillin-susceptible S. aureus (MSSA) increased from 13.6% in 2004 to 28.9% in 2020 (p < 0.001); however, it decreased from 68.7 to 61.8% (p < 0.0001) in methicillin-resistant S. aureus (MRSA). Total consumption of MLSB antibiotics increased from 2.72 defined daily doses per 1,000 inhabitants per day (DID) in 2014 to 3.24 DID in 2016. By WGS, the macrolide resistance genes detected were erm (59.8%), msrA (46%), and mphC (45.2%). The erm genes were more prevalent in MSSA (44/57, 77.2%) than in MRSA (38/80, 47.5%). Most of the erm genes identified in MSSA after 2013 differed from the predominant ermC gene (17/22, 77.3%), largely because ermT was significantly associated with MSSA after 2013 (11/29, 37.9%). All 13 ermT isolates in this study, except one, belonged to ST398 and came from 10 hospitals and six Spanish provinces. Conclusion: The significant increase in erythromycin resistance in blood MSSA correlated with the consumption of the MLSB antibiotics in Spain. These preliminary data seem support the hypothesis that the human ST398 MSSA clade with ermT-mediated resistance to erythromycin may be involved in this trend.This research was supported by CIBER—Consorcio Centro de Investigación Biomédica en Red (CB21/13/00095, CB21/13/00006, CB21/13/00054, CB21/13/00068, CB21/13/00084, CB21/13/00099 groups of CIBERINFEC; CB06/06/0058 group of CIBERES), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU. This research was also supported by Personalized and precision medicine grant from the Instituto de Salud Carlos III (MePRAM Project, PMP22/00092), and by the Antibiotic Resistance and Staphylococcus aureus Surveillance Programs of the National Center for Microbiology, Instituto de Salud Carlos III.S

Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016

BackgroundAntibiotic resistance, either intrinsic or acquired, is a major obstacle for treating bacterial infections.AimOur objective was to compare the country-specific species distribution of the four Gram-negative species Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species and the proportions of selected acquired resistance traits within these species.MethodWe used data reported for 2016 to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 countries in the European Union and European Economic Area.ResultsThe country-specific species distribution varied considerably. While E. coli accounted for 31.9% to 81.0% (median: 69.0%) of all reported isolates, the two most common intrinsically resistant species P. aeruginosa and Acinetobacter spp. combined (PSEACI) accounted for 5.5% to 39.2% of isolates (median: 10.1%). Similarly, large national differences were noted for the percentages of acquired non-susceptibility to third-generation cephalosporins, carbapenems and fluoroquinolones. There was a strong positive rank correlation between the country-specific percentages of PSEACI and the percentages of non-susceptibility to the above antibiotics in all four species (rho > 0.75 for 10 of the 11 pairs of variables tested).ConclusionCountries with the highest proportion of P. aeruginosa and Acinetobacter spp. were also those where the rates of acquired non-susceptibility in all four studied species were highest. The differences are probably related to national differences in antibiotic consumption and infection prevention and control routines

Escherichia coli and Staphylococcus aureus: bad news and good news from the European Antimicrobial Resistance Surveillance Network (EARS-Net), formerly EARSS), 2002 to 2009

Based on data collected by the European Antimicrobial Resistance Surveillance Network (EARS-Net) and the former EARSS, the present study describes the trends in antimicrobial susceptibility patterns and occurrence of invasive infections caused by Escherichia coli and Staphylococcus aureus in the period from 2002 to 2009. Antimicrobial susceptibility results from 198 laboratories in 22 European countries reporting continuously on these two microorganisms during the entire study period were included in the analysis. The number of bloodstream infections caused by E. coli increased remarkably by 71% during the study period, while bloodstream infections caused by S. aureus increased by 34%. At the same time, an alarming increase of antimicrobial resistance in E. coli was observed, whereas for S. aureus the proportion of meticillin resistant isolates decreased. The observed trend suggests an increasing burden of disease caused by E. coli. The reduction in the proportion of meticillin-resistant S. aureus and the lesser increase in S. aureus infections, compared with E. coli, may reflect the success of infection control measures at hospital level in several European countries.</p

A randomized trial of the efficacy and safety of sequential intravenous/oral moxifloxacin monotherapy versus intravenous piperacillin/tazobactam followed by oral amoxicillin/clavulanate for complicated skin and skin structure infections

