HUSRES Annual Report 2012 Martti Vaara www.huslab.fi www.intra.hus.fi Martti Vaara 2013 1
The basis of this HUSRES 2012 report is the HUSLAB/Whonet database 2012, which contains susceptibility data on more than 193.000 bacteria isolated and studied in 2012 by HUSLAB. The susceptibility interpretations are according to EUCAST 2012. The isolates originate from patients in Helsinki University Central Hospital, other hospitals in Helsinki - Uusimaa region, as well as outpatient health centers. HUSRES 2012 report contains data on 31 clinically most important bacterial species/groups. Previous annual reports from 2000 are also located at www.huslab.fi Martti Vaara 2013 2
MRSA cases in Finland 1995 2012 Pink columns: Helsinki and Uusimaa District, blue columns: other parts of Finland Tapausten lukumäärä 1800 1700 1600 1500 1400 1300 1200 1100 1000 900 800 700 600 500 400 300 200 100 0 840 1416 930 952 1028 970 978 1031 939 582 495 634 267 106 100 184 27 72 59 62 36 61 83 111 77 77 102 231 447 365 295 363 290 321 336 373 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Helsingin ja Uudenmaan shp Muu Suomi Source: National Institute for Health and Welfare Martti Vaara 2013 3
Staph. aureus 2012 (%R+I) Pus and blood isolates from in Helsinki University Central Hospital, from out-patients and from other sources. One isolate per patient (the most resistant). MRSA screenings exluded. Material n Oxa Ery Cli Lev Rif Fus Dox Net Lnz SxT HUCH (8 hosp) 2261 4 8 6 3 0 8 4 0 0 0 Blood isolates 357 2 7 6 4 1 7 2 0 0 0 Jorvi Hospital 658 3 7 6 4 0 6 3 0 0 1 Peijas Hospital 380 3 5 4 2 0 6 3 0 0 0 Hyvinkää Hosp 357 2 6 5 2 1 7 3 0 0 0 Helsinki City H 668 6 9 8 6 1 8 3 0 0 0 Outpatients 3555 3 6 5 3 7 All sources 8343 3 7 6 3 0 7 4 0 0 0 Martti Vaara 2013 4
Coagulase-negative staphylococci 2012 (%R+I) Pus and blood isolates. HUSLAB material from hospitals in Helsinki and Uusimaa districts. One isolate per patient (the most resistant). n Oxa Ery Cli Lev Rif Fus Dox Net Lnz SxT St. epidermidis 1425 71 57 43 49 14 58 21 21 0 39 St. haemolyticus 31 100 94 48 97 7 19 10 19 0 77 St. lugdunensis 105 3 13 11 3 0 8 3 1 0 3 Martti Vaara 2013 5
Streptococcus pneumoniae 2012 (%R+I) HUSLAB material from Helsinki and Uusimaa districts. One isolate per patient (the first isolate). All Blood Penicillin - R 1,1 0,0 Penicillin - I* 17 17 Ceftriaxone - R 0,1 0 Ceftriaxone - I 1,4 0 Erythromycin 25 25 Clindamycin 13 9 Doxycycline 17 Sulphamet-Trim. 21 Imipenem 0,0 Levofloxacin 2 Moxifloxacin 1 Telithromycin 8 n 704 204 *Should be interpreted (i) as S in pneumonia at the adult dose of 2 milj. IU x 6 and (ii) as R in meningitis Martti Vaara 2013 6
Multiresistant pneumococci* 2006 2012 (HUSLAB) 8,0 7,0 6,0 5,0 Proportion (%) 4,0 3,0 2,0 1,0 0,0 2006 2007 2008 2009 2010 2011 2012 * Pen MIC > 0.064 μg/ml and non-susceptibility to Ery, Cli, Dox and SxT. One isolate per patient. Martti Vaara 2013 7
Multiresistant pneumococci* 2012 (HUSLAB) MIC distribution for penicillin G and ceftriaxone (n = 36) * Pen MIC > 0.064 μg/ml and non-susceptibility to Ery, Cli, Dox and SxT. Martti Vaara 2013 8
Beta-hemolytic streptococci 2012 (%R+I) HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate). S. pyogenes S. agalact. Group G Penicillin 0 0 0 Cephalosp. I gen 0 0 0 Erythromycin 5 12 12 Clindamycin 4 11 11 n 9744 4862 3836 Group G: S. dysgalactiae spp. equisimilis group G strains Martti Vaara 2013 9
Streptococcus viridans group, blood isolates 2012 HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate). Penicillin -I 6 Penicillin -R 2 Ceftriaxone -I 0 Ceftriaxone -R 1 Erythromycin I+R 23 Clindamycin I+R 10 Gentamycin -high res. 0 Vancomycin 0 n = 155 Martti Vaara 2013 10
Str. anginosus [milleri] group 2012 (%R+I) Pus and blood isolates, HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate). Penicillin 0 Cephalospor. I gen. 0 Erythromycin 7 Clindamycin 6 Vancomycin 0 n = 667 Martti Vaara 2013 11
VRE cases in Finland 1992-2012 Green columns: Helsinki and Uusimaa District; blue columns: other parts of Finland 160 140 120 Tapausten lukumäärä 100 80 60 40 20 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Pääkaupunkiseutu muu Suomi Martti Vaara 2013 12 Source: National Institute for Health and Welfare
