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earss newsletter - European Centre for Disease Prevention and ...

No. 9, May 2008

This Newsletter is a bulletin providing

information on the European Antimicrobial

Resistance Surveillance System;

EARSS is funded by the European Center

for Disease Prevention and Control

(ECDC) and the Dutch Ministry of

Public Health, Welfare and Sports and

co-ordinated by the National Institute

of Public Health and the Environment

(RIVM) of the Netherlands.

It is the remit of EARSS to maintain

a comprehensive surveillance and

information system that links national

networks by providing comparable

and validated data on the prevalence

and spread of major invasive bacteria

with clinically and epidemiologically

relevant antimicrobial resistance in

Europe

Editing:

EARSS Management Team, RIVM

EARSS Management Team:

• Project leader/Scientific coordinator:

Hajo Grundmann

(hajo.grundmann@rivm.nl)

• Consultant Medical Microbiologist:

John Degener

(University Hospital Groningen)

• EARSS coordinator:

Ineke Roede

(ineke.roede@rivm.nl)

• Epidemiologists:

Nienke van de Sande-Bruinsma

(nienke.van.de.sande@rivm.nl)

Marlieke de Kraker

(marlieke.de.kraker@rivm.nl)

• International data manager & software

engineer: Jos Monen

(jos.monen@rivm.nl)

RIVM, Centre for Infectious Disease

Control

Epidemiology and Surveillance

P.O. Box 1, 3720 BA Bilthoven

The Netherlands

Telephone: +31 30 274 3505

www.earss.rivm.nl

EARSS NEWSLETTER

EUROPEAN ANTIMICROBIAL RESISTANCE SURVEILLANCE SYSTEM

Dear EARSS participant,

After a turbulent year we are happy to inform you that we, Hajo, Ineke, Nienke, Jos en Marlieke, will

stay on to support you as the EARSS management team until the end of 2009. With the new contract

agreed, we are confident that you will be able to continue your enthusiastic participation and we

will maintain and improve the EARSS network. In this newsletter we will inform you about the new

EARSS contract, we will announce some upcoming EARSS activities and give an updated overview of

the EARSS network in 2008.

Items in this Newsletter:

1. New EARSS contract

2. Announcements

3. Personal Matters

4. Coverage of the EARSS network in 2007

5. Participating countries, country codes and national representatives in EARSS

1. New EARSS contract

At the end of August 2007 the EARSS V contract ended and although ECDC had the intention

to continue EARSS from Stockholm, it became clear that this was not yet feasible at that time.

Therefore in November, ECDC put out a call for proposal for ‘Surveillance of antimicrobial resistance

in Europe 2007-2009’. EARSS-MT at RIVM responded to this call and in December we

received the news that our proposal was accepted and RIVM could continue hosting EARSS for

another two years, till the end of 2009.

EARSS agenda 2008

3 rd joint EARSS/SeqNet.org sequence typing workshop

RIVM, Bilthoven, The Netherlands June 5-6, 2008

Tomtebodaskolan used to be a

training centre for the visually

impaired, but is now the headquarters

of ECDC in Stockholm.

Plenary Meeting, Athens, Greece November 13-14, 2008

19th ECCMID, Helsinki, Finland May 16-19, 2009


The main deliverables for the coming two years are comparable

to what EARSS has doing so far:

• Maintaining an electronic, standardized database on antimicrobial

resistance by continuous updating of data reported by

the network participants

• Provide ongoing quarterly data for all EU countries about antimicrobial

resistance in indicator bacteria

• Expand coverage to all Member States, EEA/EFTA and candidate

countries (countries EARSS should still include are Liechtenstein,

Republic of Macedonia and Slovakia)

• Review comparability of the EARSS data (through the EQA and

annual training courses)

• Improve comparability of the EARSS data (through dissemination

of the EARSS antimicrobial susceptibility testing guidelines

in the EARSS manual and collaboration with EUCAST)

• Improvement of comprehensiveness of the EARSS data (improving

reporting of all compound-pathogen combinations by all

countries, increasing population coverage in countries with low

coverage and improve delivery of denominator information)

• Development and application of validated outcome and performance

indicators of antimicrobial resistance (Outcome

indicators will include aspects of diagnostic services in EARSS

laboratories/hospitals, performance indicators will include national

coverage, reporting of denominator data, EQA performance

etc.)

