Surveillance of Antimicrobial Resistance in Denmark

1
Surveillance of Antimicrobial Resistance in
Denmark

• Dominique L. Monnet

Dept. of Antimicrobial Resistance Hospital
Hygiene Statens Serum Institut, Copenhagen,
Denmark
2
DANMAPDanish IntegratedAntimicrobialMonitoring
andResearch Programme

• Since 1995
• Collaborative project
• - Danish Veterinary Institut
• - Danish Food Veterinary Adm.
• - Danish Medicines Agency
• - Statens Serum Institut
• Yearly report since February, 1997
• http//www.vetinst.dk (Dansk
  Zoonosecenter, DZC Publikationer)

3
Antimicrobial Resistance Surveillance in
Staphylococcus aureus Blood Isolates, Denmark,
1960-1995
Source DANMAP Report, 1997.
4
Methods MRSA

• All suspected MRSA are sent by the local clinical
  microbiology laboratories to the Staphylococcus
  Unit, Statens Serum Institut, for further
  susceptibility testing and typing
• mecA gene confirmed with 3-hour hybridization
  assay (EVIGENE)
• Phage typing
• PFGE typing

5
MRSA in Denmark, 1994-2001
Number
Source Staphylococcus Unit, Statens Serum
Institut, 2002.
6
MRSA in Denmark, 1999-2001
Number
Source Staphylococcus Unit, Statens Serum
Institut, 2002.
7
MRSA in Denmark, 1999-2001
Number
Source Staphylococcus Unit, Statens Serum
Institut, 2002.
8
PFGE Typing Results
9
MRSA in Denmark, 1999-2001
Number
Source Staphylococcus Unit, Statens Serum
Institut, 2002.
10
New Cases of EDK97-1 MRSA Community Infection,
Denmark, 01/99-12/01
Number
Source Staphylococcus Unit, Statens Serum
Institut, 2002.
11
EDK97-1 MRSA Community Infections per
County/Municipality, Denmark, 1999-2001
1999
2000
2001
Source Staphylococcus Unit, Statens Serum
Institut, 2002.
12
Methods S. pneumoniae

• All invasive S. pneumoniae isolates are sent by
  the local clinical microbiology laboratories to
  the Streptococcus Unit, Statens Serum Institut,
  for further susceptibility testing and typing
• Screening for penicillin-non susceptible
  isolates 1-microgr oxacillin tablet
  (Neo-Sensitabs, A/S Rosco) on 10 horse blood
  agar (SSI Diagnostika)
• MICs E-test (AB Biodisk) on Danish Blood Agar
  (SSI Diagnostika)
• Serotyping

13
Resistance in Streptococcus pneumoniae Isolates
from Sterile Body Sites, Denmark, 1990-2002
Erythromycin-R/I S. pneumoniae (MIC gt 1
mg/l)
R I
Penicillin-R/I S. pneumoniae (MICgt0.1 mg/l)
Year
Source Streptococcus Unit, Statens Serum
Institut, Copenhagen, 2003.
14
Monthly Percent Erythromycin-Resistant
Streptococcus pneumoniae Invasive Isolates,
Denmark, 01/1995-12/1999 (5-month moving average)
Erythromycin-R/I S. pneumoniae serotype 14
Erythromycin-R/I S. pneumoniae other
serotypes
Months
Source Konradsen HB, S. pneumoniae Reference
Lab., Statens Serum Institut, 2000.
15
Erythromycin-Resistant S. pneumoniae Serotype 14
and Pulsotype E Invasive Isolates, 1995 and 1999
1995
1999
Source Kaltoft M, S. pneumoniae Reference Lab.,
Statens Serum Institut, 2000.
16
Methods Salmonella/Campylobacter

• Salmonella
• - All S. Typhimurium and a subset of S.
  Enteritidis isolates
• - Tablet diffusion (Neo-Sensitabs, A/S Rosco) on
  Danish Blood Agar (SSI Diagnostika)
• Campylobacter
• - A subset of C. jejuni and C. coli isolates
• - Tablet diffusion (Neo-Sensitabs, A/S Rosco) on
  5 blood-yeast extract agar (SSI Diagnostika)
• Danish Registry on Gastrointestinal Infections
  (Statens Serum Institut) info. on foreign travel

17
Tetracycline and Nalidixic Acid Resistance in
Imported and Domestic Salmonella Typhimurium and
Campylobacter jejuni, Denmark, 1997-2001
Salmonella Typhimurium
Campylobacter jejuni
Source Dept. of Gastrointestinal Infections,
Statens Serum Institut, 2002.
18
Methods Escherichia coli (1)

• 10 (out of 15) local clinical microbiology
  laboratories
• - 5 labs. tablet diffusion method
  (Neo-Sensitabs, A/S Rosco) on Danish Blood Agar
  (SSI Diagnostika), ROSCO breakpoints
• - 1 lab. tablet diffusion method
  (Neo-Sensitabs, A/S Rosco) on Mueller-Hinton II
  agar (Becton-Dickinson and SSI Diagnostika),
  SRGA breakpoints
• - 3 labs. disk diffusion method (Oxoid) on 5
  horse blood Iso-Sensitest medium (Oxoid), SGA
  bkpts.
• - 1 lab. disk diffusion method (AB Biodisk) on
  5 horse blood Antibiotic Sensitivity Medium
  (PDM, AB Biodisk), SRGA breakpoints

