Predicting multi-drug resistance in Pseudomonas aeruginosa in the UK and Ireland Rosy Reynolds, Russell Hope, Kirsty Maher on behalf of The BSAC Working Party on Resistance Surveillance O nd ECCMID, London, 31 Mar - 3 Apr 2012

BSAC Resistance Surveillance Project UK & Ireland 40 laboratories (25 up to 2009) Bacteraemia ( ) Hospital-onset lower respiratory infection (2008/ /11) Target: 280 P.aeruginosa isolates /year in each programme (was 250) Excluding duplicate within 14 days and (in RTI) cystic fibrosis Central testing - HPA, London; Quotient Bioresearch, Fordham. BSAC agar dilution MICs & breakpoints

Central Laboratories HPA Colindale Russell Hope David Livermore and many others Quotient Bioresearch Kirsty Maher Ian Morrissey and many others Collecting Laboratories Sponsors Astellas AstraZeneca Cerexa / Forest Cubist J&J / Janssen Merck / MSD Novartis (Chiron) Pfizer (Wyeth) Theravance Associate sponsor Basilea ACKNOWLEDGEMENTS BSAC Resistance Surveillance Project

Single & multiple non-susceptibility bacteraemia 4/ centres 4 years

Single & multiple non-susceptibility bacteraemia respiratory 5/668 3 centres 2 years

Age Distribution of Patients 1686 isolates

Age Distribution of Patients 668 isolates

Age Distribution of Patients

Other patient characteristics Detail of focus in bacteraemia ICU/HDU % Respiratory Bacteraemia male % Respiratory Bacteraemia respiratory focus % Respiratory Bacteraemia Known focusOriginal data hospital onset % Respiratory Bacteraemia

Predictors considered Predictors alone P notes Age <0.001 Fractional polynomial Sex NS Male vs female Hospital onset >48 hours vs other Speciality <0.001 ICU vs non-ICU Focus of infection UTI or line/SSI/GI vs RTI Sample site Blood vs Respiratory Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

Predictors considered Predictors alone P together P notes Age <0.001 Fractional polynomial Sex NS- Male vs female Hospital onset >48 hours vs other Speciality < ICU vs non-ICU Focus of infection UTI or line/SSI/GI vs RTI Sample site Blood vs Respiratory Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

Predictors considered Predictors alone P together P notes Age <0.001 Fractional polynomial SexNS -Male vs female Hospital onset >48 hours vs other Speciality < ICU vs non-ICU Focus of infection UTI or line/SSI/GI vs RTI Sample site Blood vs Respiratory Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

Age

Patient with line-derived infection, not in ICU Age Estimate & 95% CI

Model shows patient aged 65 with line-derived infection Intensive Care KEYother specialityintensive care / high dependency ModelObserved - unadjusted OR 2.45

Focus of infection ModelObserved - unadjusted KEYRTIline/SSSI/GIUTIunknown/minor Model shows patient aged 65, not in ICU OR 0.95 OR 0.32

Multiple resistance in Pseudomonas aeruginosa from bloodstream and hospital-onset respiratory infection in the UK and Ireland: remains fairly uncommon (3-7%) but is more likely in in younger patients (except infants) patients in intensive care and less likely in infections from the genitourinary tract

62 bacteraemia, 49 respiratory. Multiply-resistant P. aeruginosa