• Development and maintenance of a website presenting country

level data on antimicrobial resistance

2. Announcements

2.1 New protocol for detection of

carbapenemases in K. pneumoniae

In March we had an advisory board meeting. During this meeting

it became clear that there is a need to develop a protocol for

identifying specific carbapenemase resistance mechanisms, like

KPC (K. pneumoniae carbapenemase resistance) and MBL (metallo

betalactamase mediated carbapenem resistance). Since this kind

of resistance is fortunately still rare, not all laboratories have the

expertise to identify these resistance mechanisms. Nevertheless,

this type of resistance is a threat we should start preparing for.

Alkis Vatopoulos (Greece) has quite some experience in identifying

carbapenemases at his laboratory in Athens. As shown by

the EARSS results carbapenem resistance is not exceptional in

Greece. They use the modified Hodge test (Gott test) with meropenem,

imipenem and an EDTA disk to identify these resistance

mechanisms. Before a guideline can be written the validity of

this test needs to be confirmed with strains from different laboratories.

This is in process right now and we hope to be able to

propose a new guideline at the plenary meeting in Athens, 13th and 14th of November.

Figure 1. Plate with MBL-positive K. pneumoniae strain; MEM, meropenem disk;

EDTA, EDTA disk; IMP, imipenem disk.

2

• Development of a protocol for an ecological analysis of antimicrobial

resistance and antimicrobial consumption in collaboration

with ESAC

• Forecasting of trends in antimicrobial resistance and multi

drug resistance

• Support towards a wider implementation of an electronic

alert system for the emergence and spread of antimicrobial

resistant bacteria (EARSS-ibis)

• Preparation of reports and publications

• Organisation of an annual External Quality Assurance exercize

• Organisation of training courses for the data managers and

lab personnel

• Organisation of EARSS annual plenary meetings

• Development of the strategy for transferring the data collection

and the database to the ECDC before the end of the contract

• Development of future objectives for this field in conjunction

with ECDC

• Contributing to the development of a strategy to strengthen

the integration of the surveillance of resistance, antimicrobial

consumption, and health care associated infections

We are looking forward to work on these deliverables together

with all of you.

2.2 Small adjustment of ESBL protocol

The second footnote of the ESBL protocol concerns indeterminable

ESBL production, due to MICs outside the test range. It stated

that: ‘ESBL production is not always determinable, e.g. if both the

cephalosporin and the cephalosporin+clavulanic acid produce

MICs or zone diameters outside the test range, or there is no clavulanate

synergy.’ The last part of the sentence will be replaced

by this sentence: If there is no clavulanate synergy, but they are

resistant, there is likely overproduction of AmpC. No other modifications

were deemed necessary by the Advisory Board.

2.3 External Quality Assessment EARSS 2008

In January this year, when the contract with ECDC was signed,

EARSS-MT started to discuss with UK-NEQAS about the opportunities

for an EQA exercise in 2008. Since the strains need to be selected,

prepared and disseminated, UK-NEQAS needs some time

to organise such a large scale EQA exercise. The strains will be

sent to all laboratories just after the summer holidays, beginning

of September. Of course, all laboratories will receive individual

feedback and certificate of participation and the EQA results will

be discussed at the plenary meeting in November.

2.4 Questionnaire on Diagnostic habits and

denominator data

Some of you might have been surprised by the laboratory/hospital

questionnaire that was sent to you this year, as this used to be

a bi-annual exercise and most of you will remember last year’s

questionnaire. However, a new contract entails new deliverables:

ECDC is very dedicated to improving the quality of the surveillance

data and one key issue is the availability of denominator

data. Amongst others, these data can be used to calculate patient

based risk estimates next to the resistance proportions. Therefore


they asked us to send a questionnaire each year, instead of biannual.

We know this is an extra burden for the national data

managers, the national representatives and the laboratories, we

do, however, hope that all will understand the importance of

high quality surveillance and will do their best to complete the

questionnaires.

Since we had to send out a denominator questionnaire, we took

this opportunity to also look into some other aspects that can influence

resistance proportions: diagnostic services of the microbiological

laboratory. They play a key role in adequate and successful

patient treatment and improving health care. We hope

that this year’s laboratory questionnaire will answer a number of

important questions that could shed a light on factors influencing

the ascertainment of antimicrobial resistance in Europe.

We understand the laboratory questionnaire from this year will

require more effort, however we hope and know that all of you

will understand the value of the questionnaire.

2.5 Plenary Meeting in Athens

The 13 th and 14 th of November the annual Plenary Meeting

will take place in Athens, Greece. This year it will again be a

jointly organised meeting of ESAC (European Surveillance of

Antimicrobial Consumption) on Thursday and EARSS on Friday.

