1. Resistance in Pseudomonas aeruginosa and Acinetobacter spp. from blood in the UK and Ireland 2001-2005 Rosy Reynolds, Russell Hope, BSAC Working Party on Bacteraemia Resistance Surveillance www.bsacsurv.org Collecting Laboratories Staff at 29 laboratories across the UK and Ireland who contributed isolates to the surveillance programme. HPA staff G. Brick M. Colman N. Potz D. M. Livermore THANKS TO... Sponsors Cubist J&J MSD Novartis Pfizer Theravance Wyeth

2. 25 centres / year up to 10 isolates / centre / year (non-duplicate) E. coli Klebsiella spp. Enterobacter spp. Proteeae Pseudomonas spp. other Gram-negative bacteria 1014 P. aeruginosa 200 Acinetobacter spp. Tested centrally at HPA, Colindale, London.

3. Current study: MICs - BSAC agar dilution method Breakpoints - BSAC version 6.1 (February 2007) Breakpoints have changed during the study, 2001 - present LabBase2 national database of routine results for blood isolates: ~400 centres in England & Wales (N. Ireland from 2002) Local methods Local choice of antibiotics to test Reports susceptible / resistant Breakpoints as defined at the time Methods

4. Pseudomonas aeruginosa demographics Age: mean 62, median 68 (19% aged  80 years) Male: 57% Hospital: 61% hospitalised >48 hours Speciality Focus of infection

5. Breakpoints mg/L S  R > CAZ88 CIP0.51 GEN44 IPM48 TZP16

6. Multiple resistance in P. aeruginosa Non-susceptibility to ceftazidime ciprofloxacin gentamicin imipenem piperacillin-tazobactam Number of non-susceptibilities % of isolates n = 1014 073.7 116.7 2 5.9 3 1.6 4 1.4 5 0.8 Multiple resistance is uncommon

7. Pseudomonas aeruginosa - new agents 1 mean MIC difference BPR-CAZ 1.2 dilutions MIC 90 %NS CAZ43 BPR8?

8. Pseudomonas aeruginosa - new agents 2 mean MIC difference DOR-IPM -2.8 dilutions MIC 90 %NS IPM47 DOR0.5?

9. Acinetobacter species and demographics baumannii N = 110 other species N = 90 age mean median 51 53 58 male53%60% hospital* >48 hr76%57% speciality* surgery ICU haem/oncol medicine 21% 20% 15% 8% 10% 2% 24% 18% infection focus unknown lines 40% 35% 49% 32% species

10. Breakpoints mg/L S  R > CIP11 GEN44 IPM28 TGC12 TZP16

11. Multiple resistance in Acinetobacter # of NS baumannii complex other species 062%90% 112% 9% 2 5% 1% 319% 4 2% Non-susceptibility to CIP, GEN, IPM, TZP MICs of IPM-NS isolates YearCIPGENIPMTZPTGC 2005 4 0.5 8 32 0.5 2005128 32 16512 1 2004128512 16512 2 Carbapenem non-susceptibility in 3 of 110 Acinetobacter baumannii.

12. Acinetobacter - new agents 1 mean MIC difference DOR-IPM 0.5 dilutions MIC 90 IPM0.25 DOR0.5

13. Acinetobacter - new agents 2 MIC 90 TET  256 MIN2 TGC2

14. Conclusions Pseudomonas aeruginosa Acinetobacter Generally susceptible to relevant antibiotics. Doripenem and ceftobiprole may be useful new agents. Carbapenem resistance is rare in blood isolates (though increasingly reported to HPA from other infection sites). Doripenem and tigecycline may be useful new agents.

15. BSAC Working Party on Bacteraemia Resistance Surveillance (February 2007) A. MacGowan 1, M. Allen 2, S. Barrière 3, D. F. J. Brown 4, K. Bush 5, N. Deaney 6, J. Dennison 7, R. Hennings 8, R. Hope 9, D. Lewis 10, D. M. Livermore 9, M. Lockhat 11, R. Reynolds 1, C. Thomson 12, A. White 13 1 North Bristol NHS Trust; 2 Wyeth; 3 Theravance; 4 Addenbrookes Hospital; 5 Johnson&Johnson; 6 MSD; 7 Pfizer; 8 Novartis; 9 Health Protection Agency; 10 HPA South West ; 11 AstraZeneca; 12 IMS Health; 13 Consultant www.bsacsurv.org