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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
Domselaar GMI8 Beijing Canadian WGS Surveillance ExperienceIRIDA_community
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This document summarizes an infectious diseases workshop presentation on antimicrobial resistance (AMR) in Ireland. The presentation discusses key AMR trends seen in bacteria that commonly cause bloodstream infections in Ireland, including increasing rates of drug-resistant Staphylococcus aureus, Enterococcus faecium, Escherichia coli, and Klebsiella pneumoniae. It also describes the emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE), especially the OXA-48 strain of Klebsiella pneumoniae. While CRE surveillance and reporting has improved, it remains incomplete. The presentation concludes that continued efforts are needed across healthcare settings to curb the rise of CRE through improved screening, infection control, antimicrobial stewardship
Multiplex Arrays for POC infection detentionScott Buckler
Randox is developing multiplex biochip arrays for point-of-care infection detection. Their technology allows up to 100 tests to be performed simultaneously on a single sample. They have developed arrays for sexually transmitted infections, respiratory infections, urinary tract infections, and sepsis. The sepsis array detects 47 bacterial and fungal targets and 3 antibiotic resistance genes directly from blood within 4 hours, which could transform sepsis care. Randox is also continually developing new molecular multiplex assays and working with clinical partners to define diagnostic needs.
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
Domselaar GMI8 Beijing Canadian WGS Surveillance ExperienceIRIDA_community
This document summarizes Canada's experience using whole genome sequencing (WGS) data for bacterial pathogen surveillance. It describes Canada's current enteric disease surveillance program and some early WGS applications for outbreak investigations. It then outlines Canada's genomic epidemiology roadmap, including retrospective and prospective pilot projects to generate baseline WGS data. Implementation of WGS for real-time outbreak response is discussed. The document acknowledges contributions from various Canadian public health and academic collaborators involved in developing genomic surveillance capabilities.
Presentation of Vaxxit and TatImmune, a novel immunotheraoy for HIV/AIDS, with a focus on South Africa epidemic and impact of vaccination with TatImmune on the health of people with HIV and on public HIV care costs
In Gambia 15 new cases of the novel coronavirus (COVID-19) cases have been registered - the highest reported in a single day - bringing to 93 the total number of COVID-19 cases ever confirmed in the country.
ECDC public health microbiology programme partnerships in action! 20th National Microbiology Focal Points meeting. The document discusses ECDC's public health microbiology strategy and programs from 2010-2019 including: 1) Facilitating EU-wide use of whole genome sequencing for outbreak detection and surveillance. 2) Benchmarking public health microbiology practices across EU countries. 3) Strengthening EU microbiology capacity through laboratory networks. Progress includes most EU countries now having medium to high genomic sequencing capabilities and using WGS to investigate multi-country outbreaks.
This document discusses proposed revisions to indicators and targets used in the European Union Laboratory Capability Monitoring Tool (EULabCap) survey. It provides examples of indicators being revised from using a scoring system based on participation in networks or reporting data to scoring based on absolute numbers achieved. The timeline for the 2018 EULabCap data call is also presented, including launching the call in October, a November deadline for responses from National Microbiology Focal Points, and finalizing the database and reports by December.
The document discusses ECDC and WHO collaborative activities to strengthen laboratory preparedness in Europe. It outlines several joint programs: 1) regional influenza surveillance where data is collected, analyzed, and discussed in teleconferences; 2) influenza virus characterization reporting; 3) biannual influenza meetings; 4) monitoring influenza-associated mortality; and 5) external quality assessments for influenza and RSV diagnostics. It also describes the Better Labs for Better Health initiative to identify needs to improve laboratory networks in southeast Europe and eastern Europe. Finally, it proposes establishing a European Region Laboratory Task Force for High Threat Pathogens to coordinate laboratory diagnostics and networks for priority diseases.
This document summarizes feedback from the 15th National Microbiology Focal Points meeting. It discusses ECDC's microbiology web portal and resources available, including the NMFP forum, EULabServe repository for laboratory testing services, microbiology coordination newsletters, and surveys on topics like national capacity for whole genome sequencing. It also covers the EULabCap project for indicator scoring and reporting of diagnostic capabilities and participation in European reference laboratory networks. NMFP members are asked to provide feedback on indicator clarity and updates.