There will be no joined sessions, however people arriving early

will be free to attend the afternoon sessions of the ESAC meeting

as well. Amongst other items the new guideline for detecting

carbapenemases will be discussed, Hajo will present the results

of the Spa-type initiative, Nienke will give some insights in the

preliminary results of the EQA exercise, Marlieke will talk about

the first results of the BURDEN study and Herman Goossens will

discuss the new ESAC initiatives. Thursday and Friday evening

there will be an opportunity for some informal discussions during

the social program. We are looking forward to meeting all

of you there!

3. Personal Matters

3.1 EARSS Advisory Board 2008

Name Representing

Prof. Fernando Baquero ESGARS

Hospital Ramon y Cajal, Madrid, Spain

Dr. Giuseppe Cornaglia ESCMID

University of Verona, Italy

Dr. Gunnar Kahlmeter EUCAST

Central Hospital Växjö, Sweden

Prof. John Degener all countries

University Hospital Groningen, The Netherlands

Prof. Vincent Jarlier all countries

Groupe Hospitalier Pité-Salpétrière, Paris, France

Prof. Alkis Vatopoulos all countries

National School of Public Health, Athens, Greece

Dr. Jana Kolman all countries

University Medical Center, Ljubljana, Slovenia

Dr. Arta Balode all countries

Paula Stradina Clinical University Hospital, Riga, Latvia

3

2.6 Workshops in 2008 and 2009

Like before, a workshop will be organised in Bilthoven in 2008.

This year we would like to invite scientists from National Ref.

Laboratories for the 3 rd joint EARSS/SeqNet.org sequence typing

workshop on the 5 th and 6 th of June. The results of the spa-typing

initiative of last year will be discussed in detail and possibilities

for taking this initiative forward will be discussed. In 2009, the

data managers will be invited to visit Bilthoven for a workshop

about data management and data analysis.

2.7 Site visits with ECDC

EARSS-MT members are always willing to contribute to national

meetings about antimicrobial resistance surveillance in each of

the participating countries. Recently Jos Monen was invited to

participate in the AKM meeting in Istanbul. This was a good opportunity

to present the EARSS data and to discuss with Turkish

microbiologists and with the other invited speakers like David

Livermore (UK), Keith Klugman (USA and SA) and Laurent Poirel

(FR).

If any of you is organising a national meeting and would like

to have EARSS-MT support giving a presentation about the network,

specific EARSS data or any other EARSS-related subject,

please email to one of the EARSS-MT members. Of course EARSS

participants can also help each other; you could for example, invite

National representatives and/or Data managers from neighbouring

countries to exchange experience and learn from each

other.

ECDC also started visiting different countries to get to know

the important players in the field of antimicrobial resistance in

Europe. It has been proposed to combine EARSS site visits with

ECDC visits, whenever possible, in that way creating the opportunity

for ECDC to also meet people involved in the national antimicrobial

resistance surveillance network.

Since Alkis Vatopoulous and Jana Kolman have been in the

Advisory Board (AB) as National Representatives for two years,

they will be succeeded by two new National Representatives.

Fernando Baquero will step down as member of ESGARS, therefore

we also need to find a new representative from ESGARS

who would like to enrich the EARSS AB. Fernando will, however,

remain in the AB as National Representative of Spain, thereby

succeeding Alkis. Deniz Gür from Turkey has already agreed to

become part of the AB, succeeding Jana. They will officially take

over at our Plenary Meeting in Athens. On that occasion, we will

also express our gratitude to Jana Kolman and Alkis Vatopoulous

for their valuable contributions to the EARSS network and we

are convinced they will continue to contribute in their role as

National representatives.


3.2 EARSS management team

As already mentioned before, the members of EARSS-MT had

to become involved in other activities, due to the ongoing insecurity

regarding the continuation of EARSS. Hajo Grundmann,

EARSS project leader, changed position within the institute and

is now head of bacteriology and surveillance. Nienke van de

Sande, EARSS epidemiologist, and Jos Monen, the international

data manager, have become involved in developing a new system

for the national laboratory surveillance in The Netherlands.

