Antimicrobial resistance surveillance in Ireland

1. Antimicrobial resistance surveillance in Ireland Results of invasive enterococcal bacteraemia surveillance, 2009 **** Data as of 01/12/2010 **** Ireland is a member of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

2. EARS-Net Enterococci:Objective and case definition Objective: • To determine the proportions of enterococci, E. faecalis or E. faecium, isolates from blood that are resistant to 3 key antibiotic classes: • Ampicillin • High-level gentamicin • Vancomycin Case definition: • EARS-Net collects data on the first invasive isolate (from blood only) of E. faecium per patient per quarter

3. 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)

4. 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/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/

5. Antibiotic codes and abbreviations: AMP, Ampicillin HLG, High-Level Gentamicin LNZ, Linezolid QDA, Quinupristin-Dalfopristin TEC, Teicoplanin VAN, Vancomycin AMR, Antimicrobial Resistance MDR, Multi-Drug Resistance EFA, Enterococcus faecalis EFM, Enterococcus faecium VREfm, Vancomycin-Resistant E. faecium VSEfm, Vancomycin-Susceptible E. faecium MDR, Multi-Drug Resistance

6. Enterococcus faecalis

7. Numbers and resistance proportions of E. faecalis from bacteraemia, 2002-2009 * Not all isolates tested

8. E. faecalis bacteraemia resistance trends, 2002-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

9. Numbers and proportions of E. faecalis bacteraemia by hospital type, 2009

10. Susceptibility data for E. faecalis bacteraemia isolates, 2009 (n=389)

11. Resistance profiles of E. faecalis isolates in 2009

12. Age and sex distribution of patients with invasive E. faecalis infection in 2009

13. Age and sex-specific incidence rates of E. faecalis bacteraemia in 2009 ASIR, Age-Specific Incidence Rate (per 100,000 population)

14. Mean, median, mode and range of ages of patients with E. faecalis bacteraemia in 2009

15. Sex distribution of patients with E. faecalis bacteraemia in 2009 In patients with laboratory-confirmed invasive E. faecalis infection in 2009, males were approximately 1.6-times more likely to get an infection than females (highly significant, P<0.0001).

16. E. faecalis - distribution of high-level gentamicin resistance in EARSS/EARS-Net countries, 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

17. E. faecalis - distribution of high-level gentamicin resistance in EARSS countries, 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

18. E. faecalis - distribution of vancomycin resistance in EARSS/EARS-Net countries, 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

19. E. faecalis - distribution of vancomycin resistance in EARSS countries, 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

20. Enterococcus faecium

21. Numbers and resistance proportions of E. faecium from bacteraemia, 2002-2009 * Not all isolates tested

22. E. faecium bacteraemia resistance trends, 2002-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

23. Invasive MDR E. faecium trends, 2002-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

24. Numbers and proportions of VREfm bacteraemia by hospital type, 2009

25. Numbers and proportions of MDR E. faecium bacteraemia by hospital type, 2009

26. Susceptibility data for E. faecium bacteraemia isolates, 2009 (n=397)

27. Resistance profiles of E. faecium isolates in 2009

28. Trends in NUMBERS of main resistance profiles of E. faecium isolates, 2002-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

29. Trends in PROPORTIONS of main resistance profiles of E. faecium isolates, 2002-2009

30. Age and sex distribution of patients with invasive E. faecium infection in 2009

31. Age and sex-specific incidence rates of E. faecium bacteraemia in 2009 ASIR, Age-Specific Incidence Rate (per 100,000 population)

32. Mean, median, mode and range of ages of patients with E. faecium bacteraemia in 2009

33. Sex distribution of patients with E. faecium bacteraemia in 2009 In patients with laboratory-confirmed invasive E. faecium infection in 2009, males were approximately 1.3-times more likely to get an infection than females (significant, P=0.005).

34. E. faecium - distribution of high-level gentamicin resistance in EARSS/EARS-Net countries, 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

35. 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

36. E. faecium - distribution of vancomycin resistance in EARSS/EARS-Net countries, 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

37. E. faecium - distribution of vancomycin resistance in EARSS countries, 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009