After several years of decreasing trend, foodborne hepatitis A virus (HAV) infection has re-emerged as a public health problem in EU/EEA since 2011. Several consecutive multi-country foodborne HAV outbreaks were experienced in Europe 2012-2014.
The document summarizes the results of a 2015 survey on whole genome sequencing (WGS) capacity in European Union and European Economic Area Member States. Nineteen countries reported having national reference laboratories with access to next generation sequencing technologies like Illumina, and over half were applying WGS to surveillance and outbreak investigations of pathogens. While use of WGS is expanding rapidly, future annual surveys are needed to continued monitoring increasing capacity.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
This document summarizes discussions from the 15th National Microbiology Focal Points meeting regarding whole genome sequencing (WGS) for public health surveillance in Europe. It outlines ECDC's strategy and roadmap to integrate WGS and molecular typing into EU-level surveillance from 2012-2019. Key priorities for 2016-2018 include using WGS for cross-border foodborne outbreak investigations and continuous surveillance of Listeria monocytogenes and Neisseria meningitidis. Barriers like technical capacity and cost will need to be addressed before expanding WGS-based surveillance to other priority pathogens.
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This document summarizes the results of a 2018 survey on automated laboratory reporting practices in EU/EEA countries. The survey found that nearly half of countries use automated reporting for some national infectious disease and antibiotic resistance surveillance. Automated reporting allows for early detection of outbreak clusters in most countries. However, challenges remain around lack of standards, incentives and legal obligations for laboratories to automate reporting. Next steps include publishing the results with national representatives as co-authors.
This document summarizes laboratory diagnosis of COVID-19. It discusses that molecular (rRT-PCR) tests target genes like E, RdRp, N, and ORF 1ab. Specimens collected include nasopharyngeal swabs, oropharyngeal swabs, sputum, and stool. Interpretation of rRT-PCR tests follows WHO and CDC guidelines. Serological tests detect IgM and IgG antibodies but are not recommended for diagnosis. Viral sequencing and culture are also discussed. Abnormal lab findings in COVID-19 patients include decreased lymphocytes and albumin and increased LDH, D-dimer and inflammatory markers.
This document summarizes a presentation given by Anastasia Pharris of the European Centre for Disease Prevention and Control on infections among people who inject drugs. It finds that over 30,000 new HIV diagnoses in Europe in 2016 were due to injecting drug use, with most cases concentrated in Eastern Europe. While harm reduction efforts have made progress in some countries, people who inject drugs still face high burdens of HIV, hepatitis C, and other infections. The presentation calls for improved testing, treatment, and prevention programs targeting this group.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
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In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
The ECDC aims to establish whole genome sequencing (WGS) as the standard method for microbial pathogen typing in the EU by 2020. This will improve disease surveillance and outbreak investigation by providing more accurate transmission data. The ECDC's WGS support strategy includes mapping initiatives, integrated data analysis, guidance, and pilot studies. Priority diseases for 2016-2018 are Listeria monocytogenes, Neisseria meningitidis, carbapenemase-producing Enterobacteriaceae, and antibiotic-resistant Neisseria gonorrhoeae. The roadmap will be revised in 2018-2019 to expand WGS-based surveillance to additional diseases like Salmonella, STEC, and multidrug-resistant tuberculosis, depending on member state capacity
The document discusses options for RSV surveillance in Europe presented by Eeva Broberg at a WHO meeting. It outlines 6 potential options for RSV surveillance including sentinel surveillance of GP cases and hospitalized cases, using national disease registries, and enhancing existing influenza surveillance systems. The objectives are to measure the impact of RSV vaccines, understand RSV seasonality and type prevalence, and estimate disease burden. Public health benefits of coordinated EU surveillance include evaluating vaccines, outbreak timing, burden assessment, and strain selection.
- European surveillance of Clostridium difficile infections (CDI) was launched in January 2016 using a standardized protocol developed by ECDC. 117 hospitals from 17 countries participated initially.
- Preliminary results from the first two months of surveillance found over 1,000 CDI case records reported, with diagnostic algorithms and incidence rates varying between countries. Ribotyping was performed on about a third of isolates submitted.
- The surveillance aims to improve understanding of the CDI burden in Europe by collecting comparable epidemiological and microbiological data across countries using a common protocol and tools.