Marlieke de Kraker, EARSS epidemiologist, started her PhD,

working for the BURDEN project. Fortunately, Hajo, Nienke, Jos

en Marlieke can still contribute to EARSS, but now on a parttime

basis. Our management assistant Carola Schinkel started

her own company, luckily we can still use her expertise for specific

events. Edine Tiemersma, EARSS coordinator, started working

for the KNCV Tuberculosis Foundation from January and

will no longer be involved in EARSS. Since we are dedicated to

lead a flourishing EARSS network for another two years, we have

attracted a new EARSS coordinator: Ineke Roede. She formally

4. Coverage of the EARSS network in 2007

Since the beginning of EARSS in 1999, the coverage of the network

has been extended from 13 countries in 1999, to 31 countries

in 2007. In addition to 26 of the 27 Member States, EARSS

receives data from 2 of the 3 EEA/EFTA (Norway and Iceland) and

2 out of 3 candidate countries (Turkey and Croatia) and from

Israel. It is the wish of ECDC that EARSS includes all member

states, EEA/EFTA countries and candidate countries. One of the

member states, Slovakia, was not able to deliver data in 2006 and

2007, but we hope we will soon be able to include this country

again. Liechtenstein and the Republic of Macedonia should also

be included. Since the Republic of Macedonia only recently became

a candidate country, we have not been in contact yet, but

Funded by the European Commission

EARSS

EUROPEAN ANTIMICROBIAL RESISTANCE SURVEILLANCE SYSTEM

4

worked at the Academic Medical Center in Amsterdam and will

be defending her thesis on ‘COPD exacerbations: treatment with

antibiotics and oral corticosteroid course in primary and secondary

care’ in autumn this year. She will reinforce EARSS-MT from

the beginning of May. Also Jos Monen will be supported by a new

data manager, Jeroen Alblas, starting in August.

3.3 National representatives

We would like to welcome the EARSS National Representatives

that joined in the past year, and thank all those that stepped down

for their contributions in the past few years. Anette Hammerum

will replace Dominique Monnet in Denmark, in Estonia Paul

Naaber handed his position over to Kadri Kermes, Robert Cunney

became the national representative replacing Derval Igoe in

Ireland, in Lithuania Vilma Jonaitiene has taken over Jolanta

Miciuleviciene’s position and finally Anda Baicus has succeeded

Irina Codita in Romania. Next to that we would like to welcome

Prof. Selma Uzunovic-Kamberovic, representing the new EARSS

participating country The Republic of Bosnia Herzegovina.

it is our intention to explore her participation this year. Liechtenstein

will be approached as well.

In 2008, one new country started reporting data to EARSS, Bosnia

Herzegovina. Next to that some other countries have expressed

interest in EARSS: Switzerland set up a national antimicrobial

surveillance system and promised to send data as soon as all is

finalized. There have also been very promising negotiations with

Serbia and three oblasts of the Russian Federation. Recently, interest

has been voiced by Belarus as well.

Now that the network is almost complete at country level, the

next focus of EARSS will be to assess the national coverage in

each country and encourage improvement wherever necessary.

5. Participating countries and national representatives in EARSS

Austria (AT)

HelmutMittermayer

Walter Koller

Belgium (BE)

Herman Goossens

Erik Hendrickx

Bulgaria (BG)

Barbora Mackova

Bosnia Herzegovina

(BA)

Selma Uzunovic-

Kamberovic

Croatia (HR)

Smilja Kalenic

Arjana Tambic - Andrasevic

Cyprus (CY)

Despo Bagatzouni

Czech Rep. (CZ)

Pavla Urbaskova

Denmark (DK)

Anette Hammerum

Robert Skov

Estonia (EE)

Kadri Kermes

Finland (FI)

Outi Lyytikäinen

Antti Hakanen

France (FR)

Bruno Coignard

Vincent Jarlier

Germany (DE)

Wolfgang Witte

Kirsten Heckenbach

Greece (GR)

Athanasios Tsakris

Alkiviadis Vatopoulos

Hungary (HU)

Miklos Füzi

Iceland (IS)

Karl Kristinsson

Ireland (IE)

Robert Cunney

Olive Murphy

Israel (IL)

Raul Raz

Italy (IT)

Annalisa Pantosti

Paolo D ‘Ancona

Latvia (LV)

Arta Balode

Lithuania (LT)

Vilma Jonaitiene

Luxembourg (LU)

Robert Hemmer

Malta (MT)

Michael Borg

Netherlands (NL)

Nienke van de Sande

Han de Neeling

Norway (NO)

Arne Hoiby

Gunnar Simonsen

Poland (PL)

Waleria Hryniewicz

Portugal (PT)

Manuela Caniça

Romania (RO)

Anda Baicus

Slovenia (SI)

Manica Mueller-Premru

Jana Kolman

Spain (ES)

Fernando Baquero

José Campos

Sweden (SE)

Barbro Liljequist

Turkey (TR)

Deniz Gür

United Kingdom (UK)

Alan Johnson,

Robert Hill (ENG&WAL)

Helen Hughes (NIR)

Anne Eastaway (SCT)

Other parties

represented by:

ESCMID

Giuseppe Cornaglia

ESGARS

Fernando Baquero

EUCAST

Gunnar Kahlmeter

WHO

Kathleen Holloway

WHONET

John Stelling

UK-NEQAS

Christine Walton

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