Title: #Antimicrobial #resistance #surveillance in #Europe–2015.
Subject: Antibiotics, drugs resistance, surveillance across European Region countries.
Source: European Centre for Disease Prevention and Control (ECDC), full PDF file: (LINK). Summary.
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Antimicrobial resistance surveillance in Europe - Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net), 2015
The European Centre for Disease Prevention and Control (ECDC) wishes to thank all EARS-Net participating laboratories and hospitals in the Member States for providing data for this report.
Furthermore, all EARS-Net Operational Contact Points and National Focal Points are acknowledged for facilitating data transfer and providing valuable comments for this report. WHONET representative John Stelling is acknowledged for providing technical support for the Member States during data preparation. UK NEQAS are acknowledged for the contribution to Annex 1.
In addition, ECDC wishes to thank the EARS-Net Coordination Committee members Derek Brown, José Campos, Tim Eckmanns, Christian Giske, Hajo Grundmann, Vincent Jarlier, Alan Johnson, Gunnar Kahlmeter, Jos Monen, Annalisa Pantosti, Gian Maria Rossolini, Gunnar Skov Simonsen, Nienke van de Sande-Bruinsma, Alkiviadis Vatopoulos, Dorota Żabicka and Helena Žemličková for providing scientific advice during the production of the report and contributing to the sections covering the clinical and epidemiological importance and resistance mechanisms.
Suggested citation for full report: European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2015. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2017.
Cover picture © istockphoto / Stockholm, January 2017 / ISSN 2363-2666 / ISBN 978-92-9498-029-8 / doi 10.2900/6928 / Catalogue number TQ-AM-17-001-EN-N
© European Centre for Disease Prevention and Control, 2017. Reproduction is authorised, provided the source is acknowledged.
- 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 2016 (data referring to 2015), and on trend analyses of data reported by the participating countries for the period 2012–2015.
- 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 species–antimicrobial group 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 by countries in the south and east of Europe.
- These differences are most likely related to differences in antimicrobial use, infection prevention, infection control practices, and healthcare utilisation patterns in the countries.
- This report highlights an especially worrying situation with regard to gram-negative bacteria: resistance percentages reported from many parts of Europe are high and, in many cases, on the increase.
- Over the last four years (2012–2015), resistance to third-generation cephalosporins in both Escherichia coli and Klebsiella pneumoniae increased significantly at EU/EEA level as well as in many of the individual Members States.
- A large proportion of the isolates resistant to third-generation cephalosporins produced an extended-spectrum beta-lactamase (ESBL).
- Third-generation cephalosporin resistance was often seen in combination with fluoroquinolone and aminoglycoside resistance.
- This type of combined resistance also increased significantly in the EU/EEA between 2012 and 2015, for both E. coli and K. pneumoniae.
- Increasing trends were observed in countries with both high and low levels of resistance.
- The observed increase in combined resistance to multiple antimicrobial groups, as well as the high proportion of ESBL-producing isolates, is especially worrying, as this leaves few treatment alternatives for patients suffering from infections caused by these pathogens.
- Besides its impact on treatment outcome of individual patients, frequent resistance in gram-negative bacteria may lead to an increased use of carbapenems, thus further favouring the emergence and spread of carbapenem-resistant bacteria.
- While the EU/EEA population-weighted mean for carbapenem resistance was 8.1 % for K. pneumoniae, the carbapenem resistance levels remained very low in E. coli (0.1 %).
- Wide inter-country variations were noted for carbapenem-resistant K. pneumoniae, for which resistance percentages ranged between zero and 61.9 %, with a majority of the countries reporting resistance levels below 1 %.
- With a few exceptions, countries reporting the highest levels of combined resistance to fluoroquinolones, third-generation cephalosporins and aminoglycosides also reported the highest percentages of carbapenem resistance.
- While the trend for carbapenem resistance appeared fairly stable in E. coli, with few changes observed in national data between 2012 and 2015, a more dynamic pattern was observed for K. pneumoniae, for which the EU/EEA population-weighted mean percentage of carbapenem resistance increased significantly for the period 2012–2015.
- Carbapenem resistance and resistance to multiple antimicrobial groups were also common in Pseudomonas aeruginosa and Acinetobacter spp.
- Among all species–antimicrobial group combinations monitored by EARS-Net, the highest levels of resistance were reported for Acinetobacter spp., for which carbapenem resistance percentages in some countries in the south and southeastern parts of Europe and in the Baltic States reached levels of over 80 % in 2015; carbapenem resistance was often seen in combination with resistance to other key antimicrobial groups.
- Treatment alternatives for patients infected with bacteria resistant to both carbapenems and other important antimicrobial groups are often limited to combination therapy and to older antimicrobial agents with lower efficacy such as polymyxins, e.g. colistin.
- Although data on polymyxin susceptibility as part of EARS-Net surveillance are not complete, and testing susceptibility to polymyxins is technically difficult, the fact that some countries, especially countries with already high percentages of carbapenem resistance, reported large numbers of isolates with polymyxin resistance is an indication of the further loss of effective antimicrobial treatment options for gram-negative bacterial infections.
- The increase in carbapenem resistance in K. pneumoniae observed in the EARS-Net surveillance data is most likely the result of an increase in isolates producing a carbapenemase, as previously reported from the ECDCfunded European survey on carbapenemase-producing Enterobacteriaceae (EuSCAPE).
- The continuous spread of carbapenemase-producing Enterobacteriaceae (CPE), mostly K. pneumoniae, represents a serious threat to healthcare and patient safety in European hospitals, to which many European countries have reacted by intensifying their containment efforts.
- However, results from EuSCAPE have highlighted that gaps still remain, and many countries are still lacking national guidance for CPE prevention and control.
- Resistance trends in gram-positive bacteria showed a more diverse pattern across Europe.
- For meticillinresistant Staphylococcus aureus (MRSA), the EU/EEA population-weighted mean percentage continued to decrease during the last four-year period, from 18.8 % in 2012 to 16.8 % in 2015.
- The decline in recent years has, however, been less pronounced compared with 2009–2012.
- For Streptococcus pneumoniae, resistance percentages were generally stable during the period 2012–2015, but with wide inter-country variations.
- Macrolide nonsusceptibility in S. pneumoniae was, for most countries, higher than penicillin non-susceptibility.
- For enterococci, a significantly increasing trend for vancomycin-resistant Enterococcus faecium could be noted in almost half of the reporting countries between 2012 and 2015.
- Although the overall trend was not significant in EU/EEA countries, this development needs to be monitored carefully.
- Antimicrobial resistance is a serious threat to public health in Europe.
- For invasive bacterial infections, prompt treatment with effective antimicrobial agents is especially important and is one of the single most effective interventions to reduce the risk of fatal outcome.
- The ongoing increase in antimicrobial resistance to a number of key antimicrobial groups in invasive bacterial isolates reported to EARS-Net is therefore of great concern and constitutes a serious threat to patient safety in Europe.
- Prudent antimicrobial use and comprehensive infection prevention and control strategies targeting all healthcare sectors are the cornerstones of effective interventions aiming to prevent selection and transmission of bacteria resistant to antimicrobial agents.
Keywords: ECDC; Updates; European Region; Antibiotics; Drugs Resistance.