resistance-isolates-2015-104.html
DANMAP 2015 3D
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105 danmap
2015
8. resistance in human clinical bacteria 8.1 escherichia coli escherichia coli is part of the normal intestinal flora in both humans and animals but also one of the most common causes of infections. in humans, e. coli is the most frequent cause of community- and hospital-acquired urinary tract infections and of bacteremia. e. coli also accounts for the majority of travel- related diarrhea. it further occasionally causes meningitis in newborns. for e. coli , danmap 2015 includes data on resistance referred from all 11 departments of clinical microbiology (dcm), thus for the first time covering the total danish population. these data cover all blood
and urinary isolates
from hospitals and a selected number of urines from primary health care. blood isolates from hospital patients danmap received data on the antimicrobial susceptibility of 4,618 e. coli isolates from blood. as in previous years resis- tance testing was primarily performed by disc diffusion and the referred data consisted of interpretation of resistance results based on the s-i-r system. a minor increase in the total number of e. coli isolates from blood was observed from 2014 to 2015 (figure 8.1). the increase corresponds to the increase in contribution of the last dcm to danmap 2015. the increasing tendency of the total number of e. coli isolates from blood, registered since 2010 and commented in danmap 2014, did not continue in 2015. still an increase in the number of bacteremias might continue to some extent in the future caused by demographic changes with an ageing population, since the elderly are at the highest risk of bacteremia and have the highest incidence. increasing trends in the rates of bacteremias seem not only to resemble demographic changes but to be a combination of several factors like advances in health care with improved treatment options as well as lowered thresholds for taking blood cultures and improvement in blood culturing systems. no significant changes in occurrence of antimicrobial resistance were observed in 2015 compared to 2014 (figure 8.1 and table 8.1) for interpretation of mecillinam resistance testing results, more restrictive breakpoints than eucast breakpoints are used for blood isolates by some dcm and interpretation rules have changed over time as discussed in danmap 2014. this makes comparison of results from resistance testing for mecillinam over time not valid. therefore in table 8.1 the number is presented, but without any comparison to former years. if referral of inhibition zone diameters is to be used in 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 0 2 4 6 8 10 12 14 16 06 07 08 09 10 11 12 13 14 15 % resistant isolates piperacillin/tazobactam (n=4592) gentamicin (n=4591) ciprofloxacin (n=4573) cefuroxime (n=4567) 3rd gen. cephalosporin (n=4561) meropenem (n=4045) number of positive bloodisolates 0 2 4 6 8 10 12 14 16 06 07 08 09 10 11 12 13 14 15 % resistant isolates ciprofloxacin (n=46133) gentamicin (n=40780) cefuroxime (n=41505) 3rd gen. cephalosporin (n=34817) number of positive blood isolates figure 8.1. resistance (%) in escherichia coli blood isolates from humans, denmark note: the number (n) in parentheses represents the number of isolates tested for susceptibility in 2015 danmap 2015 in 2015, a further increase of vancomycin-resistant enterococci in the capital region and the region of zealand was noted, reaching a total of 372 clinical isolates, through typing charac- terized as belonging primarily to sequence types (st), st80, st117 and st203, (textbox 8.3). 2015 was also the year with the highest incidence of drug-resistant mycobacterium tu- berculosis , with five multidrug-resistant tuberculosis (tb) cases and the second case with extensively-drug-resistant tb ever noticed in the country. even though the global incidence of tb is declining, the emergence of drug-resistant strains is challenging, also in denmark (textbox 8.6).
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