Item does not contain fulltextOBJECTIVES: The primary aim of the RELIEF study was to evaluate the efficacy and safety of two sequential intravenous (iv)/oral regimens: moxifloxacin iv/oral versus piperacillin/tazobactam (TZP) iv followed by oral amoxicillin/clavulanate (AMC). PATIENTS AND METHODS: The study had a prospective, randomized, double-dummy, double-blind, multicentre design. Patients >/=18 years were prospectively stratified according to complicated skin and skin structure infection (cSSSI) subtype/diagnosis (major abscess, diabetic foot infection, wound infection or infected ischaemic ulcer), surgical intervention and severity of illness. Diagnoses and disease severity were based on predetermined criteria, documented by repeated photographs, and confirmed by an independent data review committee. Patients were randomized to receive either 400 mg of moxifloxacin iv once daily followed by 400 mg of moxifloxacin orally once daily or 4.0/0.5 g of TZP iv thrice daily followed by 875/125 mg of AMC orally twice daily for 7-21 days. The primary efficacy variable was clinical response at test of cure (TOC) for the per-protocol (PP) population. Clinical efficacy was assessed by the data review committee based on repeated photographs and case descriptions. Clinical trials registry number: NCT 00402727. RESULTS: A total of 813 patients were randomized. Clinical success rates at TOC were similar for moxifloxacin and TZP-AMC in the PP [320/361 (88.6%) versus 275/307 (89.6%), respectively; P = 0.758] and intent-to-treat (ITT) [350/426 (82.2%) versus 305/377 (80.9%), respectively; P = 0.632] populations. Thus, moxifloxacin was non-inferior to TZP-AMC. Bacteriological success rates were high in both treatment arms [moxifloxacin: 432/497 (86.9%) versus TZP-AMC: 370/429 (86.2%), microbiologically valid (MBV) population]. Moxifloxacin was non-inferior to TZP-AMC at TOC in both the MBV and the ITT populations. Both treatments were well tolerated. CONCLUSIONS: Once-daily iv/oral moxifloxacin monotherapy was clinically and bacteriologically non-inferior to iv TZP thrice daily followed by oral AMC twice daily in patients with cSSSIs

Antimicrobial resistance surveillance in Europe 2010. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

National institutions/organisations participating in EARS-Net: Portugal - National Institute of Health Dr. Ricardo Jorge: Manuela Caniça; Vera ManageiroAntimicrobial resistance data reported to EARS-Net by 28 countries in 2010 and trend analyses including EARSS data from previous years, show that the Europewide increase of antimicrobial resistance observed in Escherichia coli during recent years is continuing unimpeded. The highest resistance proportions in E. coli were reported for aminopenicillins ranging up to 83 %. Despite the already high level of resistance the increase continues even in countries presenting resistance well above 50 %. The percentage of third-generation cephalosporin resistance reported among E. coli isolates has increased significantly over the last four years in half of the reporting countries, while a decreasing trend was observed in only one country. This resistance is directly linked to the high proportions (65–100 %) of ESBL-positives among cephalosporin-resistant E. coli isolates reported in 2010. A high frequency of multi-drug resistant Klebsiella pneumoniae was observed in southern, central and eastern Europe. In half of the reporting countries, the proportion of multiresistant K. pneumoniae isolates (combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides) was above 10 % and five countries show an increasing trend of carbapenem resistant K. pneumoniae. Carbapenems have been widely used in many countries due to the increasing rate of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae with a consequent impact on the emergence of carbapenemase production (VIM, KPC and NDM-1). Other trends in the occurrence of resistance reported to EARS-Net bring hope that national efforts on infection control and efforts targeted at containment of resistance may in some cases bring the development of resistance to a halt, or even reverse undesirable resistance trends, as exemplified by the development for meticillin-resistant Staphylococcus aureus (MRSA). Even though the proportion of MRSA among S. aureus is still above 25 % in eight out of 28 countries, the occurrence of MRSA is stabilising or decreasing in some countries and a sustained decrease has been observed in Austria, France, Ireland, Latvia, the UK and Cyprus. Furthermore, the United Kingdom has shown a consistent reduction of resistant proportions in K. pneumoniae for all antimicrobial classes under surveillance, and in a few countries (Germany, Greece, Italy and the UK) the efforts to control glycopeptide resistance in Enterococcus faecium seem to be successful and resulting in a continuous decrease of proportions of resistant isolates. Meanwhile, high-level aminoglycoside resistance in Enterococcus faecalis is stabilising in Europe at a level of 25–50%. For Streptococcus pneumoniae, non-susceptibility to penicillin remains generally stable in Europe and non-susceptibility to macrolides has declined in five countries while an increasing trend was observed in only one country. For Pseudomonas aeruginosa, high proportions of resistance to fluoroquinolones, carbapenems and combined resistance have been reported by many countries, especially in southern and eastern Europe. For several antimicrobial and pathogen combinations, e.g. fluoroquinolone resistance in E. coli, K. pneumoniae, P. aeruginosa and for MRSA, a north to south gradient is evident in Europe. In general, lower resistance proportions are reported in the north and higher proportions in the south of Europe. This is likely to be a reflection of differences in infection control practices, presence or absence of legislation regarding prescription of antimicrobial drugs. However, for K. pneumoniae, increasing trends of resistance to specific antimicrobial classes and of multiresistance have also been observed in northern European countries, like Denmark and Norway, which traditionally have a prudent approach to antimicrobial use. In addition to the regular trend analysis and situation overview, this 2010 EARS-Net report contains a focus chapter providing in-depth analysis for carbapenem resistant K. pneumoniae and P. aeruginosa. Results from susceptibility testing to carbapenems for these two pathogens reported since 2005, reveal a significant decrease of susceptibility to carbapenems in invasive K. pneumoniae over the period 2005–2010. Carbapenems are some of the few effective antimicrobials for the treatment of infections caused by bacteria that produce extended-spectrum beta-lactamases and thus resistance to carbapenems leaves very few therapeutic options available. Based on EARS-Net data, the antimicrobial resistance situation in Europe displays large variation depending on pathogen type, antimicrobial substance and geographical region. Besides evidence of stabilisation of the situation for some pathogens (e.g. MRSA) in a number of countries, the data show the unimpeded decline of antimicrobial susceptibility in other major pathogens (e.g. E. coli) and the alarming emergence of carbapenem resistance in K. pneumonia, leading to an unfortunate loss of antimicrobial treatment options

