EARSS Annual Report 2004 - European Centre for Disease ...


EARSS Annual Report 2004 - European Centre for Disease ...

Summary 7


The European Antimicrobial Resistance Surveillance System (EARSS) is an international initiative

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 (AST) data, provides spatial trend

analyses and makes up-to-date feedback available via an interactive website at www.earss.rivm.nl.

Routine data for major indicator pathogens (Streptococcus pneumoniae, Staphylococcus aureus,

Enterococcus faecalis, Enterococcus faecium, and Escherichia coli) are regularly submitted by over

800 laboratories serving 1200 hospitals in 30 European countries. Based on the laboratory/hospital

questionnaire 2004, the overall hospital catchment population of the EARSS network is estimated

to include over 100 million inhabitants in the European region, with national coverage rates that

ranged between 20-100% for individual countries. In 2004, 91% of eligible laboratories participated

also in the annual external quality assurance exercise (EQA) jointly organised by EARSS and the

United Kingdom External Quality Assurance Scheme (UK-NEQAS). Despite 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 renders valid results for the

majority of pathogen-specific susceptibility data.

For the past six years the resistance showed a clear north south gradient for penicillin nonsusceptible

S. pneumoniae (PNSP) with high levels of macrolide co-resistance in several southern

as well as northern countries. Trend analyses reveal that countries with high rates of penicillin nonsusceptibility

see decreasing proportions in 2004, whereas countries with traditionally lower rates

converge towards higher levels. For methicillin-resistant S. aureus (MRSA), the dynamics of the

global epidemic has come to a sustained halt in the UK and Ireland, whereas central and northern

European countries still show an increase. Scandinavian countries and the Netherlands, albeit at low

levels, saw a trend towards higher MRSA rates in 2004. Vancomycin-resistant enterococci (VRE)

have been reported with proportions below 10% in most countries. Increasing rates of vancomycinresistant

Enterococcus faecium were observed in Germany, France, Italy and Ireland coinciding

with the spread of the hospital adapted clonal complex 17 strains. E. coli resistance against the

aminopenicillins is common in the European region with only Sweden reporting proportions of less

than 30%. The trend for increasing resistance in E. coli continues unabated. Resistance to third

generation cephalosporins and fluoroquinolones increased significantly in twelve and fifteen of 26

countries respectively. These trends appear to be the consequence of further dissemination of

extended spectrum beta-lactamases in this species and the frequent use of fluoroquinolones.

Hospital and community-acquired E. coli infection will pose an increasing challenge to European

Health Care Systems in years to come.

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