Antimicrobial drug use and resistance in Europe

Our study confronts the use of antimicrobial agents in ambulatory care with the resistance trends of 2 major pathogens, Streptococcus pneumoniae and Escherichia coli, in 21 European countries in 2000–2005 and explores whether the notion that antimicrobial drug use determines resistance can be supported by surveillance data at national aggregation levels. The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level. Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations. Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.peer-reviewe

Worsening epidemiological situation of carbapenemase-producing Enterobacteriaceae in Europe, assessment by national experts from 37 countries, July 2018

European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net) capacity survey group (Portugal): Manuela Caniça, Vera Manageiro,A survey on the epidemiological situation, surveillance and containment activities for carbapenemase-producing Enterobacteriaceae (CPE) was conducted in European countries in 2018. All 37 participating countries reported CPE cases. Since 2015, the epidemiological stage of CPE expansion has increased in 11 countries. Reference laboratory capability, dedicated surveillance and a specific national containment plan are in existence in 33, 27 and 14 countries, respectively. Enhanced control efforts are needed for CPE containment in Europe.info:eu-repo/semantics/publishedVersio

Limited effect of patient and disease characteristics on compliance with hospital antimicrobial guidelines

Objective: Physicians frequently deviate from guidelines that promote prudent use of antimicrobials. We explored to what extent patient and disease characteristics were associated with compliance with guideline recommendations for three common infections. Methods: In a 1-year prospective observational study, 1,125 antimicrobial prescriptions were analysed for compliance with university hospital guidelines. Results: Compliance varied significantly between and within the groups of infections studied. Compliance was much higher for lower respiratory tract infections (LRTIs; 79%) than for sepsis (53%) and urinary tract infections (UTIs; 40%). Only predisposing illnesses and active malignancies were associated with more compliant prescribing, whereas alcohol/ intravenous drug abuse and serum creatinine levels > 130 mu mol/l were associated with less compliant prescribing. Availability of culture results had no impact on compliance with guidelines for sepsis but was associated with more compliance in UTIs and less in LRTIs. Narrowing initial broad-spectrum antimicrobial therapy to cultured pathogens was seldom practised. Most noncompliant prescribing concerned a too broad spectrum of activity when compared with guideline-recommended therapy. Conclusion: Patient characteristics had only a limited impact on compliant prescribing for a variety of reasons. Physicians seemed to practise defensive prescribing behaviour, favouring treatment success in current patients over loss of effectiveness due to resistance in future patients

Clinical effectiveness of rapid tests for methicillin resistant Staphylococcus aureus (MRSA) in hospitalized patients: a systematic review

<p>Abstract</p> <p>Background</p> <p>Methicillin resistant <it>Staphylococcus aureus </it>(MRSA) are often resistant to multiple classes of antibiotics. The research objectives of this systematic review were to evaluate the clinical effectiveness of polymerase chain reaction (PCR) versus chromogenic agar for MRSA screening, and PCR versus no screening for several clinical outcomes, including MRSA colonization and infection rates.</p> <p>Methods</p> <p>An electronic literature search was conducted on studies evaluating polymerase chain reaction techniques and methicillin (also spelled meticillin) resistant <it>Staphylococcus aureus </it>that were published from 1993 onwards using Medline, Medline In-Process & Other Non-Indexed Citations, BIOSIS Previews, and EMBASE. Due to the presence of heterogeneity in the selected studies, the clinical findings of individual studies were described.</p> <p>Results</p> <p>Nine studies that compared screening for MRSA using PCR versus screening using chromogenic agar in a hospital setting, and two studies that compared screening using PCR with no or targeted screening were identified. Some studies found lower MRSA colonization and acquisition, infection, and transmission rates in screening with PCR versus screening with chromogenic agar, and the turnaround time for screening test results was lower for PCR. One study reported a lower number of unnecessary isolation days with screening using PCR versus screening with chromogenic agar, but the proportion of patients isolated was similar between both groups. The turnaround time for test results and number of isolation days were lower for PCR versus chromogenic agar for MRSA screening.</p> <p>Conclusions</p> <p>The use of PCR for MRSA screening demonstrated a lower turnaround time and number of isolation days compared with chromogenic agar. Given the mixed quality and number of studies (11 studies), gaps remain in the published literature and the evidence remains insufficient. In addition to screening, factors such as the number of contacts between healthcare workers and patients, number of patients attended by one healthcare worker per day, probability of colonization among healthcare workers, and MRSA status of hospital shared equipment and hospital environment must be considered to control the transmission of MRSA in a hospital setting.</p