Antimicrobial resistance surveillance in Europe 2016: annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

National institutions/organisations participating in EARS-Net - Portugal: National Institute of Health Doutor Ricardo Jorge (Caniça, M., Fernandes, P.A., Manageiro, V.)The results presented in this report are based on antimicrobial resistance data from invasive isolates reported to EARS-Net by 30 European Union (EU) and European Economic Area (EEA) countries in 2017 (data referring to 2016), and on trend analyses of data reported by the participating countries for the period 2013 to 2016. As in previous years, the antimicrobial resistance situation in Europe displays wide variations depending on the bacterial species, antimicrobial group and geographical region. For several bacterial species–antimicrobial group combinations, a north-to-south and a west-to-east gradient is evident in Europe. In general, lower resistance percentages were reported by countries in the north while higher percentages were reported in the south and east of Europe. These differences are most likely related to variations in antimicrobial use, infection prevention and control practices, and dissimilarities in diagnostic and healthcare utilisation patterns in the countries.info:eu-repo/semantics/publishedVersio

Antimicrobial resistance surveillance in Europe 2011. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

EARS-Net Management Team & National representatives of EARS-Net (Manuela Caniça, Vera Manageiro, Eugénia Ferreira)The results presented in this report are based on antimicrobial resistance data from invasive isolates reported to EARS-Net by 29 EU/EEA countries in 2012 (data referring to 2011), and on trend analyses of EARSS/EARS-Net data reported by the participating countries during the period 2008 to 2011. The results show a general Europe-wide increase of antimicrobial resistance in the gram-negative pathogens under surveillance (Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa), whereas the occurrence of resistance in the gram-positive pathogens (Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis) appears to be stabilising or even decreasing in some countries. For most pathogen–antimicrobial combinations, large inter-country variations are evident. In 2011, the most alarming evidence of increasing antimicrobial resistance in Europe came from data on combined resistance (resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides) in E. coli and in K. pneumoniae. For both of these pathogens, more than one third of the reporting countries had significantly increasing trends of combined resistance over the last four years. The high and increasing percentage of combined resistance observed for K. pneumoniae means that for some patients with life-threatening infections, only a few therapeutic options remain available, e.g. carbapenems. However since 2010, carbapenem-resistance has increased in a number of countries, further aggravating the situation. For P. aeruginosa, combined resistance is also common, with 15% of the isolates resistant to at least three of the antimicrobial classes under surveillance. The seemingly unimpeded increase of antimicrobial resistance in the major gram-negative pathogens will unavoidably lead to loss of therapeutic treatment options. In parallel, other trends of antimicrobial resistance reported to EARS-Net indicate that national efforts on infection control and containment of resistance are effective, as illustrated by the trends for meticillinresistant S. aureus (MRSA), antimicrobial-resistant S. pneumoniae and antimicrobial-resistant enterococci, for which the situation appears generally stable or even improving in some countries. For MRSA, these observations are consistent with reports from the national surveillance programmes of some Member States and recent scientific studies on the results of infection control efforts. Large inter-country variations can be noted for S. pneumoniae, but non-susceptibility to commonly used antimicrobials has remained relatively stable in Europe during recent years, and this observation was confirmed by the 2011 data. High-level aminoglycoside resistance in E. faecalis seems stable in Europe and several countries which previously reported relatively high levels of resistance now have decreasing trends. Likewise, the occurrence of vancomycin-resistance in E. faecium is stabilising or decreasing. For several antimicrobial–pathogen combinations, e.g. fluoroquinolone-resistance in E. coli, K. pneumoniae, P. aeruginosa and for MRSA, a north-to-south gradient is evident in Europe. In general, lower resistance percentages are reported in the north and higher percentages in the south of Europe. These geographical differences may reflect differences in infection control practices and antimicrobial use in the reporting countries. Prudent use of antimicrobial agents and comprehensive infection control measures should be cornerstones of effective prevention and control efforts aimed at reducing the selection and transmission of antimicrobial-resistant bacteria