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Stabilization in prevalence of ESBLs & ciprofloxacin non-susceptibility in Enterobacteriaceae from blood in the

Stabilization in prevalence of ESBLs & ciprofloxacin non-susceptibility in Enterobacteriaceae from blood in the UK and Ireland. Rosy Reynolds, Russell Hope on behalf of the BSAC Working Party on Resistance Surveillance. O135, 20th ECCMID, Vienna, 10-13 April 2010 rosy.reynolds@nbt.nhs.uk.

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Stabilization in prevalence of ESBLs & ciprofloxacin non-susceptibility in Enterobacteriaceae from blood in the

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  1. Stabilization in prevalence ofESBLs & ciprofloxacin non-susceptibilityin Enterobacteriaceae from bloodin the UK and Ireland Rosy Reynolds, Russell Hopeon behalf ofthe BSAC Working Party on Resistance Surveillance O135, 20th ECCMID, Vienna, 10-13 April 2010 rosy.reynolds@nbt.nhs.uk

  2. 2008 BSAC Bacteraemia Resistance Surveillance • 25 laboratories / year • 20 E. coli (10 up to 2007), 10 Klebsiella, Enterobacter, Proteeae, Others • per laboratory per year • Central testing - • HPA Centre for Infections, London. • BSAC agar dilution MICs • ESBL by clavulanate synergy; PCR for CTX-M • Data on website: www.bsacsurv.org

  3. ACKNOWLEDGEMENTS British Society for Antimicrobial Chemotherapy (BSAC) Bacteraemia Resistance Surveillance Programme HPA Centre for Infections, Colindale Sponsors 2001-2008 Collecting Laboratories

  4. All bacteraemia Hospital bacteraemia ( 48 hours) Distribution of genera in Enterobacteriaceae Estimated from: BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

  5. Minor species % non-susceptibility and ESBLs BSAC Bacteraemia 2001-2008

  6. Enterobacter % non-susceptibility and ESBLs BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

  7. Klebsiella % non-susceptibility and ESBLs BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

  8. p <0.0005 OR = 1.60 p = 0.33 OR = 0.94 Q1 2004 Klebsiella segmented logistic regression BSAC Bacteraemia 2001-2008

  9. E. coli % non-susceptibility and ESBLs BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

  10. p = 0.15 OR = 0.86 p <0.0005 OR = 1.76 Q3 2005 E. coli - ESBL prevalence segmented logistic regression BSAC Bacteraemia 2001-2008

  11. ESBLs in hospital and community E. coli (<48 vs. ≥ 48 hours in hospital) BSAC Bacteraemia 2001-2008

  12. Ciprofloxacin resistance in ESBL-negative E. coli BSAC Bacteraemia 2001-2008

  13. Summary - 2008 % non-susceptibility and ESBLs Non-susceptibility to imipenem or meropenem or doripenem: 0/467 E. coli 1/205 Klebsiella 3/157 Enterobacter (all ESBL-negative) BSAC Bacteraemia 2008

  14. Conclusions • The prevalence of ESBLs and ciprofloxacin non-susceptibility in Klebsiella and E. coli has stabilised after a sharp rise. • Ciprofloxacin non-susceptibility also increased in ESBL-negative E. coli. • Carbapenem resistance was still rare in 2008. • Resistance varies between groups e.g. patients with hospital- vs. community-acquired bacteraemia. • Continued vigilance and care in the selection of empirical treatment is still needed.

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