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

2. EARS-Net K. pneumoniae: Objective and case definition Objective : To determine the proportions of K. pneumoniae isolates from blood and/or CSF that are resistant to 4 key antibiotic classes: ◦ Aminopenicillins (e.g. ampicillin) ◦ 3 rd Generation Cephalosporins (e.g. cefotaxime, ceftazidime) ◦ Fluoroquinolones (e.g. ciprofloxacin) ◦ Aminoglycosides (e.g. gentamicin, tobramycin, amikacin) Case definition: EARS-Net collects data on the first invasive isolate (from blood/CSF) of K. pneumoniae 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/EuropeanAntimic robialResistanceSurveillanceSystemEARSS/

5. Antibiotic codes and abbreviations: AMK, Amikacin AMP, Ampicillin CTX, CefotaximeCPD, Cefpodoxime CAZ, CeftazidimeCRO, Ceftriaxone CIP, CiprofloxacinGEN, Gentamicin IPM, ImipenemMEM, Meropenem OFX, OfloxacinTZP, Piperacillin-Tazobactam TOB, Tobramycin3GC, 3 rd -Generation Cephalosporin AMR, Antimicrobial Resistance KPN, K. pneumoniae ESBL, Extended-Spectrum Beta-Lactamase FQ-R, Fluoroquinolone-Resistant FQ-S, Fluoroquinolone-Susceptible MDR, Multi-Drug Resistance

6. Numbers and resistance proportions of K. pneumoniae from invasive infection, 2006-2009 * Not all isolates tested

7. Proportions of ESBLs and MDR among K. pneumoniae from invasive infection, 2006-2009 * Not all isolates tested

8. Invasive K. pneumoniae resistance trends, 2006-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

9. Invasive K. pneumoniae resistance trends, 2006-2009: 3GCs and ESBLs Number of laboratories participating by year-end and quarter are indicated above the bars

10. Invasive MDR K. pneumoniae trends, 2006-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

11. Numbers and proportions of fluoroquinolone (FQ)-resistant invasive K. pneumoniae infection by hospital type, 2009

12. Numbers and proportions of MDR invasive K. pneumoniae infection by hospital type, 2009

13. Susceptibility data for invasive K. pneumoniae isolates, 2009 (n=323)

14. Resistance profiles of K. pneumoniae isolates, 2009

15. Age and sex distribution of patients with invasive K. pneumoniae infection, 2009

16. Age and sex-specific incidence rates of invasive K. pneumoniae infection, 2009 ASIR, Age-Specific Incidence Rate (per 100,000 population)

17. Mean, median, mode and range of ages of patients with invasive K. pneumoniae infection, 2009

18. Sex distribution of patients with invasive K. pneumoniae infection, 2009 In patients with laboratory-confirmed invasive K. pneumoniae infection in 2009, males were approximately 1.3-times more likely to get an infection than females (significant, P=0.021).

19. K. pneumoniae - distribution of 3GC (e.g. CTX or CAZ) resistance in EARSS/EARS-Net countries in 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

20. K. pneumoniae - distribution of 3GC (e.g. CTX or CAZ) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

21. K. pneumoniae - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS/EARS-Net countries in 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

22. K. pneumoniae - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

23. K. pneumoniae - distribution of aminoglycoside (e.g. GEN) resistance in EARSS/EARS-Net countries in 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

24. K. pneumoniae - distribution of aminoglycoside (e.g. GEN) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

25. K. pneumoniae - distribution of carbapenems (e.g. MEM) resistance in EARSS/EARS-Net countries in 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

26. K. pneumoniae - distribution of carbapenems (e.g. MEM) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009