Antimicrobial resistance surveillance in Europe 2013: Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

Portugal - EARS-Net Management Team & National representatives of EARS-Net (Manuela Caniça, José Artur Paiva, Vera Manageiro, Eugénia Ferreira)The results presented in this report are based on antimicrobial resistance data from invasive isolates reported to EARS-Net by 30 EU/EEA countries in 2014 (data referring to 2013), and on trend analyses of EARS-Net data reported by the participating countries during the period 2010 to 2013. The antimicrobial resistance situation in Europe displays large variations depending on bacteria, antimicrobial group and geographical region. For several antimicrobial group and bacterium combinations, a north-to-south and west-to-east gradient is evident in Europe. In general, lower resistance percentages are reported by countries in the north and higher percentages reported by countries in the south and east of Europe. Overall, the most concerning trends in Europe in 2013 were related to the occurrence of resistance in gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species). For E. coli and K. pneumoniae, a continuous increase in resistance to key antimicrobial groups was noted. A majority of the isolates reported to EARS-Net in 2013 was resistant to at least one of the antimicrobial groups under surveillance, and many of these showed combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides. Over the last four years (2010 to 2013), resistance to third-generation cephalosporins in K. pneumoniae and E. coli increased significantly at EU/EEA level, as well as in many of the individual Members States. Many of the isolates resistant to third-generation cephalosporins were ESBL-positive and showed resistance to additional antimicrobial groups. In addition, resistance to fluoroquinolones, aminoglycosides and carbapenems, as well as combined resistance to fluoroquinolones, third-generation cephalosporins and aminoglycosides increased significantly at EU/EEA level for K. pneumoniae, but not for E. coli. Interestingly, there was a decrease in fluoroquinolone resistance in P. aeruginosa, which was seen for both the EU/EEA population-weighted mean percentage as well as in the trends for several individual countries, whereas fluoroquinolone resistance increased in K. pneumoniae. While the EU/EEA population-weighted mean for carbapenem resistance was 8.3% for K. pneumoniae, carbapenem resistance remained very low in E. coli (0.2%). However, five countries reported trends of increasing carbapenem resistance in E. coli in 2013; four of them belonging to the countries with the highest levels of resistance. Carbapenem resistance and resistance to multiple antimicrobial groups were also common in Pseudomonas aeruginosa and Acinetobacter spp. isolates. Data for polymyxin resistance (colistin and polymyxin B) were limited but indicated the presence of polymyxin resistance in all gram-negative bacterial species included in EARS-Net reporting, especially in countries with already high levels of carbapenem resistance. Resistance trends for gram-positive bacteria showed a more diverse pattern across Europe. For meticillin-resistance in Staphylococcus aureus (MRSA), the population-weighted EU/EEA mean has decreased significantly over the last four years. The decrease has, however, been less pronounced compared with the previous four-year period. The trends for Streptococcus pneumoniae were generally stable, but with large inter-country variations in the percentage of resistant isolates. Macrolide non-susceptibility in S. pneumoniae was, for most countries, higher than the percentages for penicillin-non-susceptibility. For enterococci, the population-weighted EU/EEA mean percentage for vancomycin resistance in E. faecium increased significantly between 2010 and 2013. The decrease in the percentage of high-level aminoglycoside resistant E. faecalis observed in a number of countries in recent years continued in 2013, although the populationweighted EU/EEA mean showed no significant change

Supranational surveillance of antimicrobial resistance: The legacy of the last decade and proposals for the future

Antimicrobial resistance among clinically important bacteria is widely acknowledged as a major global public health threat. A decade ago, several supranational surveillance initiatives were introduced. Few of them are still ongoing, and only one features an interactive database in the public domain. No public surveillance system monitors resistance trends among non-invasive isolates on a supranational level. Although the relevance of measuring antimicrobial resistance in invasive isolates is undisputable and there is a large consensus on sampling techniques for these isolates, surveillance systems monitoring invasive infections will only have low sensitivity for early detection of emerging resistance trends, also missing an important opportunity for intervention. Surveillance of resistance patterns should ideally include characterization of important clones involved in the dissemination of resistance. This review also emphasizes important methodological issues to be considered whenever performing surveillance, and provides general recommendations applicable to surveillance at all levels