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Is the ratio of associated Escherichia coli resistance comparable over Europe?
Abstract number: 1732_235
van de Sande-Bruinsma N., Kahlmeter G., de Kraker M., Tiemersma E., Monen J., Grundmann H., participants EARSS
Introduction: The EARSS database discloses increasing levels of antimicrobial resistance in Escherichia coli in most parts of Europe. We investigated the levels of associated resistance in the E. coli database. Methods: Invasive E. coli susceptibility results to aminopenicillin (AMP), 3rd-gen cephalosporins (3CP), fluoroquinolones (FQ) and aminoglycosides (AG) from 2005 were extracted for 7 countries representing different geographic areas and levels of antimicrobial resistance: the Czech Republic (CZ), Germany (DE), Ireland (IE), Finland (FI), France (FR), Slovenia (SI) and Spain (ES). Associated resistance was defined as ``resistance to one drug in the presence of resistance of another drug''. The levels of associated resistance were determined. For each drug the levels of resistance was determined for isolates susceptible and resistant to the other drugs. Table. Minimum (min) and maximum (max) % resistance reported per antimicrobial group, and level of associated resistance within these groups of resistant isolates | Resistant to: | Min/max resistance (country) | Associated resistance versus (resistance in susceptible group)a |
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| AMP | 3CP | FQ | AG | | | |
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| Aminopenicillins (AMP) | Min | 36% (FI) | – | 7% (0%)a | 21% (2%) | 7% (0%) | | Max | 68% (IE) | – | 5% (0%) | 24% (2%) | 11% (1%) | | | 3rd gen cephalosporins (3CP) | Min | 1% (FR) | 99% (49%) | – | 69% (10%) | 42% (4%) | | Max | 8% (ES) | 100% (59%) | – | 70% (25%) | 35% (8%) | | | Fluoroquinolones (FQ) | Min | 9% (FI) | 86% (31%) | 22% (1%) | – | 26% (0%) | | Max | 28% (ES) | 86% (52%) | 19% (3%) | – | 29% (2%) | | | Aminoglycosides (AG) | Min | 3% (FI) | 97% (34%) | 66% (1%) | 91% (6%) | – | | Max | 10% (ES) | 93% (58%) | 27% (5%) | 82% (22%) | – | | | aInterpretation: ``In Finland 36% of E. coli were resistant to AMP; in these resistance to 3CP was 7% as compared to 0% in the 64% not resistant to AMP.'' |
Results: Overall, most if not all resistance to a drug was in the presence of resistance to one or more of the other drugs. More than half of the isolates resistant to 3CP were resistant to FQ. Whereas only 3–10% of all isolates were resistant to AG, similarly almost all isolates resistant to AG were also resistant to FQ (82–91%) as compared to the much lower rates in those sensitive to AG (6–22%). Large differences were observed between countries in antimicrobial resistance rates, whereas the levels of associated resistance among the group of resistant isolates did not vary to the same extent (Table). Conclusions: (i) The level of associated resistance for the isolates resistant to the different antimicrobial groups under EARSS study seemed comparable between countries, irrespective of their differences in overall resistance proportions. (ii) The group of isolates resistant to one group of antibiotics was more likely to be resistant to other antimicrobial groups (under EARSS surveillance) compared to their susceptible counterparts. The observation that most resistance is associated with other types of resistance and that the level of associated resistance seems comparable between countries would suggest that the overall reduction of the antibiotic use is probably more important in the society as a whole than targeted reduction of single drugs. Our analysis suggest that efforts should be focused on these `multi' resistant strains.
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