1. Predicting multi-drug resistance in Pseudomonas aeruginosa in the UK and Ireland Rosy Reynolds, Russell Hope, Kirsty Maher on behalf of The BSAC Working Party on Resistance Surveillance O348 22 nd ECCMID, London, 31 Mar - 3 Apr 2012 rosy.reynolds@nbt.nhs.uk

2. BSAC Resistance Surveillance Project UK & Ireland 40 laboratories (25 up to 2009) Bacteraemia (2003 - 2010) Hospital-onset lower respiratory infection (2008/09 - 2010/11) Target: 280 P.aeruginosa isolates /year in each programme (was 250) Excluding duplicate within 14 days and (in RTI) cystic fibrosis Central testing - HPA, London; Quotient Bioresearch, Fordham. BSAC agar dilution MICs & breakpoints. www.bsacsurv.org 2012

3. Central Laboratories HPA Colindale Russell Hope David Livermore and many others Quotient Bioresearch Kirsty Maher Ian Morrissey and many others Collecting Laboratories Sponsors 2003-2010 Astellas AstraZeneca Cerexa / Forest Cubist J&J / Janssen Merck / MSD Novartis (Chiron) Pfizer (Wyeth) Theravance Associate sponsor Basilea ACKNOWLEDGEMENTS BSAC Resistance Surveillance Project 2003-11

4. Single & multiple non-susceptibility bacteraemia 4/1686 2 centres 4 years

5. Single & multiple non-susceptibility bacteraemia respiratory 5/668 3 centres 2 years

6. Age Distribution of Patients 1686 isolates

7. Age Distribution of Patients 668 isolates

8. Age Distribution of Patients

9. Other patient characteristics Detail of focus in bacteraemia ICU/HDU % Respiratory Bacteraemia male % Respiratory Bacteraemia respiratory focus % Respiratory Bacteraemia Known focusOriginal data hospital onset % Respiratory Bacteraemia

10. Predictors considered Predictors alone P notes Age <0.001 Fractional polynomial Sex NS Male vs female Hospital onset 0.009 >48 hours vs other Speciality <0.001 ICU vs non-ICU Focus of infection 0.001 0.746 UTI or line/SSI/GI vs RTI Sample site 0.001 Blood vs Respiratory Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

11. Predictors considered Predictors alone P together P notes Age <0.001 Fractional polynomial Sex NS- Male vs female Hospital onset 0.009- >48 hours vs other Speciality <0.0010.001 ICU vs non-ICU Focus of infection 0.001 0.746 0.020 0.850 UTI or line/SSI/GI vs RTI Sample site 0.001- Blood vs Respiratory Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

12. Predictors considered Predictors alone P together P notes Age <0.001 Fractional polynomial SexNS -Male vs female Hospital onset0.009 ->48 hours vs other Speciality <0.001 0.001 ICU vs non-ICU Focus of infection 0.001 0.746 0.020 0.850 UTI or line/SSI/GI vs RTI Sample site0.001 -Blood vs Respiratory Logistic regression models with robust errors for centre clustering; Infants under 1 year excluded.

13. Age

14. Patient with line-derived infection, not in ICU Age Estimate & 95% CI

15. Model shows patient aged 65 with line-derived infection Intensive Care KEYother specialityintensive care / high dependency ModelObserved - unadjusted OR 2.45

16. Focus of infection ModelObserved - unadjusted KEYRTIline/SSSI/GIUTIunknown/minor Model shows patient aged 65, not in ICU OR 0.95 OR 0.32

17. Multiple resistance in Pseudomonas aeruginosa from bloodstream and hospital-onset respiratory infection in the UK and Ireland: remains fairly uncommon (3-7%) but is more likely in in younger patients (except infants) patients in intensive care and less likely in infections from the genitourinary tract

19. 62 bacteraemia, 49 respiratory. Multiply-resistant P. aeruginosa