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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
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The document discusses the global spread of the mcr-1 gene, which confers plasmid-mediated colistin resistance in Enterobacteriaceae. This poses a substantial public health risk as it limits treatment options for multidrug-resistant infections. Options for response include improved detection of mcr-1 via laboratory methods like PCR and whole genome sequencing, enhanced surveillance programs, infection control measures in healthcare settings, antimicrobial stewardship, and reducing colistin use in animals to prevent further spread. A One Health approach combining human and veterinary medicine is needed to monitor mcr-1 in food and the environment.
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This document discusses proposed revisions to indicators and targets used in the European Union Laboratory Capability Monitoring Tool (EULabCap) survey. It provides examples of indicators being revised from using a scoring system based on participation in networks or reporting data to scoring based on absolute numbers achieved. The timeline for the 2018 EULabCap data call is also presented, including launching the call in October, a November deadline for responses from National Microbiology Focal Points, and finalizing the database and reports by December.
The document discusses ECDC and WHO collaborative activities to strengthen laboratory preparedness in Europe. It outlines several joint programs: 1) regional influenza surveillance where data is collected, analyzed, and discussed in teleconferences; 2) influenza virus characterization reporting; 3) biannual influenza meetings; 4) monitoring influenza-associated mortality; and 5) external quality assessments for influenza and RSV diagnostics. It also describes the Better Labs for Better Health initiative to identify needs to improve laboratory networks in southeast Europe and eastern Europe. Finally, it proposes establishing a European Region Laboratory Task Force for High Threat Pathogens to coordinate laboratory diagnostics and networks for priority diseases.
This document summarizes feedback from the 15th National Microbiology Focal Points meeting. It discusses ECDC's microbiology web portal and resources available, including the NMFP forum, EULabServe repository for laboratory testing services, microbiology coordination newsletters, and surveys on topics like national capacity for whole genome sequencing. It also covers the EULabCap project for indicator scoring and reporting of diagnostic capabilities and participation in European reference laboratory networks. NMFP members are asked to provide feedback on indicator clarity and updates.
After several years of decreasing trend, foodborne hepatitis A virus (HAV) infection has re-emerged as a public health problem in EU/EEA since 2011. Several consecutive multi-country foodborne HAV outbreaks were experienced in Europe 2012-2014.
The document summarizes the results of a 2015 survey on whole genome sequencing (WGS) capacity in European Union and European Economic Area Member States. Nineteen countries reported having national reference laboratories with access to next generation sequencing technologies like Illumina, and over half were applying WGS to surveillance and outbreak investigations of pathogens. While use of WGS is expanding rapidly, future annual surveys are needed to continued monitoring increasing capacity.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
This document summarizes discussions from the 15th National Microbiology Focal Points meeting regarding whole genome sequencing (WGS) for public health surveillance in Europe. It outlines ECDC's strategy and roadmap to integrate WGS and molecular typing into EU-level surveillance from 2012-2019. Key priorities for 2016-2018 include using WGS for cross-border foodborne outbreak investigations and continuous surveillance of Listeria monocytogenes and Neisseria meningitidis. Barriers like technical capacity and cost will need to be addressed before expanding WGS-based surveillance to other priority pathogens.
HCV Treatment Access across Europe - Raquel PeckReShape
The document discusses hepatitis C virus (HCV) treatment access across Europe. It notes that the World Health Organization and Global Hepatitis Summit have set goals to eliminate viral hepatitis by 2030. The document then provides statistics on HCV prevalence and treatment rates across the European Union, with over 3.6 million estimated viremic infections but only 133,000 patients treated in 2015. Case studies are presented on HCV elimination efforts in countries like France, Germany, Portugal, and Australia. The document argues for more active screening, prevention efforts, expanding treatment eligibility criteria, and ensuring strong patient advocacy to work towards HCV elimination in the EU.
This document summarizes the results of a 2018 survey on automated laboratory reporting practices in EU/EEA countries. The survey found that nearly half of countries use automated reporting for some national infectious disease and antibiotic resistance surveillance. Automated reporting allows for early detection of outbreak clusters in most countries. However, challenges remain around lack of standards, incentives and legal obligations for laboratories to automate reporting. Next steps include publishing the results with national representatives as co-authors.
