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Antimicrobial resistance surveillance in Germany: first results for E.coli, K.pneumoniae and P.mirabilis from urine samples in ambulatory care, 20082009

Abstract number: P1615

Noll I., Schweickert B., Krause G., Eckmanns T.

Objectives: In 2008, Germany expanded the scope of its national antimicrobial resistance surveillance system to the sector of ambulatory care. This presentation gives a first insight into resistance in the most frequent Gram-negative pathogens isolated from urine samples from outpatients in 2008/2009. Data will be stratified by age groups and selected geographical regions.

Methods: The dataset is taken from the German Antimicrobial Resistance Surveillance (ARS) System. Analysis is based on non-duplicate isolates of E. coli, K. pneumoniae and P. mirabilis from urine samples in four laboratories with continuous data collection from January 2008 to October 2009. Species identification and antimicrobial susceptibility testing is performed by VITEK 2, results are evaluated according to CLSI guidelines. Proportions of susceptible isolates were calculated for the following antibiotics: ampicillin (AMP), ampicillin/sulbactam (AMS), piperacillin (PIP), piperacillin/tazobactam (PIT), cefotaxime (CTX), ciprofloxacin (CIP), co-trimoxazole (SXT).

Results: The most frequent Gram-negative pathogens isolated from a total of 87.873 urine samples were E. coli (n = 49,179; 47.2% out of 104,248 isolates), P. mirabilis (n = 5,065; 4.9%) and K. pneumoniae (n = 4,393; 4.2%). Results of susceptibility testing are displayed as percentages of susceptible isolates of all non-duplicate isolates tested in table 1. In E. coli overall proportions of susceptibility for the most frequently used antimicrobials in urinary tract infections as AMP, AMS, SXT and CIP vary from 54.6% (AMP) to 84.2% (CIP), in P. mirabilis the corresponding range spans from 64% (SXT) to 92.3% (AMS) and in K. pneumoniae proportions for selected antibiotics are all above 80%. Stratification by age groups shows significant lower levels of susceptibility for patients older than 60 for AMP, PIP, CIP and SXT in E. coli as well as in P. mirabilis. Regional differences with similar patterns are observed for CIP, SXT and PIP across species. Significant changes in resistance between 2008 and 2009 did not occur.

Conclusions: These first large-scale data from ambulatory care indicate that non-susceptibility of E. coli and to a lesser degree of P. mirabilis from urines to first-line antibiotics is highly prevalent, that it is even higher in patients older than 60 and that there are some regional variations. Interpretation of the data should consider that in ambulatory care settings specimens are mainly taken from pre-treated patients.

Table 1. Susceptibility of E. coli, P. mirabilis, K. pneumoniae from urine samples of outpatients in Germany 2008/09

PathogenStratificationaSusceptibilitybn
  AMPAMSPIPPITCTXCIPSXT 
E. coliTotal54.669.257.287.397.084.270.841,449
 by agegroup        
   leqslant R: less-than-or-eq, slant1557.772.959.690.198.296.675.34,391
   16–5958.271.160.388.797.689.374.615,555
   geqslant R: gt-or-equal, slanted6051.467.254.585.796.378.167.121,503
 by region        
   BEcc60.188.397.088.873.88,944
   BWc70.160.986.294.983.874.33,677
   NW53.768.454.487.297.982.667.917,667
   SH56.671.557.788.296.984.670.46,519
P. mirabilisTotal68.292.371.496.199.087.964.04,577
 by agegroup        
   leqslant R: less-than-or-eq, slant1579.793.979.196.899.496.174.6727
   16–5972.893.674.496.799.390.965.21,150
   geqslant R: gt-or-equal, slanted6063.591.468.095.698.884.460.62,700
 by region        
   BEcc77.197.999.793.570.41,059
   BWc92.773.196.699.189.068.6328
   NW66.890.767.094.698.781.757.91,844
   SH71.295.071.796.998.893.563.2804
K. pneumoniaeTotalR*82.8R*89.196.292.486.43,975
 by agegroup        
   leqslant R: less-than-or-eq, slant15R*82.5R*90.699.497.789.8177
   16–59R*83.7R*89.297.294.686.71,245
   geqslant R: gt-or-equal, slanted60R*82.3R*88.995.590.986.12,553
 by region        
   BER*R*91.996.896.490.4788
   BWR*82.7R*89.195.791.084.8376
   NWR*83.6R*88.096.190.486.21,680
   SHR*80.2R*88.595.795.080.9575
aBE, Berlin; BW, Baden-Wuerttemberg; NW, North Rhine-Westfalia; SH, Schles­wig-Holstein.
bPercentages of susceptible isolates from non-duplicate isolates tested (n) against AMP, ampicillin; AMS, ampicillin/sulbactam; PIP, pipera­cillin; PIT, piperacillin/tazobactam; CTX, cefotaxime; CIP, ciprofloxacin; SXT, co-trimoxazole.
cNot tested.
*Intrinsic resistance.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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