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European Antimicrobial Resistance Surveillance System: Presented at ECCMID

By Chris Berrie

NICE, FRANCE -- April 7, 2006 -- In Europe, general levels of fluoroquinolone-resistant Escherichia coli continue to climb, even though increases in Enterococcus faecium might be specifically restricted and even in those countries that have successfully maintained low levels of methicillin-resistant Staphylococcus aureus (MRSA).

These data on the European temporal trends of antimicrobial resistance were presented here on April 3^rd at the 16^th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

Nienke van de Sande-Bruinsma, PhD, EARSS management team member and epidemiologist, Centre of Infectious Disease Epidemiology, Bilthoven, The Netherlands, presented the data on behalf of the European Antimicrobial Resistance Surveillance System (EARSS).

The remit of the EARSS is to maintain a comprehensive surveillance and information system that links national networks by providing comparable and validated data on the prevalence and spread of major invasive bacteria with clinically and epidemiologically relevant antimicrobial resistance in Europe. And, as Dr. van de Sande-Bruinsma put it, "It is a network of networks."

The EARSS monitors data from laboratories that serve more than 30% of the European population and is the most comprehensive public health effort to describe and analyze geographic and secular trends in antimicrobial resistance in Europe.

Dr. van de Sande-Bruinsma presented the resistance trends from 1999 to 2004 for some of the main indicator pathogens -- MRSA, vancomycin-resistant E. faecium and fluoroquinolone-resistant E. coli. This EARSS antimicrobial susceptibility data is routinely generated from submissions by more than 800 laboratories serving 1300 hospitals in 31 European countries.

For MRSA, the countries of central and northern Europe are still showing an increase in rates of resistance. This is even happening in Scandinavian countries, which have maintained low rates of MRSA infection (<1%) for many years. This trend must be taken seriously as a low threshold for losing control may exist, although it remains to be defined, Dr. van de Sande-Bruinsma said.

The increase in fluoroquinolone-resistant E. coli continues unabated in most European countries, probably due to the widespread use of these agents, she said. The EARSS believes that treatment options for this problem are now becoming slim, which threatens to pose an increasing challenge to European health care systems for years to come, she added.

Although the E. faecium overview is perhaps looking better, with rates below 10% in most European countries, vancomycin-resistant E. faecium has seen significant rate increases recently in Germany, France and Ireland. And even though this can be explained by the spread of strains belonging to a particular hospital-adapted clonal lineage (termed complex 17), this should not be a sign for complacency.

"The core business of EARSS is that we want to show what the situation of antibiotic resistance is, and what are the ongoing changes," said Dr van de Sande-Bruinsma, and it is this revealing of the early trends that should have an impact on the ways in which this problem is confronted throughout Europe, she added.


[Presentation title: EARSS: European Antimicrobial Resistance Surveillance System. Abstract P1383]

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