This document summarizes laboratory diagnosis of COVID-19. It discusses that molecular (rRT-PCR) tests target genes like E, RdRp, N, and ORF 1ab. Specimens collected include nasopharyngeal swabs, oropharyngeal swabs, sputum, and stool. Interpretation of rRT-PCR tests follows WHO and CDC guidelines. Serological tests detect IgM and IgG antibodies but are not recommended for diagnosis. Viral sequencing and culture are also discussed. Abnormal lab findings in COVID-19 patients include decreased lymphocytes and albumin and increased LDH, D-dimer and inflammatory markers.
This document summarizes a presentation given by Anastasia Pharris of the European Centre for Disease Prevention and Control on infections among people who inject drugs. It finds that over 30,000 new HIV diagnoses in Europe in 2016 were due to injecting drug use, with most cases concentrated in Eastern Europe. While harm reduction efforts have made progress in some countries, people who inject drugs still face high burdens of HIV, hepatitis C, and other infections. The presentation calls for improved testing, treatment, and prevention programs targeting this group.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Amanda Mocroft, UCL
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
The ECDC aims to establish whole genome sequencing (WGS) as the standard method for microbial pathogen typing in the EU by 2020. This will improve disease surveillance and outbreak investigation by providing more accurate transmission data. The ECDC's WGS support strategy includes mapping initiatives, integrated data analysis, guidance, and pilot studies. Priority diseases for 2016-2018 are Listeria monocytogenes, Neisseria meningitidis, carbapenemase-producing Enterobacteriaceae, and antibiotic-resistant Neisseria gonorrhoeae. The roadmap will be revised in 2018-2019 to expand WGS-based surveillance to additional diseases like Salmonella, STEC, and multidrug-resistant tuberculosis, depending on member state capacity
The document discusses options for RSV surveillance in Europe presented by Eeva Broberg at a WHO meeting. It outlines 6 potential options for RSV surveillance including sentinel surveillance of GP cases and hospitalized cases, using national disease registries, and enhancing existing influenza surveillance systems. The objectives are to measure the impact of RSV vaccines, understand RSV seasonality and type prevalence, and estimate disease burden. Public health benefits of coordinated EU surveillance include evaluating vaccines, outbreak timing, burden assessment, and strain selection.
- European surveillance of Clostridium difficile infections (CDI) was launched in January 2016 using a standardized protocol developed by ECDC. 117 hospitals from 17 countries participated initially.
- Preliminary results from the first two months of surveillance found over 1,000 CDI case records reported, with diagnostic algorithms and incidence rates varying between countries. Ribotyping was performed on about a third of isolates submitted.
- The surveillance aims to improve understanding of the CDI burden in Europe by collecting comparable epidemiological and microbiological data across countries using a common protocol and tools.
Dr ghazi final evaluation of hepatitis a surveillanceGhazi Sharkas
The document evaluates hepatitis A surveillance in Mafraq Health Directorate, Jordan from 2004-2009. It finds that reported cases of hepatitis A dramatically decreased from 1612 in 1997 to 492 in 2009. Surveillance sensitivity was 96% from health centers to the directorate but documentation was only found for 15% of reported cases. Discrepancies in reported numbers and a lack of investigation forms indicated issues with adherence to reporting protocols. Health worker training was insufficient as the majority were not trained in surveillance and knowledge of case definitions and reporting procedures was poor. Recommendations included improving documentation, training for all involved health workers including nurses, and ensuring all hepatitis A cases are investigated.
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
Carbapenem-resistant Acinetobacter baumannii poses a significant threat in healthcare settings across Europe. It can cause serious infections that are difficult to treat due to limited antibiotic options. The number of countries reporting spread and endemicity of carbapenem-resistant A. baumannii has increased in recent years. Increased detection and control efforts are needed to prevent it from becoming endemic in more European regions and healthcare facilities.
The document discusses the global spread of the mcr-1 gene, which confers plasmid-mediated colistin resistance in Enterobacteriaceae. This poses a substantial public health risk as it limits treatment options for multidrug-resistant infections. Options for response include improved detection of mcr-1 via laboratory methods like PCR and whole genome sequencing, enhanced surveillance programs, infection control measures in healthcare settings, antimicrobial stewardship, and reducing colistin use in animals to prevent further spread. A One Health approach combining human and veterinary medicine is needed to monitor mcr-1 in food and the environment.
