Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

1. EARSS/EARS-Net 1999-2013:
15 years of European AMR surveillance in perspective
Liselotte Diaz Högberg, Expert, Surveillance and Response Unit
European Centre for Disease Prevention and Control

2. 1
Number of unique isolates reported to
EARSS/EARS-Net* 1999-2013
0
5
10
15
20
25
30
35
0
50000
100000
150000
200000
250000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Numberofreportingcountries(redline)
Numberofisolates(greenbars)
Year
Number of isolates Number of reporting countries
*) Data restricted to EU/EEA Members States

3. 2
Number of unique isolates reported to
EARSS/EARS-Net* 1999-2013
0
5
10
15
20
25
30
35
0
50000
100000
150000
200000
250000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Numberofreportingcountries(redline)
Numberofisolates(greenbars)
Year
Number of isolates Number of reporting countries
*) Data restricted to EU/EEA Members States
> 1 300 000
isolates!
30
countries

4. 3
Number of unique isolates reported to
EARSS/EARS-Net,* per pathogen, 1999-2013
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Numberofisolates
Year
S. pneumoniae S. aureus P. aeruginosa K. pneumoniae
E. coli Enterococcus Acinetobacter spp

5. 4
The world is changing: we are getting older
Population pyramid, EU-28, 2001 and 2013
Source: Eurostat
% of total population

6. 5
The world is changing: we are getting older
Median age of population, 2001–13
Source: Eurostat
The median age in the EU-28 increased, on average, by 0.3 years per
year during the past 12 years, rising from 38.3 years in 2001 to 41.9
years in 2013. During this period the median age increased in all of the
EU Member States.

7. 6
The world is changing: health and health care
Increase in incidence of bacteraemia
Source: CDC/NCHS
Similar increase has been reported from Europe (Skogberg et al 2012, de Kraker et al
2013, Buoza et al 2015 etc)

8. 7
The world is changing: we travel more
International Tourist Arrivals 2000-2014
0
200
400
600
800
1000
1200
2000 2005 2010 2012 2013 2014
InternationalTouristArrivals(millions)
Year
World
EU28
Source: World Tourism Organization (UNWTO)

9. 8
EARSS/EARS-Net: Mean age (years) for
patients contributing isolates, by pathogen,
2003 -2013
50
52
54
56
58
60
62
64
66
68
70
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Meanage(years)
E. coli K. pneumoniae P. aeruginosa S. aureus S. pneumoniae Enterococcus
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

10. 9
S. pneumoniae by age group and year
48
50
52
54
56
58
60
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Meanage,yeas(line)
Percentageperagegroup(bars)
65 years or older 40 to 65 years 18 to 40 years
5 to18 years Under 5 years Mean
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

11. 10
E. coli by age group and year
64
65
66
67
68
69
70
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Meanage(line)
Percentageperagegroup(bars)
65 years or older 40 to 65 years 18 to 40 years
5 to18 years Under 5 years Mean
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

12. 11
Changes in age structure in EARSS/EARS-
Net data 1998-2013
• Mean age varies between bacteria and year.
• The mean age has increased for all bacteria under EARS-Net
surveillance, but the proportional increase has not been the same.
• The increase in mean age among cases contributing S.
pneumoniae isolates seems to be partly explained by a decrease
in the number of cases among children starting around 2007
• The increase in age among cases contributing E. coli isolates has
been more gradual and seems to be partly explained by a gradual
increase in elderly cases

13. 12
K. pneumoniae: percentage resistance to fluoroquinolones,
aminoglycosides, third-generation cephalosporins and
carbapenems (population-weighted EU/EEA mean), by year,
2005-2013
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageresistance
Fluoroquinolones Third-generation cephalosporins Aminoglycosides Carbapenems
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

