Antimicrobial resistance Antimicrobial resistance surveillance in Irelandsurveillance in Ireland

Results of invasive Klebsiella pneumoniae infection

(blood/CSF) surveillance, 2009**** Data as of 01/12/2010 ******** Data as of 01/12/2010 ****

Ireland is a member of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

EARS-Net EARS-Net K. pneumoniaeK. pneumoniae::Objective and case definitionObjective and case definitionObjective:

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)

◦ 3rd 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

Caveats in interpreting EARS-Net dataCaveats 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)

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/

EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/

Antibiotic codes and abbreviations:Antibiotic codes and abbreviations:AMK, Amikacin AMP, Ampicillin CTX, Cefotaxime CPD, Cefpodoxime CAZ, Ceftazidime CRO, Ceftriaxone CIP, Ciprofloxacin GEN, GentamicinIPM, Imipenem MEM, MeropenemOFX, Ofloxacin TZP, Piperacillin-TazobactamTOB, Tobramycin 3GC, 3rd-Generation

Cephalosporin

AMR, Antimicrobial ResistanceKPN, K. pneumoniaeESBL, Extended-Spectrum Beta-LactamaseFQ-R, Fluoroquinolone-ResistantFQ-S, Fluoroquinolone-SusceptibleMDR, Multi-Drug Resistance

Numbers and resistance proportions of Numbers and resistance proportions of K. pneumoniaeK. pneumoniae from invasive infection, from invasive infection, 2006-2009 2006-2009

* Not all isolates tested

Time period

Number of labs

Number of isolates %AMP-R* %3GC-R*

%CIP/ OFX-R* %GEN-R*

%IPM/ MEM-R*

2006 36 217 97.7 10.2 15.3 7.8 0.02007 39 244 99.2 9.9 18.1 9.9 0.62008 41 311 99.7 11.3 12.7 10.6 0.02009 42 323 99.7 11.1 13.0 11.1 0.0

2009Q1 43 56 100.0 10.9 10.7 12.5 0.02009Q2 43 76 100.0 3.9 9.2 6.6 0.02009Q3 42 101 99.0 14.9 17.8 12.9 0.02009Q4 42 90 100.0 13.3 12.4 12.2 0.0

Proportions of ESBLs and MDR among Proportions of ESBLs and MDR among K. pneumoniaeK. pneumoniae from invasive infection, from invasive infection, 2006-2009 2006-2009

* Not all isolates tested

YearNumber of labs

Number of isolates %3GC-R* %ESBL+* %MDR*

2006 36 217 10.2 8.6 11.22007 39 244 9.9 3.7 11.92008 41 311 11.3 7.7 9.92009 42 323 11.1 8.2 11.9

2009Q1 43 56 10.9 9.4 10.92009Q2 43 76 3.9 4.1 5.42009Q3 42 101 14.9 9.3 16.82009Q4 42 90 13.3 9.8 12.4

Invasive Invasive K. pneumoniaeK. pneumoniae resistanceresistance trends, trends, 2006-20092006-2009

Number of laboratories participating by year-end and quarter are indicated above the bars

0%

5%

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%Re

sist

ance

Num

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Time periodTotal K. pneumoniae %3GC-R %CIP/OFX-R %GEN-R

413936 42 4342 42 43

Invasive Invasive K. pneumoniaeK. pneumoniae resistanceresistance trends, trends, 2006-2009: 3GCs and ESBLs2006-2009: 3GCs and ESBLs

Number of laboratories participating by year-end and quarter are indicated above the bars

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%Re

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Time periodTotal K. pneumoniae tested for ESBL %ESBL-positive %3GC-R

36 4139 42 43 43 4242

Invasive MDR Invasive MDR K. pneumoniaeK. pneumoniae trends, trends, 2006-20092006-2009

Number of laboratories participating by year-end and quarter are indicated above the bars

0%

5%

10%

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%Re

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Num

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Time periodTotal K. pneumoniae tested for MDR MDR %MDR

413936 42 43 424243

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

Hospital TypeNumber of

isolates FQ-R FQ-S %FQ-RSpecialist/Tertiary 187 29 157 15.6%Secondary 75 8 67 10.7%General (Private) 27 2 25 7.4%Primary 13 2 11 15.4%Paediatric 7 0 7 0.0%Maternity 6 0 6 0.0%Other 6 1 5 16.7%Radiotherapy/Oncology 2 0 2 0.0%Total 323 42 280 13.0%