Presentation from the ECDC expert consultation on Whole Genome Sequencing organised by the European Centre of Disease Prevention and Control - Stockholm, 19 November 2015
Presentation from the ECDC expert consultation on Whole Genome Sequencing organised by the European Centre of Disease Prevention and Control - Stockholm, 19 November 2015
Dag Harmsen presented on the evolvement and challenges of cgMLST for the harmonization of bacterial genome sequencing and analysis. Key points include:
- cgMLST (core genome multilocus sequence typing) involves identifying and comparing alleles across a fixed set of core genome genes and has been applied to outbreak investigation and global pathogen nomenclature.
- Tools for cgMLST analysis have been developed and improved to work on read, draft, and complete genome levels and allow scalable, additive analysis of single genes to whole genomes.
- Standardizing a hierarchical cgMLST-based approach and developing common nomenclature poses challenges but is important for microbial genotypic surveillance across laboratories and countries.
Presentation from the ECDC expert consultation on Whole Genome Sequencing organised by the European Centre of Disease Prevention and Control - Stockholm, 19 November 2015
Presentation from the ECDC expert consultation on Whole Genome Sequencing organised by the European Centre of Disease Prevention and Control - Stockholm, 19 November 2015
Presentation from the ECDC expert consultation on Whole Genome Sequencing organised by the European Centre of Disease Prevention and Control - Stockholm, 19 November 2015
This document summarizes discussions from several sessions of a meeting on antimicrobial resistance and healthcare-associated infections. Key points include:
- Most countries submit antimicrobial consumption data close to the deadline, and there are specific rules for who can access and publish the data.
- It is important but challenging to compare hospital antimicrobial consumption data between countries due to differences in how data is collected. Both defined daily doses and packages are needed for comparison.
- A pilot hospital-based antimicrobial consumption survey was proposed to collect additional data starting in late 2015, but the protocol requires further review and clarification before implementation.
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
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
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
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
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
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
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
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
Validation studies are essential to accurately assess the sensitivity, specificity, and predictive values of point prevalence surveys (PPS) of healthcare-associated infections (HAI). Previous validation studies of PPS have shown varied results, underscoring the need for formal evaluations. Without validation, true HAI prevalence is unknown and differences between locations cannot be properly investigated. International organizations can help support national validation efforts to improve HAI surveillance.
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
This document contains forms and instructions for conducting a point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. The forms collect data at the hospital, ward, patient, and national/regional level. Hospital data includes bed numbers, staffing levels, infection control activities and organizational culture. Ward data includes bed numbers, hand hygiene infrastructure. Patient data collects infection details, antimicrobial use, and patient characteristics for those with infections or receiving antibiotics. National data provides healthcare system context. The forms standardize data collection to allow prevalence comparisons across settings.
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5. Enlist some common indications for obtaining an ECG
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3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Data call timeline and deliverables. Liselotte Diaz Högberg (ECDC)
1. Preparing for the EARS-Net 2015
data call
Liselotte Diaz Högberg, Expert, Surveillance and Response Unit
European Centre for Disease Prevention and Control
2. 1
• Results from 2014 EARS-Net data call
• Preparing for the EARS-Net 2015 data call:
- timeline and outputs
• The future of Acinetobacter spp surveillance
• Improving comparability of S. pneumoniae data
3. 2
0
1
2
3
4
5
6
7
8
9
10
14-20
April
21-27
April
28 April -
4 May
5 -11
May
12-18
May
19-25
May
26 May-1
June
2-8 June 9-15
June
16-22
June
23-29
June
30 June -
6 July
7-13 July
Numberofreportingcountries
Overview of data call 2014
Active data call
Deadline
Cumulative number of reporting countries
2 3 4 5 6 12 19 28 30
4. 3
Percentage isolates per pathogen, 2013
Data from EARS-Net
E. faecium
4%
E. facealis
7%
S. pneumoniae
7%
S. aureus
22%
Acinetobacter spp
2%
P. aeruginosa
6%
K. pneumoniae
10%
E. coli
42%
5. 4
Number of reported isolates per pathogen.