14. 13
K. pneumoniae: percentage fully susceptible, and percentage
resistant to one, two or three antimicrobial groups
(population-weighted EU/EEA means),by year, 2005 -2013*
* Analysis restricted to isolates tested for all three antimicrobial groups of fluoroquinolones,
aminoglycosides and third-generation cephalosporins
0
10
20
30
40
50
60
70
80
90
2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageresistance
Fully susceptible R to one antimicrobial group
R to two antimicrobial groups R to three antimicrobial groups
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

15. 14
K. pneumoniae: percentage fully susceptible, and percentage
resistant to one, two or three antimicrobial groups
(population-weighted EU/EEA means),by year and admission
status, 2005 -2013*
Fully susceptible
* Analysis restricted to isolates tested for all three antimicrobial groups of fluoroquinolones,
aminoglycosides and third-generation cephalosporins
Resistance to one antimicrobial group
___ Inpatient ____ Outpatient
0
20
40
60
80
100
2005 2006 2007 2008 2009 2010 2011 2012 2013
PercentagefullyS
0
1
2
3
4
5
6
7
8
9
2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageresistant
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageresistant
0
5
10
15
20
25
30
2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageresistant
Resistance to two antimicrobial groups Resistance to three antimicrobial groups
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

16. 15
E. coli: percentage resistance to aminopenicillins,
fluoroquinolones, aminoglycosides and third-generation
cephalosporins (population-weighted EU/EEA mean), by year,
2005-2013
0
10
20
30
40
50
60
70
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageresistance
Aminopenicillin Fluoroquinolones
Third-generation cephalosporins Aminoglycosides
Carbapenems
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

17. 16
E. coli: percentage fully susceptible, and percentage resistant to
one, two, three and four antimicrobial groups, by year
(population-weighted EU/EEA mean)*
* Analysis restricted to isolates tested for all three antimicrobial groups of aminopenicillins,
fluoroquinolones, aminoglycosides and third-generation cephalosporins
0
5
10
15
20
25
30
35
40
45
50
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentage
Fully susceptible R to one antimicrobial group
R to two antimicrobial groups R to three antimicrobial groups
R to four antimicrobial groups
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

18. 17
E. coli: percentage fully susceptible, and percentage resistant
to one, two or three antimicrobial groups (population-
weighted EU/EEA means),by year and admission status, 2005
-2013*
Fully susceptible
* Analysis restricted to isolates tested for all three
antimicrobial groups of fluoroquinolones,
aminoglycosides and third-generation
cephalosporins
Resistance to one antimicrobial group
___ Inpatient ____ Outpatient
Resistance to two antimicrobial groups Resistance to three antimicrobial groups
0
10
20
30
40
50
60
20032004200520062007200820092010201120122013
28
30
32
34
36
38
40
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
0
5
10
15
20032004200520062007200820092010201120122013
0
2
4
6
8
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
0
2
4
6
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Resistance to four antimicrobial groups
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

19. 0
5
10
15
20
25
30
35
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
PercentageMRSA
Year
S. aureus: percentage MRSA (population-weighted EU/EEA
mean), by year, 2003-2013
Data from EARSS/EARS-Net. Preliminary analysis and results
*) Data restricted to EU/EEA Members States

20. 19
S. aureus: MRSA (population-weighted
EU/EEA means), by year and admission
status, 2005 -2013
0
5
10
15
20
25
30
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
PercentageMRSA
Year
Inpatient
Outpatient
Data from EARSS/EARS-Net

21. 20
Summary resistance trends
• There was an increase in resistance for all antimicrobial
groups under surveillance for E. coli and K. pneumoniae
during the period
• The increase was larger for K. pneumoniae compared to
E. coli
• In K. pneumoniae the increase was mainly in resistance
to three antibiotic groups
• There were larger differences between inpatient and
outpatients for K. pneumoniae compared to E. coli
• MRSA decreased during the period, but the decrease
was mainly seen among inpatients

22. 21
Thank you for your attention!
Thanks to all laboratories, hospitals
and EARSS/EARS-Net network
participants contributing data to the
network.

23. 22

24. 23

25. 24
Inpatient outpatient
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Outpatient
Outpatient