Antimicrobial Susceptibility StudiesResistance surveillance program report for selected European nations (2011)☆
Introduction
Bacterial strains resistant to commonly used β-lactams, fluoroquinolones, and other antimicrobial agents remain a significant challenge to successful chemotherapy in both developed and developing nations (Rice, 2012). β-lactamase–mediated resistances among Gram-negative bacilli (Bonnet, 2004, Castanheira et al., 2008, Castanheira et al., 2011, Kumarasamy et al., 2010, Rolain et al., 2010) and the expansion of Gram-positive resistant species (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin [VAN]–resistant enterococci [VRE], multidrug-resistant [MDR] Streptococcus pneumoniae) present the most critical compromises to favorable patient outcomes (Sader et al., 2010, Sader et al., 2011, Woodford and Livermore, 2009).
To address these concerns, a structured antimicrobial surveillance program was organized for 2011 to 1) sample key pathogens by nation in the European area, especially Eastern areas; 2) use reference quantitative susceptibility testing methods (Clinical and Laboratory Standards Institute [CLSI]) in a central monitoring laboratory design; and 3) offer a wide range of tested antimicrobials, usually more than 20 agents. These program results can then be compared to other regional or national surveillance programs that utilize available “non-reference” (convenience samples), often commercial categorical (not quantitative) results (Bolmstrom et al., 2002, Castanheira et al., 2008, Castanheira et al., 2011, Flamm et al., 2013, Rodloff et al., 2008, Sader et al., 2010, Sader et al., 2011). The categorical susceptible breakpoint definitions may vary as well as the quality/accuracy of the method (Clinical and Laboratory Standards Institute (CLSI), 2013, EUCAST, 2013); therefore, structured programs such as this Regional Resistance Surveillance (RRS) Study offers expanded, validating information for other programs such as the European Antimicrobial Resistance Surveillance Network (EARS-Net) (2011) of the European Antimicrobial Resistance Surveillance System especially for Eastern Europe and Mediterranean nations.
In the European component of RRS, 21 nations were monitored in 2011 (12,572 isolates), enabling comparison of numerous drugs to that data generated by the EARS-Net (2011) and other published program information.
Section snippets
Nations and organisms monitored
A total of 21 countries (47 sites, 97–492 strains/site) were sampled with a target of ≥200 isolates of specific species per nation. The organisms were isolated from a wide variety of clinical infection types/sites including respiratory tract (26.3%), acute bacterial skin and skin structure (17.2%), and bacteremias (26.3%). The countries (sample size) were: Belgium (492), Bulgaria (BU; 100), Croatia (200), Czech Republic (447), France (F; 1535), Germany (GE; 756), Greece (GR; 418), Ireland (IR;
Antimicrobial profiles of Gram-positive pathogens (Table 1)
S. aureus isolates (2413; 31.3% MRSA overall) exhibited complete (100.0%) susceptibility to LZD (MIC50/90, 1/2 μg/mL), teicoplanin (MIC50/90, ≤2/≤2 μg/mL; data not shown), TIG (MIC50/90, 0.06/0.12 μg/mL), and VAN (MIC50/90, 1/1 μg/mL). Highest MRSA rates (≥50.0%) occurred in Eastern nations (PO, RO, RU, SK, Ukraine) and PT, range 50.0–60.0%. Rarer non-susceptibility to daptomycin (0.1%; strains from Croatia, GE, GR, and T), doxycycline (0.7–5.7%), and trimethoprim/sulfamethoxazole (TMP/SMX;
Conclusions
In this study, resistances in Gram-positive pathogens across Europe remain common, particularly among S. aureus (MRSA) and CoNS, but some agents still have high potencies (LZD, daptomycin, and glycopeptides) (Bolmstrom et al., 2002, Flamm et al., 2013, Sader et al., 2011). Enterococcal resistance (VRE at 9.2–10.1%) was rare for LZD and daptomycin and not increasing, but some isolates were detected confirming epidemic clones emerging in some institutions (Mendes et al., 2010). Ceftriaxone
Acknowledgments
The co-authors wish to thank the other participants/sites for contributing the isolates and especially University Hospital Antwerp, Antwerp, Belgium (Dr H. Goossens); Alexander University Hospital, Sofia, BU (Dr B. Markova); Clinical Hospital Center, Zagreb, Croatia (Dr V. Plecko); University Hospital, Brno, Czech Republic (Dr M. Hanslianova); Meir Medical Center, Kfar Saba, IS (Dr Y. Paitan); Rambam Medical Center, Haifa, IS (Dr H. Sprecher); National Medicines Institute, Warsaw, PO (Drs W.
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This study was presented in part at the ECCMID (2013) in Berlin, Germany. Poster no. P1503.