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Comparative Study
. 2008 Nov;14(11):1722-30.
doi: 10.3201/eid1411.070467.

Antimicrobial drug use and resistance in Europe

Nienke van de Sande-Bruinsma  1 , Hajo Grundmann, Didier Verloo, Edine Tiemersma, Jos Monen, Herman Goossens, Matus Ferech; European Antimicrobial Resistance Surveillance System Group; European Surveillance of Antimicrobial Consumption Project Group
Collaborators, Affiliations
Comparative Study

Antimicrobial drug use and resistance in Europe

Nienke van de Sande-Bruinsma et al. Emerg Infect Dis. 2008 Nov.

Abstract

Our study confronts the use of antimicrobial agents in ambulatory care with the resistance trends of 2 major pathogens, Streptococcus pneumoniae and Escherichia coli, in 21 European countries in 2000-2005 and explores whether the notion that antimicrobial drug use determines resistance can be supported by surveillance data at national aggregation levels. The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level. Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations. Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.

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Figures

Figure 1
Figure 1
Total antimicrobial drug consumption in ambulatory care in defined daily dose per 1,000 inhabitants per day (DID) by antimicrobial class in 21 European countries in 2004. See Table 1 footnote for country designations.
Figure 2
Figure 2
Proportion of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP), erythromycin-nonsusceptible S. pneumoniae (ENSP), and fluoroquinolone-resistant Escherichia coli (FQRE) in 2005, ranked in descending order by country-specific resistance score indicated above bars. *For Greece and Slovakia, data on S. pneumoniae resistance were not available. Country (total no. of S. pneumoniae isolates reported/ total no. of E. coli isolates reported): ES (740/2993); HU (86/468); FR (632/6028); LU (43/188); PT (202/1086); BE (1539/1461); BG (43/196); DE (119/957); HR (129/637); IE (397/1411); AT (290/2049); FI (525/1743); SI (208/657); CZ (194/2233); UK (1373/2359); IS (23/46); DK (1081/1283); NL (802/2140); SE (1017/3035); GR (0/1136); SK (0/132). See Table 1 footnote for country designations.
Figure 3
Figure 3
Occurrence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) plotted against outpatient use of penicillins in 17 European countries including 95% confidence intervals. DID, defined daily doses per 1,000 inhabitants. See Table 1 footnote for country designations.
Figure 4
Figure 4
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE) plotted against outpatient use of fluoroquinolone antimicrobial agents in 17 European countries including 95% confidence intervals. DID, defined daily doses per 1,000 inhabitants. See Table 1 footnote for country designations.
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