1. Antimicrobial resistance surveillance in Ireland Results of invasive Pseudomonas aeruginosa 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. Antibiotic codes and abbreviations: AMK, AmikacinATM, Aztreonam CAZ, Ceftazidime CIP, Ciprofloxacin GEN, Gentamicin IPM, Imipenem MEM, Meropenem OFX, Ofloxacin PIP, Piperacillin TZP, Piperacillin-Tazobactam TOB, Tobramycin AMR, Antimicrobial Resistance PAE, Pseudomonas aeruginosa MDR, Multi-Drug Resistance

3. EARS-Net P. aeruginosa: Objective and case definition Objective: To determine the proportions of P. aeruginosa isolates from blood or CSF that are resistant to piperacillin (+/- tazobactam), ceftazidime, carbapenems (imipenem or meropenem), fluoroquinolones (e.g. ciprofloxacin or ofloxacin) and aminoglycosides (e.g. gentamicin) Case definition: EARS-Net collects data on the first invasive isolate (from blood or CSF) of P. aeruginosa per patient per quarter

4. 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)

5. Numbers and resistance proportions of P. aeruginosa from invasive infection, 2006-2009 * Not all isolates tested

6. Invasive P. aeruginosa resistance trends (1), 2006-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

7. Invasive P. aeruginosa resistance trends (2), 2006-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

8. Numbers and proportions of MDR invasive P. aeruginosa infection by hospital type, 2009

9. Susceptibility data for invasive P. aeruginosa isolates, 2009 (n=248)

10. Age and sex distribution of patients with invasive P. aeruginosa infection in 2009

11. Age and sex-specific incidence rates of invasive P. aeruginosa infection in 2009 ASIR, Age-Specific Incidence Rate (per 100,000 population)

12. Mean, median, mode and range of ages of patients with invasive P. aeruginosa infection in 2009

13. Sex distribution of patients with invasive P. aeruginosa infection in 2008 In patients with laboratory-confirmed invasive P. aeruginosa infection in 2009, males were approximately 1.3-times more likely to get an infection than females (boderline significant, P=0.04).

14. Resistance profiles of P. aeruginosa isolates in 2009 P, Piperacillins; 3, Ceftazidime; M, Meroepenem; C, Ciprofloxacin; G, Gentamicin * MDR, defined as resistance to 3 or more antibiotic classes

15. P. aeruginosa - distribution of piperacillin (e.g. PIP or TZP) 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

16. P. aeruginosa - distribution of piperacillin (e.g. PIP or TZP) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

17. P. aeruginosa - distribution of ceftazidime 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

18. P. aeruginosa - distribution of ceftazidime resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

19. P. aeruginosa - 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

20. P. aeruginosa - 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

21. P. aeruginosa - 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

22. P. aeruginosa - 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

23. P. aeruginosa - distribution of carbapenem (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

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