By country, 2013
Data from EARS-Net
0
5000
10000
15000
20000
25000
FR SE UK DE ES IT NL AT BE DK PT CZ FI NO EL HU IE PL SK HR SI RO LT BG EE LU LV CY MT IS
E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp
S. aureus
S. pneumoniae
E. facealis
E. faecium
6. 5
2014 data call in summary:
Reporting completeness
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age Gender Patient type Hospital unit type Date hosp
Data from EARS-Net
7. 6
2014 data call in summary:
Reporting completeness
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age Gender Patient type Hospital unit type Date hosp
Mean 66.1 years
Median 71 years
Female 44.9%
Male 55.1%
Inpatients 86.5%
Outpatients 13.5%
8. 7
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
E. coli K. pneumoniae P. aeruginosa Acinetobacter
spp
S. aureus S. pneumoniae Enterococcus
PEDSICU
PEDS
URO
INFECT
OBGYN
ONCOL
SURG
INTMED
ED
ICU
2014 data call in summary:
Hospital unit type, by pathogen
9. 8
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
E. coli K. pneumoniae P. aeruginosa Acinetobacter
spp
S. aureus S. pneumoniae Enterococcus
No info
Zone diameter
E-test
Mic
2014 data call in summary:
Quantitative susceptibility data, by pathogen
10. 9
Data call
Data
analysis,
report draft
Internal
ECDC
approval
MS report
approval
Re-analysis
Final ECDC
approval
Editing and
layout
Timeline 2015: from data call to finalised
report
1st
MS data
approval
2nd
MS report
approval
•Non-negotiable deadline: European Antibiotic Awareness Day on
November 18
• Two separate MS approval processes: during data call and the report
approval
TESSy
approval
Deadline 1
July
SeptemberAugust October
11. Data call outputs 2015
EARS-Net annual report
• online version with country summary sheets
• printed version without country sheets (tbc)
Summary for EAAD briefing kit
EARS-Net on-line database
• maps
• tables
• trend graphs
Published
18
November!
15. Background
• Concern for increasing AMR problem in Acinetobacter
raised at the Joint ARHAI Annual Meeting in Warsaw,
2010
• Survey sent out late 2010 to assess feasibility for
surveillance
• Agreed to include as 2-year pilot at 2nd network
meeting in 2011
• Data collection completed 2013 and 2014 - time for
evaluation
Acinetobacter spp surveillance in EARS-Net
16. EARS-Net 2010 Acinetobacter Survey
summary
• High participation in the survey: response received from 29/30 countries
• Acinetobacter was already included in national AMR surveillance in more than
half of the countries, but blood stream isolates constitute a small proportion
(<5%) of all isolates in most cases
• A relatively high number of antimicrobials were included in AST panels in more
than half of the countries having AST results for Acinetobacter
• Multidrug resistance in Acinetobacter was assessed in >50% of blood stream
isolates in 1/4 of the countries
• The importance of Acinetobacter was perceived as “significant “ by 1/3 of the
countries, while 1/3 considered Acinetobacter as being of “minor” importance
• 80% of the countries would like Acinetobacter included in EARS-Net
Acinetobacter spp surveillance in EARS-Net
17. EARS-Net Coordination Group advice
regarding feasibility of Acinetobacter
surveillance (February 2012)
• Number of isolates will be very low for some countries (blood
isolates only)
• Challenges of species identification and susceptibility testing to be
carefully considered – only include at spp level
• Limit the antimicrobial groups under surveillance
• Acinetobacter data collected in the HAI-PSS should be reviewed to
validate EARS-Net results
Acinetobacter spp surveillance in EARS-Net
18. Acinetobacter spp: Number of reporting
countries (green), 2012 and 2013
2012 2013
Acinetobacter spp surveillance in EARS-Net
18 countries 27 countries
19. 18
Frequency of Acinetobacter spp. as percentage of all
bacteria reported to EARS-Net, by country (n:4120),
2013
No data
<1%
1-<2 %
2-<4 %
4-<6 %
6-<8 %
>8 %
Acinetobacter spp surveillance in EARS-Net
20. 19
Relative frequency of Acinetobacter spp. as a
percentage of all microorganisms reported
for HAIs, by country (n=366 isolates), ECDC PPS
2011–2012
* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania and very poor in Denmark and Sweden. See table 18 for
total number of microorganisms by country.
