The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System

Abstract

We investigated bacteraemia trends for five major bacterial pathogens, Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium, and determined how expanding antimicrobial resistance influenced the total burden of bacteraemias in Europe. Aetiological fractions of species and antibiotic phenotypes were extracted from the European Antimicrobial Resistance Surveillance System (EARSS) database for laboratories, which consistently reported between 2002 and 2008. Trend analyses used generalized linear models. Robustness of results was assessed by iterative analysis for different geographic regions. From 2002 to 2008, the overall number of reports increased annually by 6.4% (95% confidence interval (CI) 6.2-6.5%), from 46 095 to 67 876. In the subset of laboratories providing denominator information, the overall incidence increased from 0.58/1000 patient-days to 0.90/1000 patient-days (7.2% per year; 95% CI 6.9-7.5%). The frequency of reported bacteraemia isolates of S. aureus and Streptococcus pneumoniae increased moderately, while increase in E. coli and Enterococcus faecium was more pronounced. Bacteraemias caused by methicillin-resistant S. aureus increased until 2005 (7.6% per year; 95% CI 6.1-9.1%), and then decreased (-4.8% per year; 95% CI -6.1 to -3.5%), whereas the number attributable to methicillin-sensitive S. aureus increased continuously (3.4% per year; 95% CI 3.0-3.7). Increasing rates of E. coli were mainly caused by antibiotic-resistant phenotypes. Our data suggest that the burden of bacterial bloodstream infection has been increasing for all species during EARSS surveillance. Trends were mainly driven by resistant strains and clearly dissociated between resistant and susceptible isolates. It appears that infections with resistant clones add to rather than replace infections caused by susceptible bacteria. As a consequence, expansion of antibiotic resistance creates an additional strain on healthcare systems.

Antimicrobial resistance of selected invasive bacteria in a tertiary care center: results of a prospective surveillance study

“…coli is the most frequent cause of bloodstream infections in Europe and in the past few years evinced the largest annual increase, mostly due to expansion of MDR E. coli bacteremia [13]. In our study, one-third of E. coli isolates were resistant to third-generation cephalosporins and 21% were resistant to amikacin, which is slightly lower than the uppermost value in Europe reported by Bulgaria (39.6% and 32.1%, respectively) [6].…”

The evaluation of resistance genes and gene mutations in quinolone resistant Escherichia coli and Klebsiella spp. isolates

“…Son yıllarda yapılan bildirimler kinolon direncinin dünyada ve ülkemizde oldukça yüksek düzeylere ulaştığını göstermektedir (16) . Çalışma-mızda, siprofloksasin direnci E. coli ve K. pneumoniae izolatları için sırasıyla %46.7 ve %21.1 olarak bulunmuştur.…”

Evaluation of Methicillin-Resistant Staphylococcus aureus Bacteremia and Comparison of Prognosis According to Vancomycin MIC Values: Experience of the Last Ten Years

“…Bizim çalışmamızda, yıllar içinde saptanan MRSA bakteriyemi sayıları incelendiğinde özellikle 2006 yılından itibaren azalmanın olduğu, 2010 yılında ise sadece bir olgunun olduğu belirlenmiştir (Şekil 1). Bu dönem içerisinde dünyanın değişik ülkelerin-de, özellikle Avrupa kıtasında, MRSA oranlarında bir azalma olmuştur 15 . Bizim hastanemizde gözlenen azalma, ülkemizde benzer hastanelerde de gözlenmiştir.…”

“…Bu durum, aynı yıllarda yeni problem olmaya başlayan vankomisine dirençli enterokoklar (VRE) için hastane enfeksiyon kontrol önlemlerinin çok iyi uygulanması ve takip edilmesiyle MRSA oranlarında da azalmanın olduğu şeklinde yorumlanabilir. Ancak bu azalmanın, Avrupa ülkelerinin çoğunda aynı anda görülen genel azalmaya paralel olması, genel mikrobiyolojik dengeyle ilgili olabilir 15 .…”