isolates-2015-resistance-109.html
DANMAP 2015 3D
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danmap
2015
110 resistance
in human clinical bacteria 8. in general, the level of antimicrobial resistance decreased since its peak in 2009. this is probably due to clonal shifts in the infectious strains happening over the years. piperacillin/ tazobactam is the only antimicrobial with continuously slowly increasing resistance from its first registration in the danmap report 2010 until 2014 (figure 8.7). this is concordant to an increased use of this agent due to a change in the danish an- tibiotic policy preferring piperacillin/tazobactam for 2 nd and 3 rd generation cephalosporins that happened in the years 2008 and onwards and might have lessened the selection pressure from cephalosporins at danish hospitals. in 2015 there was a non-significant decrease (p=0,061) in piperacillin/tazobactam resistance, from 8% in 2014 to 6% in 2015 (table 8.2 and figure 8.7). the year 2015 is the first year where the dcm reported data on zone diameter (not shown) as well as interpretations of resistance. from this it became clear that rules for interpret- ing resistance in enterobacteriaceae are not completely the same in denmark. some dcm report as tested according to the measured zone diameter, others have different local (expert) rules. this might for example be inferring all esbl producing isolates
as fully or intermediary resistant towards any beta- lactams or combinations of a penicillin with a beta -lactamase inhibitor, no matter of the measured zone diameters. accord- ing to eucast expert rules, it should be ? reported as tested and enclosed a warning on uncertain therapeutic outcome for infections other than urinary tract infections ? (version 2.0 available from 29 oct, 2011). these varying local interpreta- tions developed for helping in the choice of the clinically most relevant treatment might interfere with surveillance analysis when interpreting trends for the different drugs e.g. piperacil- lin/tazobactam resistance. a more stringent surveillance of amr is expected in the future with reporting of zone diame- ters rather than, sometimes, individual interpretations that are meaningful in treatment of the patient in a clinical situation but not in harmonized national surveillance. the only significant change in 2015 compared to 2014 is ami- noglycoside resistance, which decreased from 4.6% in 2014 to 2.5% in 2015. this decrease is not paralleled by a decrease in aminoglycoside consumption at hospitals (table 5.5). resistance to 2nd generation cephalosporins (cefuroxime) was 11% and resistance to 3rd generation cephalosporins was 8%. the resistance to 3rd generation cephalosporins is the highest reported level in ears-net among the nordic countries (which in 2014 were reported below 6% for the other nordic coun- tries), but remains lower than the occurrence reported by most other european countries. [ears-net 2014]. in 2015, none carbapenem (meropenem) resistant and two intermediary resistant k. pneumoniae blood isolates were reported. these data cover the first k. pneumoniae isolate per patient per year and might thus be different from the number of resistant isolates referred to the reference laboratory for further resistance analysis. in 2014, 3 carbapenem (merope- nem) resistant and one intermediary resistant isolates were reported. this is divergent from the general trend for 2015, where an increase in carbapenem resistance in enterobacte- riacae and non-fermenters is observed. (textbox 8.2) the level of resistance to ciprofloxacin, which decreased insignificantly from 7.0% in 2014 to 5.5% in 2015, came to the same lower level as in the other nordic countries. this is the first time since the reporting of resistance in k. pneumoniae from blood isolates began in 2008. urine isolates from hospital patients danmap received data on 7175 k. pneumoniae isolated from urine in hospitalized patients. resistance levels to all the reported antibiotics were un- changed compared to 2014, except for ciprofloxacin where a decrease from 8% to 6% was observed. (table 8.2 and figure 8.8) in 2015, carbapenem (meropenem) resistance was reported in four and intermediary resistance in seven k. pneumoniae urine isolates from hospitalized patients. not all dcm performed routine susceptibility testing for meropenem, thus the number of these strains represents a selected population. urine isolates from primary health care danmap received data on the antimicrobial susceptibility of 6372 k. pneumoniae isolates from urine from patients in primary health care. in 2015, there was a significant decrease in resistance to- wards ciprofloxacin from 7% to 5% compared to 2014. (table 8.2 and figure 8.9) the overall trend, as in k. pneumonia from hospital urines and blood, the level of antibiotic resistance has been decreasing compared to 2009. in 2015, one carbapenem (meropenem) resistant and three intermediary resistant k. pneumoniae urine isolates from pa- tients in primary health care were reported. as for the hospital urine isolates, this number represents a selected population, since meropenem is only routinely tested for in urine samples from primary health care by four dcm sissel skovgaard, stefan s. olsen and ute wolff sönksen
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