EARS-Net data on antimicrobial resistance in Ireland Quarter 3 2015 14th December 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 KEY POINTS (General) E. coli The numbers of invasive E. coli infections have been increasing since 2004 The proportion of ESBL-positive E. coli has been increasing since 2004 Fluoroquinolone- and aminoglycoside-resistance and multi-drug resistance show signs of decreasing in 2015 S. aureus/MRSA The numbers and proportion of MRSA bloodstream infections have been decreasing since 2006 K. pneumoniae ESBL-positivity and resistance to fluoroquinolones and aminoglycosides increased dramatically between 2012 and 2013 corresponding with the rise of multidrug resistant K. pneumoniae (MDRKP) Carbapenem-resistance, particularly as a result of carbapenemase production, among K. pneumoniae is increasing E. faecium/VREfm (vancomycin-resistant E. faecium) The numbers and proportion of VREfm bloodstream infections have been increasing since 2004 Ireland has the highest proportion of VREfm in Europe EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

KEY POINTS (* 2015 data are provisional for Q1-3 only) Escherichia coli The proportion of patients with invasive infections caused by E. coli producing extended-spectrum beta-lactamases (ESBLs) increased from 10.2% (2014) to 10.8% The proportion of invasive infections caused by multi-drug resistant (MDR) E. coli (displaying resistance to three or more antimicrobial classes) decreased from 15.0% (2014) to 14.0% Staphylococcus aureus The proportion of S. aureus BSI that were meticillin-resistant (i.e. MRSA) decreased from 19.4% in 2014 to 19.0% in 2015* Klebsiella pneumoniae The proportion of patients with invasive infections caused by MDR-K. pneumoniae (MDRKP) increased from 8.0% in 2014 to 11.3% in 2015*, the second highest proportion reported to date The proportion of patients with invasive infections caused by carbapenem-resistant K. pneumoniae isolates increased from 1.1% in 2014 to 2.9% in 2015* Enterococcus faecium The proportion of E. faecium BSI that were vancomycin-resistant (i.e. VRE) increased from 46.0% in 2014 to 48.1% in 2015*. Ireland has by far the highest proportion of VRE in Europe EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net case definition EARS-Net collects antimicrobial resistance data on the first invasive isolate (specimen types indicated below) per patient per quarter for eight key pathogens (arranged in order of frequency reported): Escherichia coli (blood or CSF) Staphylococcus aureus (blood only) Enterococcus faecium (blood only) Klebsiella pneumoniae (blood or CSF) Streptococcus pneumoniae (blood or CSF) Enterococcus faecalis (blood only) Pseudomonas aeruginosa (blood or CSF) Acinetobacter spp. (blood or CSF) EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

Participation in EARS-Net Between 2007 and 2014, all laboratories (n=39) and acute hospitals (n=58) participated in EARS-Net resulting in 100% coverage of the Irish population In 2015, a number of laboratories have suspended their participation due to resource issues: As of Q2 2015 – Midland Regional Hospitals Portlaoise and Tullamore As of Q3 2015 – Letterkenny General Hospital The population coverage by EARS-Net is 95% as of the end of Q3 2015 EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Escherichia coli invasive infections *2015 data to the end of Q3 only Key messages: The numbers of invasive E. coli infections have been increasing since 2004 The proportion of ESBL-positive E. coli has been increasing since 2004 Fluoroquinolone- and aminoglycoside-resistance and multi-drug resistance show signs of decreasing in 2015* EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in E. coli invasive infections showing percentage resistance to fluoroquinolones, aminoglycosides and 3rd-generation cephalosporins *2015 data to the end of Q3 only FQREC, fluoroquinolone (e.g. ciprofloxacin)-resistant E. coli; GEN, gentamicin, TOB, tobramycin; AMK, amikacin (GEN, TOB and AMK are aminoglycosides); 3GC, 3rd-generation cephalosporins (e.g. cefotaxime, ceftazidime) EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in E. coli invasive infections showing percentage 3GC-resistance and ESBL-positivity *2015 data to the end of Q3 only 3GC, 3rd-generation cephalosporins (e.g. cefotaxime, ceftazidime); ESBL, extended-spectrum beta-lactamase EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Distribution of 3rd-generation cephalosporin resistant E. coli in EARS-Net countries in 2014 Map downloaded from ECDC’s TESSy database on 21/10/2015: http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in E. coli invasive infections with percentage multi-drug resistance *2015 data to the end of Q3 only MDR, multidrug resistance (defined as resistance to 3 or more classes of antibiotics OR a confirmed carbapenemase producer) EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Staphylococcus aureus bloodstream infections *2015 data to the end of Q3 only Key message: The numbers and proportion of MRSA bloodstream infections have been decreasing since 2006 EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in S. aureus bloodstream infections showing %MRSA *2015 data to the end of Q3 only EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

