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DANMAP 2015 3D
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danmap 2015 108
resistance
in human clinical bacteria 8. in general, the
data
reported from clinical human samples have become increasingly consistent and adequate during the years. still carefulness in interpretation and comparison of
data
is im- portant. for the year 2015, the
dcm
s reported zone diameters as well as interpretations of antimicrobial
resistance
which made it possible to compare local interpretations with eucast interpretational breakpoints. from the differences in these, it is clear, that different rules for reporting results of the suscepti- bility of the isolate to the clinicians still exist. for the antibiot- ics mostly affected, this is commented below in the relevant sections. in addition, differences between patient populations covered by the different
dcm
s can influence the comparability of
resistance
prevalence in-between
dcm
s. furthermore, for each pathogen, danmap counts
resistance
data
on the first isolate per patient per year per
dcm
. thereby transportation of chronically ill patients in-between hospitals or regions can in- fluence the results, since the patient might be counted twice. it seems more appropriate instead to compare clinical depart- ments of the same medical specialty, for example hematology, across the
dcm
s, which we foresee could be done more readily in the future with
data
bases like the miba ii and eres (see the jubilee chapter for more information). when looking at invasive e. coli during all 20 years of report- ing (figure 8.5)
data
stem from four
dcm
covering 1995 to 1999. for two of the
dcm
s
data
were not included in the first danmap reports but those
data
were included later. from 2000 and onwards
data
covered at least 63% of the danish population, and since then an average value of
resistance
for denmark is presented. the trend for ampicillin
resistance
is a crawling increase over the 20 years with
resistance
of around 35% of invasive e. coli in 1995 to 1998, around 40% from 2000 to 2006 and from 2007 and onwards the ampicillin
resistance
in e. coli is around 45%. the earliest ears-net
data
are from 1999 with norway reporting 27%
resistance
in 584 e. coli isolates and germany reporting 36%
resistance
in 166 e. coli isolates. the increasing trend has been the same in the european coun- tries with most countries in 2014 showing 50-60% resis- tance and a few reaching above 70%
resistance
, while the nordic countries stay below 45% [ears-net 2014 ]. in this 20 year period the consumption of penicillins with extended spectrum in total increased significantly in denmark mainly driven by a steep increase in the consumption of (piv)mecilli- nam, while the consumption of (piv)ampicillin decreased both in primary care and in the hospital sector. thus there is no direct link between the occurence of ampicillin
resistance
and the consumption of the drug class. for ciprofloxacin
resistance
, a steep increase in
resistance
was observed, from 2-3 % around year 2000 to 14% in the years 2009 to 2012. for the last three years, a small decrease was observed, with 12%
resistance
in 2015 (figure 8.6). the same pattern was observed for e. coli isolated from urine both from hospitalized patients and from the primary health care sector. ciprofloxacin was appointed special focus in denmarks action plan on antimicrobial
resistance
in 2010 and one of the three antimicrobials with recommendations on restricted use by the danish health authorities in 2012 showing a slight decrease in consumption observed since 2011 (figure 5.2). figure 8.5.
resistance
(%) in escherichia coli blood isolates from humans, denmark, 20 years of surveillance, incl. ampicillin. 0 2 4 6 8 10 12 14 16 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
dcm
1, 2, 3 og 4 cefuroxime cefuroxime gentamicin ciprofloxacin
dcm
1, 2, 3 og 4 gentamicin 3rd gen. cephalosporin piperacillin/tazobactam meropenem % resistant isolates % resistant isolates 0 10 20 30 40 50 60 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
dcm
1, 2, 3 og 4 ampicillin ampicillin cefuroxime gentamicin
dcm
1, 2, 3 og 4 cefuroxime ciprofloxacin 3rd gen. cephalosporin piperacillin/tazobactam
dcm
1, 2, 3 og 4 gentamicin meropenem danmap 2015
isolates-2015-resistance-109.html
