6 Summary Summary The European Antimicrobial Resistance Surveillance System (EARSS) is an international network funded by the Director General for Health and Consumer Protection (DG SANCO) of the European Commission and the Dutch Ministry of Health, Welfare and Sports. It maintains 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. EARSS collects routinely generated antimicrobial susceptibility testing (AST) data, provides spatial trend analyses and makes up-to-date feedback available via an interactive Website at http://www.earss.rivm.nl. Over 700 laboratories serving 1100 hospitals in 28 European countries regularly submit routine data for major indicator pathogens (Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, and Escherichia coli). On the basis of the 2002 laboratory/hospital questionnaire, the overall hospital catchment population of the EARSS network is estimated at more than 100 million inhabitants in the European region, with national coverage rates that range between 20% and 100% for individual countries. In 2002, 93% of the eligible laboratories also participated in the annual external quality assurance (EQA) exercise, which is jointly organised by EARSS, the United Kingdom External Quality Assurance Scheme (UK- NEQAS) and the Centre Réfèrence des Antibiotiques (CRAB). Despite the different guidelines used in various countries, the overall concordance of susceptibility results was of sufficient quality, which shows that pooling and analysis of EARSS surveillance data render valid results for most pathogenspecific susceptibility data. For the last 4 years, the resistance showed a clear north–south gradient for penicillin non-susceptible S. pneumoniae (PNSP), with high levels of macrolide co-resistance in several of the southern and the northern countries. The dynamics of the global epidemic of methicillin-restistant S. aureus (MRSA) has slowed down in the United Kingdom and Ireland, but it showed the fastest increasing proportions in Germany and Austria between 1999 and 2002. Scandinavian countries have been spared from this trend, but the Netherlands saw the beginning of a trend towards higher MRSA rates in 2002. Vancomycin-resistant enterococci (VRE), with proportions less than 10% in most countries, have been reported. The six countries that reported higher rates of VRE also had large MRSA proportions, which suggests an epidemiological association. E. coli resistance to the aminopenicillins is common in the European region; only Finland and Sweden report proportions of less than 30%. Resistance of E. coli to third-generation cephalosporins remained less than 6% in most countries. Greater proportions were noted for some eastern European countries that appeared to have problems with extended spectrum beta-lactamase (ESBL)-producing strains. However, there was a consistent and marked rise in fluoroquinolone-resistant E. coli in most European countries, eight of which witnessed an 1.5-fold increase or more in only 2 years (2001 – 2002). This trend may to be related to the widespread acceptance and use of newer fluoroquinolones with enhanced activity against gram-positive pathogens. We predict that both hospital and community-acquired E. coli infection may become a new challenge as a pathogen that will be difficult to treat in the European region in the years to come. EARSS has become an internationally accepted surveillance initiative, which provides meaningful information about the status and trends of antimicrobial resistance in the European region. The possible relationship between antimicrobial resistance and consumption will be explored in close
Summary 7 cooperation with European Surveillance of Antimicrobial Consumption (ESAC). We envision EARSS serving as a platform for the detection and identification of clones with particular importance to public health in terms of antimicrobial resistance and virulence properties. The EARSS2002 annual report would not have been possible without the financial support of DG SANCO of the European Commission (SI2.324194/2001CVG4 – 011) and the Dutch Ministry of Health, Welfare and Sports.