Distribution of MRSA in EARS-Net countries in 2014 Map downloaded from ECDC’s TESSy database on 21/10/2015: http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Klebsiella pneumoniae invasive infections *2015 data to the end of Q3 only Key messages: The highest number of invasive K. pneumoniae infections were reported in 2014 ESBL-positivity and resistance to fluoroquinolones and aminoglycosides increased dramatically between 2012 and 2013 corresponding with the rise of multidrug resistant K. pneumoniae (MDRKP) Carbapenem-resistance, particularly as a result of carbapenemase production (see later slide), among K. pneumoniae is increasing EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in K. pneumoniae invasive infections showing percentage resistance to fluoroquinolones, aminoglycosides and 3rd-generation cephalosporins *2015 data to the end of Q3 only 3GC, 3rd-generation cephalosporins (e.g. cefotaxime, ceftazidime); CIP, ciprofloxacin; OFX, ofloxacin (CIP and OFX are fluoroquinolones); GEN, gentamicin, TOB, tobramycin; AMK, amikacin (GEN, TOB and AMK are aminoglycosides) EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in K. pneumoniae invasive infections with percentage 3GC-resistance and ESBL-positivity *2015 data to the end of Q3 only EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Distribution of 3rd-generation cephalosporin resistant K. pneumoniae in EARS-Net countries in 2014 Map downloaded from ECDC’s TESSy database on 21/10/2015: http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

Carbapenemase-producing K. pneumoniae in 2014 *2015 data to the end of Q3 only CBP, carbapenem Key messages: In 2015*, there have been 7 confirmed carbapenemase-producing K. pneumoniae from invasive infections compared with just 2 in 2014 and 2 in 2013 Of 15 confirmed carbapenemases to date, 12 are OXA-48 and 3 are KPC EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

Trends in carbapenemase-producing K. pneumoniae in 2014 EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Distribution of carbapenem-resistant K. pneumoniae in EARS-Net countries in 2014 Map downloaded from ECDC’s TESSy database on 21/10/2015: http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in K. pneumoniae invasive infections with percentage multi-drug resistance *2015 data to the end of Q3 only MDRKP, multi-drug resistance K. pneumoniae (defined as simultaneously ESBL-positive and non-susceptible to ciprofloxacin and gentamicin AND/OR a confirmed carbapenemase producer) EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Distribution of multi-drug resistant (MDR) K. pneumoniae in EARS-Net countries in 2014 Note: MDR defined here as combined resistance to 3GCs, fluoroquinolones and aminoglycosides Map downloaded from ECDC’s TESSy database on 21/10/2015: http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Enterococcus faecium bloodstream infections *2015 data to the end of Q3 only Key messages: The numbers and proportion of VREfm bloodstream infections have been increasing since 2004 Ireland has the highest proportion of VREfm in Europe EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Trends in E. faecium bloodstream infections showing %VRE *2015 data to the end of Q3 only VRE, vancomycin-resistant enterococcus; VREfm, vancomycin-resistant E. faecium; VSEfm, vancomycin-susceptible E. faecium EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Distribution of vancomycin-resistant E. faecium (VREfm) in EARS-Net countries in 2014 Map downloaded from ECDC’s TESSy database on 21/10/2015: http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015 Acknowledgements We would like to sincerely thank all microbiology laboratories for their continued support for EARS-Net and for providing data for this report EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015