21. 20
Relative frequency of Acinetobacter spp. as a
percentage of all microorganisms reported
for HAIs, by country (n=366 isolates), ECDC PPS
2011–2012
* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania and very poor in Denmark and Sweden. See table 18 for
total number of microorganisms by country.
EARS-Net
23. 22
Percentage of Acinetobacter baumannii isolates non-
susceptible to carbapenems in HAIs in acute care
hospitals, ECDC PPS 2011-2012
ECDC PPS
* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania
and very poor in Denmark and Sweden. See table 18 for total number of microorganisms by country.
24. 23
Percentage of Acinetobacter baumannii isolates non-
susceptible to carbapenems in HAIs in acute care
hospitals, ECDC PPS 2011-2012
ECDC PPS
EARS-Net
25. 24
Occurrence of carbapenem-resistant Acinetobacter baumannii (CRAb)
(all types of isolates) based on self-assessment by national experts,
EuSCAPE project, 38 European countries, March 2013
The stage designations for CRAb should be taken with caution for all 38 participating countries. Most national experts highlighted that the exact
epidemiology of CRAb remains uncertain in their country, because at the time of the survey surveillance and reporting of CRAb are not
26. 25
Occurrence of carbapenem-resistant Acinetobacter baumannii (CRAb)
(all types of isolates) based on self-assessment by national experts,
EuSCAPE project, 38 European countries, March 2013
The stage designations for CRAb should be taken with caution for all 38 participating countries. Most national experts highlighted that the exact
epidemiology of CRAb remains uncertain in their country, because at the time of the survey surveillance and reporting of CRAb are not
EARS-Net
27. 26
Summary: Reporting capacity
• Number of reporting countries increased from 18 in 2013 to
27 in 2014
• Most isolates had susceptibility information on all three
antimicrobial groups under regular surveillance
• Number of reported isolates were in most cases equal to or
higher than estimated in 2011
• Number of reported isolates increased in most countries
between 2013 and 2014
• Proportion Acinetobacter spp isolates varied between
countries, and was especially high in south-eastern
countries
• Frequency of Acinetobacter spp is similar as reported from
ECDC PPS
28. 27
Summary: Resistance situation
• Large variations in antimicrobial resistance of Acinetobacter
spp. isolates in Europe were reported, with generally higher
resistance percentages reported from countries in the south
of Europe than in the north.
• Carbapenem resistance was common, and in most cases
combined with resistance to fluoroquinolones and
aminoglycosides.
• Results are difficult to compare between EARS-Net and PPS
and EuSCAPE, but shows a similar geographical gradient
29. 28
Suggested way forward:
• Keep surveillance of Acinetobacter spp in
EARS-Net in current format:
• Reporting on genus level (i.e.,
Acinetobacter spp)
• Panel of antimicrobials: fluoroquinolones,
aminoglycosides, carbapenems and
polymyxins
31. 30
The problem
30
• S. pneumoniae breakpoints for
penicillin susceptibility differ
depending on clinical guidelines
used and site of infection.
• The use of clinical breakpoints
differ between countries. Many
countries are now changing fro
use of CLSI to EUCAST.
32. 31
Penicillin susceptibility in S. pneumoniae:
Use of clinical breakpoints for 2012 data
31
EUCAST non-menigitis
14%
EUCAST depending on
site of infection
40%
CLSI meningitis
13%
CLSI depending on site
of infection
13%
CLSI oral
13%
Mix
7%
Number of respondents: 14/29 countries
33. 32
Use of clinical guidelines, by year, 2008-2013
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012 2013
CLSI
EUCAST+
35. 34
Penicillin susceptibility in S. pneumoniae:
Reporting of quantitative information (2013)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AT BE BG CY CZ DE DK EE EL FI FR HR HU IE IS ES LT LU LV MT NL NO PL PT RO SE SI SK UK
No info
Zone diam results %
MIC result%
Gradient strip result %
36. 35
Suggested way forward
Present data according to fixed
breakpoints:
MIC S <= 0.06 mg/L (R>2 mg/L)
Limit results to non-susceptible (better harmonisation
between breakpoints)?
How to achieve this?
1. MS adjust their SIR interpretation before data upload
- If not possible, countries can still report data but need to inform
ECDC that the set breakpoints are not used
2. ECDC analyse according to reported quantitative data
- Reporting of quantitative data must increase to make this
meaningful