Preparing for the EARS-Net 2015 data call

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

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• Results from 2014 EARS-Net data call

• Preparing for the EARS-Net 2015 data call:

- timeline and outputs

• The future of Acinetobacter spp surveillance

• Improving comparability of S. pneumoniae data

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14-20April

21-27April

28 April -4 May

5 -11May

12-18May

19-25May

26 May-1June

2-8 June 9-15June

16-22June

23-29June

30 June -6 July

7-13 July

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Overview of data call 2014

Active data call

Deadline

Cumulative number of reporting countries

2 3 4 5 6 12 19 28 30

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Percentage isolates per pathogen, 2013

Data from EARS-Net

E. faecium4%

E. facealis7%

S. pneumoniae7%

S. aureus22%

Acinetobacter spp2%

P. aeruginosa6%

K. pneumoniae10%

E. coli42%

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Number of reported isolates per pathogen. By country, 2013

Data from EARS-Net

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FR SE UK DE ES IT NL AT BE DK PT CZ FI NO EL HU IE PL SK HR SI RO LT BG EE LU LV CY MT IS

E. coli

K. pneumoniae

P. aeruginosa

Acinetobacter spp

S. aureus

S. pneumoniae

E. facealis

E. faecium

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2014 data call in summary:Reporting completeness

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Age Gender Patient type Hospital unit type Date hosp

Data from EARS-Net

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2014 data call in summary:Reporting completeness

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Age Gender Patient type Hospital unit type Date hosp

Mean 66.1 yearsMedian 71 years

Female 44.9%Male 55.1%

Inpatients 86.5%Outpatients 13.5%

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E. coli K. pneumoniae P. aeruginosa Acinetobacterspp

S. aureus S. pneumoniae Enterococcus

PEDSICU

PEDS

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OBGYN

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2014 data call in summary:Hospital unit type, by pathogen

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E. coli K. pneumoniae P. aeruginosa Acinetobacterspp

S. aureus S. pneumoniae Enterococcus

No info

Zone diameter

E-test

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2014 data call in summary:Quantitative susceptibility data, by pathogen

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Data callData

analysis, report draft

Internal ECDC

approval

MS report approval

Re-analysisFinal ECDC approval

Editing and layout

Timeline 2015: from data call to finalised report

1st

MS data approval

2nd

MS report approval

•Non-negotiable deadline: European Antibiotic Awareness Day on November 18• Two separate MS approval processes: during data call and the report approval

TESSy approval

Deadline 1 July

SeptemberAugust October

Data call outputs 2015

EARS-Net annual report

• online version with country summary sheets • printed version without country sheets (tbc)

Summary for EAAD briefing kit

EARS-Net on-line database

• maps• tables• trend graphs

Published 18

November!

New design for tables and trend analysis results

Background data for all tables and graphs can be downloaded from the ECDC website

Acinetobacter spp pilot surveillance in EARS-Net – experience and way forward

Background

• Concern for increasing AMR problem in Acinetobacter raised at the Joint ARHAI Annual Meeting in Warsaw, 2010

• Survey sent out late 2010 to assess feasibility for surveillance

• Agreed to include as 2-year pilot at 2nd network meeting in 2011

• Data collection completed 2013 and 2014 - time for evaluation

Acinetobacter spp surveillance in EARS-Net

EARS-Net 2010 Acinetobacter Survey summary

• High participation in the survey: response received from 29/30 countries

• Acinetobacter was already included in national AMR surveillance in more than half of the countries, but blood stream isolates constitute a small proportion (<5%) of all isolates in most cases

• A relatively high number of antimicrobials were included in AST panels in more than half of the countries having AST results for Acinetobacter

• Multidrug resistance in Acinetobacter was assessed in >50% of blood stream isolates in 1/4 of the countries

• The importance of Acinetobacter was perceived as “significant “ by 1/3 of the countries, while 1/3 considered Acinetobacter as being of “minor” importance

• 80% of the countries would like Acinetobacter included in EARS-Net

Acinetobacter spp surveillance in EARS-Net

EARS-Net Coordination Group advice regarding feasibility of Acinetobactersurveillance (February 2012)

• Number of isolates will be very low for some countries (blood isolates only)

• Challenges of species identification and susceptibility testing to be carefully considered – only include at spp level

• Limit the antimicrobial groups under surveillance

• Acinetobacter data collected in the HAI-PSS should be reviewed to validate EARS-Net results

Acinetobacter spp surveillance in EARS-Net

Acinetobacter spp: Number of reporting countries (green), 2012 and 2013

2012 2013

Acinetobacter spp surveillance in EARS-Net

18 countries 27 countries

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Frequency of Acinetobacter spp. as percentage of all bacteria reported to EARS-Net, by country (n:4120), 2013

No data

<1%

1-<2 %

2-<4 %

4-<6 %

6-<8 %

>8 %

Acinetobacter spp surveillance in EARS-Net

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Relative frequency of Acinetobacter spp. as a percentage of all microorganisms reportedfor HAIs, by country (n=366 isolates), ECDC PPS 2011–2012

* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania and very poor in Denmark and Sweden. See table 18 for total number of microorganisms by country.

