EARSS/EARS-Net 1999-2013:15 years of European AMR surveillance in perspective

Liselotte Diaz Högberg, Expert, Surveillance and Response Unit European Centre for Disease Prevention and Control

1

Number of unique isolates reported to EARSS/EARS-Net* 1999-2013

0

5

10

15

20

25

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35

0

50000

100000

150000

200000

250000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Number of isolates Number of reporting countries

*) Data restricted to EU/EEA Members States

2

Number of unique isolates reported to EARSS/EARS-Net* 1999-2013

0

5

10

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0

50000

100000

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250000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Number of isolates Number of reporting countries

*) Data restricted to EU/EEA Members States

> 1 300 000 isolates!

30 countries

3

Number of unique isolates reported to EARSS/EARS-Net,* per pathogen, 1999-2013

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Year

S. pneumoniae S. aureus P. aeruginosa K. pneumoniae

E. coli Enterococcus Acinetobacter spp

4

The world is changing: we are getting older

Population pyramid, EU-28, 2001 and 2013

Source: Eurostat

% of total population

5

The world is changing: we are getting older

Median age of population, 2001–13

Source: Eurostat

The median age in the EU-28 increased, on average, by 0.3 years per year during the past 12 years, rising from 38.3 years in 2001 to 41.9 years in 2013. During this period the median age increased in all of the EU Member States.

6

The world is changing: health and health care

Increase in incidence of bacteraemia

Source: CDC/NCHS

Similar increase has been reported from Europe (Skogberg et al 2012, de Kraker et al 2013, Buoza et al 2015 etc)

7

The world is changing: we travel more

International Tourist Arrivals 2000-2014

0

200

400

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1200

2000 2005 2010 2012 2013 2014

Inte

rna

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mil

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ns)

Year

World

EU28

Source: World Tourism Organization (UNWTO)

8

EARSS/EARS-Net: Mean age (years) for patients contributing isolates, by pathogen, 2003 -2013

50

52

54

56

58

60

62

64

66

68

70

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Me

an

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e (

ye

ars

)

E. coli K. pneumoniae P. aeruginosa S. aureus S. pneumoniae Enterococcus

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

9

S. pneumoniae by age group and year

48

50

52

54

56

58

60

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Me

an

ag

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ye

a s

(li

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)

Pe

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pe

r a

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gro

up

(b

ars

)

65 years or older 40 to 65 years 18 to 40 years

5 to18 years Under 5 years Mean

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

10

E. coli by age group and year

64

65

66

67

68

69

70

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Me

an

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(li

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)

Pe

rce

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ge

pe

r a

ge

gro

up

(b

ars

)

65 years or older 40 to 65 years 18 to 40 years

5 to18 years Under 5 years Mean

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

11

Changes in age structure in EARSS/EARS-Net data 1998-2013

• Mean age varies between bacteria and year.

• The mean age has increased for all bacteria under EARS-Net surveillance, but the proportional increase has not been the same.

• The increase in mean age among cases contributing S. pneumoniae isolates seems to be partly explained by a decrease in the number of cases among children starting around 2007

• The increase in age among cases contributing E. coli isolates has been more gradual and seems to be partly explained by a gradual increase in elderly cases

12

K. pneumoniae: percentage resistance to fluoroquinolones, aminoglycosides, third-generation cephalosporins and carbapenems (population-weighted EU/EEA mean), by year, 2005-2013

0

5

10

15

20

25

30

35

2005 2006 2007 2008 2009 2010 2011 2012 2013

Pe

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Fluoroquinolones Third-generation cephalosporins Aminoglycosides Carbapenems

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

13

K. pneumoniae: percentage fully susceptible, and percentage resistant to one, two or three antimicrobial groups (population-weighted EU/EEA means),by year, 2005 -2013*

* Analysis restricted to isolates tested for all three antimicrobial groups of fluoroquinolones, aminoglycosides and third-generation cephalosporins

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10

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50

60

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80

90

2005 2006 2007 2008 2009 2010 2011 2012 2013

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Fully susceptible R to one antimicrobial group

R to two antimicrobial groups R to three antimicrobial groups

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

14

K. pneumoniae: percentage fully susceptible, and percentage resistant to one, two or three antimicrobial groups (population-weighted EU/EEA means),by year and admission status, 2005 -2013*

Fully susceptible

* Analysis restricted to isolates tested for all three antimicrobial groups of fluoroquinolones, aminoglycosides and third-generation cephalosporins

Resistance to one antimicrobial group

___ Inpatient ____ Outpatient

0

20

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60

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100

2005 2006 2007 2008 2009 2010 2011 2012 2013

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2005 2006 2007 2008 2009 2010 2011 2012 2013

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2005 2006 2007 2008 2009 2010 2011 2012 2013

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2005 2006 2007 2008 2009 2010 2011 2012 2013

Perc

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Resistance to two antimicrobial groups Resistance to three antimicrobial groups

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

15

E. coli: percentage resistance to aminopenicillins, fluoroquinolones, aminoglycosides and third-generation cephalosporins (population-weighted EU/EEA mean), by year, 2005-2013

0

10

20

30

40

50

60

70

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pe

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sis

tan

ce

Aminopenicillin Fluoroquinolones

Third-generation cephalosporins Aminoglycosides

Carbapenems

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

16

E. coli: percentage fully susceptible, and percentage resistant to one, two, three and four antimicrobial groups, by year (population-weighted EU/EEA mean)*

* Analysis restricted to isolates tested for all three antimicrobial groups of aminopenicillins, fluoroquinolones, aminoglycosides and third-generation cephalosporins

0

5

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20

25

30

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50

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pe

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Fully susceptible R to one antimicrobial group

R to two antimicrobial groups R to three antimicrobial groups

R to four antimicrobial groups

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

17

E. coli: percentage fully susceptible, and percentage resistant to one, two or three antimicrobial groups (population-weighted EU/EEA means),by year and admission status, 2005 -2013*

Fully susceptible

* Analysis restricted to isolates tested for all three antimicrobial groups of fluoroquinolones, aminoglycosides and third-generation cephalosporins

Resistance to one antimicrobial group

___ Inpatient ____ Outpatient

Resistance to two antimicrobial groups Resistance to three antimicrobial groups

0

10

20

30

40

50

60

20032004200520062007200820092010201120122013

28

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38

40

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

0

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20032004200520062007200820092010201120122013

0

2

4

6

8

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

0

2

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6

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Resistance to four antimicrobial groups

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

0

5

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35

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Year

S. aureus: percentage MRSA (population-weighted EU/EEA mean), by year, 2003-2013

Data from EARSS/EARS-Net. Preliminary analysis and results*) Data restricted to EU/EEA Members States

19

S. aureus: MRSA (population-weighted EU/EEA means), by year and admission status, 2005 -2013

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Year

Inpatient

Outpatient

Data from EARSS/EARS-Net

20

Summary resistance trends

• There was an increase in resistance for all antimicrobial groups under surveillance for E. coli and K. pneumoniaeduring the period

• The increase was larger for K. pneumoniae compared to E. coli

• In K. pneumoniae the increase was mainly in resistance to three antibiotic groups

• There were larger differences between inpatient and outpatients for K. pneumoniae compared to E. coli

• MRSA decreased during the period, but the decrease was mainly seen among inpatients

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Thank you for your attention!

Thanks to all laboratories, hospitals and EARSS/EARS-Net network participants contributing data to the network.

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Inpatient outpatient

0%

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50%

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80%

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Outpatient

Outpatient