1. Antimicrobial resistance surveillance in Ireland Results of invasive Escherichia coli infection (blood/CSF) surveillance, 2009 **** Data as of 01/12/2010 **** Ireland is a member of the European Antimicrobial Resistance Surveillance Network (EARS-Net)

2. EARS-Net E. coli: Objective and case definition Objective : To determine the proportions of E. coli isolates from blood and/or CSF that are resistant to 4 key antibiotic classes: ◦ Aminopenicillins (e.g. ampicillin) ◦ 3 rd Generation Cephalosporins (e.g. cefotaxime, ceftazidime) ◦ Fluoroquinolones (e.g. ciprofloxacin) ◦ Aminoglycosides (e.g. gentamicin, tobramycin, amikacin) Case definition: EARS-Net collects data on the first invasive isolate (from blood/CSF) of E. coli per patient per quarter

3. Caveats in interpreting EARS-Net data Care must be exercised when interpreting the raw figures, i.e. increases in numbers of isolates, as the numbers of laboratories reporting to EARS-Net has increased over the years EARS-Net data does not distinguish clinically significant isolates from contaminants If a resistant isolate is identified subsequent to a susceptible one within the same quarter, then that isolate is not counted (and similarly if susceptible isolates is identified subsequent to resistant one)

4. For further information on antimicrobial resistance and EARS-Net in Ireland, including quarterly and annual reports, plus reference/ resource material on the individual pathogens under surveillance, see: http://www.hpsc.ie/hpsc/A- Z/MicrobiologyAntimicrobialResistance/EuropeanAntimic robialResistanceSurveillanceSystemEARSS/

5. Antibiotic codes and abbreviations: AMK, Amikacin AMP, Ampicillin CTX, CefotaximeCPD, Cefpodoxime CAZ, CeftazidimeCRO, Ceftriaxone CIP, CiprofloxacinGEN, Gentamicin IPM, ImipenemMEM, Meropenem OFX, OfloxacinTZP, Piperacillin-Tazobactam TOB, Tobramycin3GC, 3 rd -Generation Cephalosporin AMR, Antimicrobial Resistance ECO, Escherichia coli ESBL, Extended-Spectrum Beta-Lactamase FQREC, Fluoroquinolone-Resistant E. coli FQSEC, Fluoroquinolone-Susceptible E. coli MDR, Multi-Drug Resistance

6. Numbers and resistance proportions of E. coli from invasive infection, 2002-2009 * Not all isolates tested

7. Proportions of ESBLs and MDR among E. coli from invasive infection, 2002-2009 * Not all isolates tested

8. Invasive E. coli resistance trends, 2002-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

9. Invasive E. coli resistance trends, 2002-2009: 3GCs and ESBLs Number of laboratories participating by year-end and quarter are indicated above the bars

10. Invasive MDR E. coli trends, 2002-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

11. Numbers and proportions of fluoroquinolone (FQ)-resistant invasive E. coli infection by hospital type, 2009

12. Numbers and proportions of MDR invasive E. coli infection by hospital type, 2009

13. Susceptibility data for invasive E. coli isolates, 2009 (n=2064)

14. Resistance profiles of E. coli isolates, 2009

15. Trends in NUMBERS of main resistance profiles of E. coli isolates, 2002-2009 Number of laboratories participating by year-end and quarter are indicated above the bars

16. Trends in PROPORTIONS of main resistance profiles of E. coli isolates, 2002-2009 (1) See next slide…………….

17. Trends in PROPORTIONS of main resistance profiles of E. coli isolates, 2002-2009 (2)

18. Age and sex distribution of patients with invasive E. coli infection, 2009

19. Age and sex-specific incidence rates of invasive E. coli infection, 2009 ASIR, Age-Specific Incidence Rate (per 100,000 population)

20. Mean, median, mode and range of ages of patients with invasive E. coli infection, 2009 The difference in the mean age of patients with invasive infections due to FQREC and FQSEC is highly significant (F-statistic=28.47; P<0.0001) The difference in the mean age of patients with invasive infections due to MDR and non-MDR E. coli is highly significant (F-statistic=16.84; P<0.0001)

21. Sex distribution of patients with invasive E. coli infection, 2009 In patients with laboratory-confirmed invasive E. coli infection in 2009, females were approximately 1.25-times more likely to get an infection than males (highly significant, P<0.0001). However, males were approx. 1.25- times more likely to get an infection with FQREC (significant, P=0.024) and 1.2-times more likely to get an infection with MDR E. coli (not significant, P=0.15) than females.

22. E. coli - distribution of 3GC (e.g. CTX or CAZ) resistance in EARSS/EARS-Net countries in 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

23. E. coli - distribution of 3GC (e.g. CTX or CAZ) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

24. E. coli - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS/EARS-Net countries in 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

25. E. coli - distribution of fluoroquinolone (e.g. CIP) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009

26. E. coli - distribution of aminoglycoside (e.g. GEN) resistance in EARSS/EARS-Net countries in 2009 Map downloaded from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/Database.aspx on 21/12/2010

27. E. coli - distribution of aminoglycoside (e.g. GEN) resistance in EARSS countries in 2008 Map downloaded from http://www.rivm.nl/earss/database/ on 24/08/2009