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Relative frequency of Acinetobacter spp. as a percentage of all microorganisms reportedfor HAIs, by country (n=366 isolates), ECDC PPS 2011–2012

* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania and very poor in Denmark and Sweden. See table 18 for total number of microorganisms by country.

EARS-Net

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Acinetobacter spp. Percentage (%) of invasive isolates with

resistance to carbapenems, by country, EU/EEA, 2013

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Percentage of Acinetobacter baumannii isolates non-susceptible to carbapenems in HAIs in acute care hospitals, ECDC PPS 2011-2012

ECDC PPS* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania and very poor in Denmark and Sweden. See table 18 for total number of microorganisms by country.

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Percentage of Acinetobacter baumannii isolates non-susceptible to carbapenems in HAIs in acute care hospitals, ECDC PPS 2011-2012

ECDC PPS

EARS-Net

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Occurrence of carbapenem-resistant Acinetobacter baumannii (CRAb) (all types of isolates) based on self-assessment by national experts, EuSCAPE project, 38 European countries, March 2013

The stage designations for CRAb should be taken with caution for all 38 participating countries. Most national experts highlighted that the exact epidemiology of CRAb remains uncertain in their country, because at the time of the survey surveillance and reporting of CRAb are not performed routinely in their country, and because only few national reference laboratory structures for CRAb exist in European countries.

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Occurrence of carbapenem-resistant Acinetobacter baumannii (CRAb) (all types of isolates) based on self-assessment by national experts, EuSCAPE project, 38 European countries, March 2013

The stage designations for CRAb should be taken with caution for all 38 participating countries. Most national experts highlighted that the exact epidemiology of CRAb remains uncertain in their country, because at the time of the survey surveillance and reporting of CRAb are not performed routinely in their country, and because only few national reference laboratory structures for CRAb exist in European countries.

EARS-Net

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Summary: Reporting capacity

• Number of reporting countries increased from 18 in 2013 to 27 in 2014

• Most isolates had susceptibility information on all three antimicrobial groups under regular surveillance

• Number of reported isolates were in most cases equal to or higher than estimated in 2011

• Number of reported isolates increased in most countries between 2013 and 2014

• Proportion Acinetobacter spp isolates varied between countries, and was especially high in south-eastern countries

• Frequency of Acinetobacter spp is similar as reported from ECDC PPS

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Summary: Resistance situation

• Large variations in antimicrobial resistance of Acinetobacter spp. isolates in Europe were reported, with generally higher resistance percentages reported from countries in the south of Europe than in the north.

• Carbapenem resistance was common, and in most cases combined with resistance to fluoroquinolones and aminoglycosides.

• Results are difficult to compare between EARS-Net and PPS and EuSCAPE, but shows a similar geographical gradient

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Suggested way forward:

• Keep surveillance of Acinetobacter spp in EARS-Net in current format:

• Reporting on genus level (i.e., Acinetobacter spp)

• Panel of antimicrobials: fluoroquinolones, aminoglycosides, carbapenems and polymyxins

Presenting penicillin susceptibility data in S. pneumoniae- improving comparability

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The problem

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• S. pneumoniae breakpoints for penicillin susceptibility differ depending on clinical guidelines used and site of infection.

• The use of clinical breakpoints differ between countries. Many countries are now changing fro use of CLSI to EUCAST.

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Penicillin susceptibility in S. pneumoniae: Use of clinical breakpoints for 2012 data

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EUCAST non-menigitis

14%

EUCAST depending on

site of infection

40%CLSI meningitis

13%

CLSI depending on site

of infection

13%

CLSI oral

13%

Mix

7%

Number of respondents: 14/29 countries

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Use of clinical guidelines, by year, 2008-2013

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2008 2009 2010 2011 2012 2013

CLSI

EUCAST+

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Penicillin susceptibility in S. pneumoniae: Reporting of quantitative information (2013)

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AT BE BG CY CZ DE DK EE EL FI FR HR HU IE IS ES LT LU LV MT NL NO PL PT RO SE SI SK UK

No info

Zone diam results %

MIC result%

Gradient strip result %

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Suggested way forward

Present data according to fixed breakpoints:MIC S <= 0.06 mg/L (R>2 mg/L)

Limit results to non-susceptible (better harmonisation between breakpoints)?

How to achieve this?

1. MS adjust their SIR interpretation before data upload- If not possible, countries can still report data but need to inform ECDC that the set breakpoints are not used

2. ECDC analyse according to reported quantitative data- Reporting of quantitative data must increase to make this

meaningful