1. Resistance in agents of hospital-acquired respiratory infection in the UK and Ireland 2008/09 Rosy Reynolds, Ian Morrissey, Russell Hope on behalf of the BSAC Working Party on Resistance Surveillance O480, 20th ECCMID, Vienna, 10-13 April 2010 rosy.reynolds@nbt.nhs.uk

2. BSAC Respiratory Resistance Surveillance Up to 13 S. aureus, 13 Pseudomonas 13 Acinetobacter 50 Enterobacteriaceae per laboratory per year from patients in hospital ≥48 hours Central testing - Quotient Bioresearch BSAC agar dilution MICs, & tests for β-lactamase, ESBL, CTX-M, mecA, mupA Data: www.bsacsurv.org 2008/09 22 collecting laboratories

3. ACKNOWLEDGEMENTS British Society for Antimicrobial Chemotherapy (BSAC) Resistance Surveillance Project 2008-2009 Sponsors Collecting Laboratories Astellas AstraZeneca Johnson & Johnson Novartis Pfizer (Wyeth) Wyeth Kirsty Maher Ian Morrissey Angela Brook Quotient Bioresearch Russell Hope David Livermore Marina Warner HPA Centre for Infections Rachael Adkin Aishya Chaudhry Dorothy James

4. Hospital-acquired isolates: % from patients in ICU/HDU BSAC: Respiratory 2008/09, Bacteraemia 2001-2008

5. Distribution of genera in Enterobacteriaceae (≥ 48 hours in hospital) Respiratory BSAC Respiratory 2008/09 n = 789 Bacteraemia Estimate from HPA voluntary 2008 and BSAC bacteraemia 2001-08

6. Distribution of genera in Enterobacteriaceae (≥ 48 hours in hospital) - excluding ICU/HDU Respiratory BSAC Respiratory 2008/09 n = 374 Bacteraemia Estimate from HPA voluntary 2008 and BSAC bacteraemia 2001-08

7. Non-susceptibility in Enterobacteriaceae (≥ 48 hours in hospital) BSAC: Respiratory 2008/09, Bacteraemia 2008

8. Non-susceptibility in Enterobacteriaceae (≥ 48 hours in hospital) excluding ICU/HDU BSAC: Respiratory 2008/09, Bacteraemia 2008

9. Non-susceptibility in S. aureus: % MRSA (≥ 48 hours in hospital) BSAC: Respiratory 2008/09, Bacteraemia 2008

10. Non-susceptibility in S. aureus: MSSA and MRSA (≥ 48 hours in hospital)

11. Non-susceptibility in Pseudomonas (≥ 48 hours in hospital) BSAC: Respiratory 2008/09, Bacteraemia 2008

12. Conclusions In infections after ≥ 48 hours in hospital: Resistance rates are broadly similar in blood and respiratory infections for most organism-agent combinations...BUT differ substantially in some cases. Klebsiella and Enterobacter are more prominent (among Enterobacteriaceae) in respiratory infections than in blood.  Direct surveillance of resistance in specific infections and settings is preferable to extrapolation when possible.