Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May;36(5):839-846.
doi: 10.1007/s10096-016-2869-4. Epub 2016 Dec 26.

Surveillance of Gram-negative bacteria: impact of variation in current European laboratory reporting practice on apparent multidrug resistance prevalence in paediatric bloodstream isolates

J A Bielicki  1   2 , D A Cromwell  3 , A Johnson  4 , T Planche  5 , M Sharland  6 ; ARPEC project
Affiliations

Surveillance of Gram-negative bacteria: impact of variation in current European laboratory reporting practice on apparent multidrug resistance prevalence in paediatric bloodstream isolates

J A Bielicki et al. Eur J Clin Microbiol Infect Dis. 2017 May.

Abstract

This study evaluates whether estimated multidrug resistance (MDR) levels are dependent on the design of the surveillance system when using routine microbiological data. We used antimicrobial resistance data from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project. The MDR status of bloodstream isolates of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa was defined using European Centre for Disease Prevention and Control (ECDC)-endorsed standardised algorithms (non-susceptible to at least one agent in three or more antibiotic classes). Assessment of MDR status was based on specified combinations of antibiotic classes reportable as part of routine surveillance activities. The agreement between MDR status and resistance to specific pathogen-antibiotic class combinations (PACCs) was assessed. Based on all available antibiotic susceptibility testing, the proportion of MDR isolates was 31% for E. coli, 30% for K. pneumoniae and 28% for P. aeruginosa isolates. These proportions fell to 9, 14 and 25%, respectively, when based only on classes collected by current ECDC surveillance methods. Resistance percentages for specific PACCs were lower compared with MDR percentages, except for P. aeruginosa. Accordingly, MDR detection based on these had low sensitivity for E. coli (2-41%) and K. pneumoniae (21-85%). Estimates of MDR percentages for Gram-negative bacteria are strongly influenced by the antibiotic classes reported. When a complete set of results requested by the algorithm is not available, inclusion of classes frequently tested as part of routine clinical care greatly improves the detection of MDR. Resistance to individual PACCs should not be considered reflective of MDR percentages in Enterobacteriaceae.

PubMed Disclaimer

Conflict of interest statement

Funding

The ARPEC project was co-funded by DG Sanco through the Executive Agency for Health and Consumers (grant number ARPEC Project A 2009-11-01). The funder had no role in the study design, data collection or data analysis.

Conflict of interest

JAB’s husband is the senior corporate counsel at Novartis International AG, Basel, Switzerland, and holds Novartis stock and stock options. MS chairs and APJ is a member of the Department of Health Expert Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). All other authors have no conflicts of interest to declare.

Ethical approval and informed consent

The study was assessed against the National Research Ethics Service “Defining Research” leaflet by the Joint Research Office at the lead centre (St George’s, University of London, UK) and was found not to constitute research. The local research ethics committee confirmed that formal evaluation was not required. Participating centres were instructed to seek local ethical approval if legally required in their setting and were asked to confirm this at the time they submitted data. Informed consent was not required as all collected data were fully anonymised, and there was no contact with patients and/or their families and no interventions or changes to treatment and management were made.

Figures

Fig. 1
Fig. 1
Number and percentage of isolates classified as MDR based on different sets of antibiotic classes (see Table 1 for definitions of the sets). The total number of isolates for each bacterial species is shown at the top of each bar
Fig. 2
Fig. 2
Number and percentage of isolates identified correctly or incorrectly as MDR based on individual pathogen–antibiotic class combinations (PACCs). The white stacks correspond to isolates neither resistant to the PACC nor identified as MDR on the basis of the ARPEC set (see Table 1 for definitions). The total number of isolates for each bacterial species are shown underneath. 3/4GC third- or fourth-generation cephalosporin, QUIN fluoroquinolone, AMG aminoglycoside, CPM carbapenem. For P. aeruginosa, only cephalosporins with antipseudomonal activity were considered
See this image and copyright information in PMC

References

    1. Pulcini C, Bush K, Craig WA, et al. Forgotten antibiotics: an inventory in Europe, the United States, Canada, and Australia. Clin Infect Dis. 2012;54(2):268–274. doi: 10.1093/cid/cir838. - DOI - PubMed
    1. de Kraker ME, Davey PG, Grundmann H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med. 2011;8(10) doi: 10.1371/journal.pmed.1001104. - DOI - PMC - PubMed
    1. Falagas ME, Bliziotis IA, Kasiakou SK, et al. Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria. BMC Infect Dis. 2005;5(1):24. doi: 10.1186/1471-2334-5-24. - DOI - PMC - PubMed
    1. Giske CG, Monnet DL, Cars O, et al. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother. 2008;52(3):813–821. doi: 10.1128/AAC.01169-07. - DOI - PMC - PubMed
    1. Hawkey PM. Multidrug-resistant Gram-negative bacteria: a product of globalization. J Hosp Infect. 2015;89(4):241–247. doi: 10.1016/j.jhin.2015.01.008. - DOI - PubMed

MeSH terms

LinkOut - more resources