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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 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

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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
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ACKNOWLEDGEMENTS

British Society for Antimicrobial Chemotherapy (BSAC)

Bacteraemia Resistance Surveillance Programme

HPA Centre for Infections, Colindale

Sponsors 2001-2008

Collecting Laboratories

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All bacteraemia

Hospital bacteraemia ( 48 hours)

Distribution of genera in Enterobacteriaceae

Estimated from:

BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

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Minor species

% non-susceptibility and ESBLs

BSAC Bacteraemia 2001-2008

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Enterobacter

% non-susceptibility and ESBLs

BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

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Klebsiella

% non-susceptibility and ESBLs

BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

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p <0.0005

OR = 1.60

p = 0.33

OR = 0.94

Q1 2004

Klebsiella

segmented logistic regression

BSAC Bacteraemia 2001-2008

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E. coli

% non-susceptibility and ESBLs

BSAC Bacteraemia 2001-2008; HPA voluntary bacteraemia surveillance 2008

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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

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ESBLs in hospital and community E. coli

(<48 vs. ≥ 48 hours in hospital)

BSAC Bacteraemia 2001-2008

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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

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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.