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

2. 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

3. 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

4. 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

5. 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 Q – Midland Regional Hospitals Portlaoise and Tullamore
As of Q – 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

6. 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

7. 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

8. 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

9. 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:
EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

10. 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

11. 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

12. 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

13. Distribution of MRSA in EARS-Net countries in 2014
Map downloaded from ECDC’s TESSy database on 21/10/2015:
EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

14. 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

15. 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

16. 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

17. 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:
EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

18. 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

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

20. 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:
EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

21. 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

22. 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:
EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

23. 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

24. 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

25. 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:
EARS-Net data on Antimicrobial Resistance in Ireland, Q3 2015

26. 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