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

Hospital TypeNumber of

isolates MDR Non-MDR %MDR

Specialist/Tertiary 187 25 158 13.7%

Secondary 75 5 70 6.7%General (Private) 27 2 25 7.4%Primary 13 2 11 15.4%Paediatric 7 0 7 0.0%Maternity 6 3 3 50.0%Radiotherapy/Oncology 6 1 5 16.7%Other 2 0 2 0.0%Total 323 38 281 11.9%

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

0

50

100

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350N

umbe

r of i

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AntibioticResistant Susceptible No data

99.7%

6.3%

11.4%10.7%

1.6%

11.2%10.0%

0.0% 13.0% 11.1%0.3%

11.3%

11.1%

Resistance profiles of Resistance profiles of K. pneumoniaeK. pneumoniae isolates, isolates, 20092009

Resistance ProfileNumber of

isolates ES

BL

+

ve

ES

BL

-ve

Fully susceptible 1 1

A 259 246

3 0

C 0

G 0

A3 8 4 3

AC 10 10

AG 3 3

CG 0

A3C* 6 3 2

A3G* 6 5 1

ACG* 10 8

A3CG* 16 13 2Not tested against all 4 4

Total 323 25 280

A, Ampicillin; 3, 3GC; C, Ciprofloxacin; G, Gentamicin

* Multi-drug resistant (defined as resistance to 3 or more classes)

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

0

5

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25N

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Age Groupfemale male

Age and sex-specific incidence rates of Age and sex-specific incidence rates of invasive invasive K. pneumoniaeK. pneumoniae infection, 2009infection, 2009

ASIR, Age-Specific Incidence Rate (per 100,000 population)

0

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100A

SIR

Age Group

female male TOTAL

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

KPN

n 323

n with age 323

Mean 60.7y

Median 65y (62-68y)

Mode 0y

Range 0-94y

Sex distribution of patients with invasive Sex distribution of patients with invasive K. pneumoniaeK. pneumoniae infection, 2009infection, 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).

KPN

No. male 182

%male 56.3

No. female 141

%female 43.7

m/f ratio 1.29

z-test 2.30

P-value 0.021

K. pneumoniaeK. pneumoniae - distribution of 3GC (e.g. CTX - distribution of 3GC (e.g. CTX or CAZ) resistance in or CAZ) resistance in EARSS/EARS-NetEARSS/EARS-Net countries in 2009countries in 2009

Map downloaded from:

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

K. pneumoniaeK. pneumoniae - distribution of 3GC (e.g. CTX - distribution of 3GC (e.g. CTX or CAZ) resistance in EARSS countries in 2008or CAZ) resistance in EARSS countries in 2008

Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

K. pneumoniaeK. pneumoniae - distribution of - distribution of fluoroquinolone (e.g. CIP) resistance in fluoroquinolone (e.g. CIP) resistance in EARSS/EARS-NetEARSS/EARS-Net countries in 2009 countries in 2009

Map downloaded from:

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

K. pneumoniaeK. pneumoniae - distribution of - distribution of fluoroquinolone (e.g. CIP) resistance in fluoroquinolone (e.g. CIP) resistance in EARSS countries in 2008EARSS countries in 2008

Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

K. pneumoniaeK. pneumoniae - distribution of - distribution of aminoglycoside (e.g. GEN) resistance in aminoglycoside (e.g. GEN) resistance in EARSS/EARS-NetEARSS/EARS-Net countries in 2009 countries in 2009

Map downloaded from:

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

K. pneumoniaeK. pneumoniae - distribution of - distribution of aminoglycoside (e.g. GEN) resistance in aminoglycoside (e.g. GEN) resistance in EARSS countries in 2008 EARSS countries in 2008

Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

K. pneumoniaeK. pneumoniae - distribution of carbapenems - distribution of carbapenems (e.g. MEM) resistance in (e.g. MEM) resistance in EARSS/EARS-NetEARSS/EARS-Net countries in 2009 countries in 2009

Map downloaded from:

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

K. pneumoniaeK. pneumoniae - distribution of - distribution of carbapenems (e.g. MEM) resistance in carbapenems (e.g. MEM) resistance in EARSS countries in 2008 EARSS countries in 2008

Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009