19
Methods Escherichia coli (2)

• All labs. participate in NEQAS and 4 labs.
  participate in the EARSS external quality
  assessment exercise
• All labs. sent summary data yearly on
• - resistance in E. coli isolated from blood
  isolates (hospitals), from urine isolates
  (hospitals, comm.)
• - no. isolates, tested, S, I, R
• Repeat isolates from the same patient are
  excluded
• - 2 labs. window of 30 days
• - 2 labs. window of 21 days
• - 4 labs. whole year
• - 2 labs. cannot exclude repeat isolates

20
Resistance in Escherichia coli Blood and Urine
Isolates, Denmark, 1995-1999
Blood isolates
Urine isolates
Ampicillin
Sulfamethizole Ampicillin
Gentamicin Cefuroxime

Ciprofloxacin
Source Frimodt-Møller N, Møller JK, Schønheyder
HC, and Westh H. DANMAP 2000.
21
Resistance in Escherichia coli Blood and Urine
Isolates, Denmark, 1995-1999
Blood isolates
Urine isolates
Ampicillin
Sulfamethizole Ampicillin
Antimicrobial-R E. coli ()
Gentamicin Cefuroxime

Ciprofloxacin
Source Frimodt-Møller N, Møller JK, Schønheyder
HC, and Westh H. DANMAP 2000.
22
Ampicillin Resistance in Escherichia coli Blood
and Urine Isolates, Denmark, 1995-1999
Blood isolates Urine
isolates
Ampicillin-R E. coli ()
Source DANMAP, 2002.
23
Ampicillin Resistance in Escherichia coli Blood
and Urine Isolates, Denmark, 1995-1999
Blood isolates Urine
isolates
Ampicillin-R E. coli ()
Source DANMAP, 2002.
24
Ampicillin Resistance in Escherichia coli Blood
and Urine Isolates, Denmark, 1995-2001
Blood isolates Urine
isolates (hosp.)
Ampicillin-R E. coli Isolates ()
Source DANMAP, 2002.
25
Ampicillin Resistance in Escherichia coli Blood
and Urine Isolates, Denmark, 1995-2001
Blood isolates Urine
isolates (hosp.)
Ampicillin-R E. coli Isolates ()
Source DANMAP, 2002.
26
Ampicillin Resistance in Escherichia coli Blood
Isolates from 10 Danish Counties, 2001
Ampicillin-R E. coli Blood Isolates ()
n478 n434 n229 n190 n202
n119 n107 n560 n148
n379
Source DANMAP, 2002.
27
From IT-System to Surveillance Center
230455-1230","24022000","pae","GEN","31
"230455-1230","24022000","pae","CIP","30
"230455-1230","24022000","pae","IMP","20"
"230455-1230","24022000","pae","CAZ","30"
X
X
X
b6c8ed5","24022000","pae","GEN","31" "b6c8ed5","2
4022000","pae","CIP","30" "b6c8ed5","24022000","pa
e","IMP","20" "b6c8ed5","24022000","pae","CAZ","30
"
KOORDINATIONSCENTER
230455-1230","24022000","pae","GEN","31" "
230455-1230 ","24022000","pae","CIP","30" "
230455-1230 ","24022000","pae","IMP","20" "
230455-1230 ","24022000","pae","CAZ","30"
QEVAwUBOqg92I0ZSRQxA/UrAQE2nwf/Vmh72tbxd4h9UqagB4h
1sNkDhwzdRm jh4CTUBxlLlgmDohUnZq5vOAkS5a23Fq4PRZc
h3O5Njo/PaVdR3SgVRSlZxa/P
28
Tak!

• Kristiane B. Beicher, Jens Jørgen Christensen,
  Jørgen Engberg, Steen Ethelberg, Niels
  Frimodt-Møller, Peter Gerner-Smidt, Elsebeth T.
  Jensen, Margit S. Kaltoft, Thomas Klemmensen,
  Helle B. Konradsen, Anders R. Larsen, Berit
  Müller-Pebody, Kåre Mølbak, Hand Ulrik K.
  Nielsen, Robert Skov, Thomas L. Sørensen,
  Christina Zinn (Statens Serum Institut)
• Hans Erik Busk (Næstved Hospital), Henrik Friis
  (Slagelse Hospital), Jens Otto Jarløv (Herlev
  Hospital), Kjeld T. Jensen (Esbjerg Hospital),
  Jens Møller (Aarhus Municipality Hospital), Steen
  Schrøder (Herning Hospital), Helga Schuamcher,
  Jørgen Prag (Viborg Hospital), Henrik Schønheyder
  (Aalborg Hospital), Henrik Westh (Hvidovre
  Hospital)
• Flemming Bager, Hanne-Dorthe Emborg, Ole Heuer,
  Erik Jacobsen, Henrik Wegener, Frank Aarestrup
  (Danish Veterinary Laboratory)
• Sigrid Andersen, Jeppe Boel (Danish Veterinary
  and Food Administration)
• Karin Hovgaard, Helle L. Johansen, Lasse Larsen
  (Danish Medicines Agency)
• José María López-Lozano (Hospital Vega Baja,
  Orihuela, Spain)

29
More on DANMAP...
http//www.vetinst.dk Dansk Zoonosecenter,
then DZC Publikationer