6 Acknowledgement Acknowledgements May I take this opportunity to express my gratitude to all national representatives, national data managers and participating laboratories for their enthusiasm and willingness to share the antimicrobial susceptibility data, for their participation in the external quality control exercise and for providing the background information requested by the laboratory hospital questionnaire. I thank UK-NEQAS for their major role in preparing and organising the 5 th successive external QA exercise. I would also like to thank the different members of the EARSS Advisory Board and the EARSS Management Team for sharing their expertise, for their contribution to this report and also for making the activities organised within EARSS again successful during the past year. Furthermore I would like to thank John Stelling for visiting many participating countries to give support on WHONET forEARSS and Bennie Bloemberg for his technical support in developing the country summary sheets that are a substantial part of this report. Finally I would like to thank you all for your extremely professional collaborative effort to the unique and well functioning EARSS network which now includes more than 800 laboratories in 30 countries. I look forward to continue this fruitful cooperation for the years to come. Hajo Grundmann Project leader EARSS Project Department of Infectious Diseases Epidemiology National Institute of Public Health and the Environment
Summary 7 Summary 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.