E. faecalis and E. faecium 2012 %R+I (pus & blood); %R (urine). HUSLAB material from Helsinki and Uusimaa districts. One isolate per patient (the most resistant). E. faecalis E. faecium pus blood urine pus blood urine Ampicillin 0 0 0 97 92 97 Imipenem 5 3,5 98 97 Pip/taz 6 6 98 97 Linezolid-I 0 0 0 0 Linezolid-R 0 1 0 0 Vancomycin 0 0 0 0,3 0 0 Gentam. (hi) 18 7 Levofloxacin 53 23 100 97 Nitrofurantoin 0 91 SuTri 23 91 n 881 113 3770 313 62 861 Martti Vaara 2013 13
Pseudomonas aeruginosa 2012 (%R+I) Pus and blood isolates. One isolate per patient (the most resistant isolate). HUSLAB material from selected hospitals in Helsinki and Uusimaa Districts n Ctaz Mero Pi-Tz Tob Ami Cip Meilahti 198 12 21 15 5 6 19 Töölö 172 6 26 16 5 3 20 Helsinki City hospitals 167 8 20 14 3 1 21 Jorvi Hospital 183 8 21 15 6 4 24 Peijas Hospital 83 11 16 8 5 7 22 Childrens Hospital 40 10 20 8 3 10 20 Uusimaa regional hospitals 199 9 16 10 6 4 17 Outpat. in Health Cntrs 648 3 10 7 5 3 13 Martti Vaara 2013 14
Ps. aeruginosa, MDR strains 2001-2012* *Nonsusceptibility to 1) meropenem and 2) tobramycin as well as 3) ceftazidime and/or piperacillintazobactam. HUSLAB material from Helsinki and Uusimaa District. 160 140 120 Number of patients 100 80 60 All sources Other sources Meilahti Hosp 40 20 PseuMDR, new definition Resistant to meropenem and ceftazidime 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2011 102 2012 82 Martti Vaara 2013 15
Acinetobacter spp. and S. maltophilia 2012 (%R+I) Pus and blood isolates from Helsinki University Central Hospital. One isolate per patient (the most resistant). n Mero Pi-Tz Tob Levo SuTri Acinetobacter 168 4 6 4 6 6 S. maltophilia 217 R R R 19 3 Martti Vaara 2013 16
Acinetobacter spp., MDR strains* *Nonsusceptibility to meropenem, tobramycin and piperacillin-tazobactam HUSLAB material from Helsinki and Uusimaa District. 60 50 Number of patients 40 30 20 All sources Other sources Toolo Hosp 10 0 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Martti Vaara 2013 17
Acinetobacter spp., MDR strains* HUSLAB material from Helsinki and Uusimaa District. AcinMDR, new definition: Resistant to meropenem and at least two from the following: ceftazidime, fluoroquinolone, aminoglycoside, ampicillin/sulbactam 2011 14 2012 2 Martti Vaara 2013 18
Enterobacteriaceae 2012 (%R+I) Pus and blood isolates at hospitals in Helsinki University Central Hospital. One isolate per patient (the most resistant). n Cfur Ctax Pi-Tz Tob Levo Mero E. coli 1458 12 9 9* 8 14 0 Kl. pneumoniae 331 10 5 5* 1 5 0 Kl. oxytoca 202 10 6 9 1 2 0 Proteus mirabilis 116 3 3 1 1 3 0 Ent. cloacae 412 (42) 32** 32** 1 3 0,7 Citrob. spp. 145 (29) 21** 21** 0 2 0 Serratia marc. 252 96 14** 14** 5 6 0 Proteus vulgaris 45 98 2** 2** 0 0 0 Morganella morg 68 97 22** 22** 3 9 2 *: all ESBL strains reported here as nonsusceptible **: Resistance (due to ampc derepression mutation) develops easily during therapy to cefotaxime and other III gen. cephalosporins, hence cephalosporin monotherapy not recommended. ***: all cefotaxime-nonsusceptible strains (mainly ampc strains) reported here as nonsusceptible Martti Vaara 2013 19
Frequency of E. coli ESBL among all E. coli blood isolates. HUSLAB material 2001-2012 9 Proportion (%) 8 7 Proportion (%) 6 5 4 3 2 1 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 One isolate per patient. Martti Vaara 2013 20
E. coli ESBL 2004 2012, number of new cases by age categories in Huslab material 350 300 Number of new cases 250 200 150 100 50 2005 2006 2007 2008 2009 2010 2011 2012 0 0-20 21-40 41-60 61-80 81-100 Age group Martti Vaara 2013 21
ESBL strains, resistance to non-betalactams and carbapenems 2012 % R+I in blood, pus, and urine isolates. HUSLAB material from Helsinki and Uusimaa districts. One isolate per patient (the most resistant isolate). E. coli Ciprofloxacin 72 Tobramycin 44 Sulphatrimetoprim 66 Trimetoprim 68 Nitrofurantoin 5 Fosfomycin 3,8 Meropenem 0 Ertapenem 2,6 n 1111 Martti Vaara 2013 22
Carbapenemase-producing Enterobacteriaceae (CPE) isolated/received by HUSLAB 2008-2012 14 12 10 8 6 4 Sme NMC-A OXA-181 GES NDM VIM OXA-48 KPC IMI 2 0 2008 2009 2010 2011 2012 Jalava, Kirveskari, Vaara (HUSLAB and THL) Martti Vaara 2013 23
Enterobacteriaceae, urine isolates 2011 (%R) HUSLAB material from Helsinki and Uusimaa districts. One isolate per patient (the most resistant). E. coli Kl. pneum. P. mirabilis Other Nitrofurantoin 1 13 100 30 Mecillinam 9 9 10 28 1st gen. cephalospor.* 8 4 6 57 Cefuroxime 6 4 1 34 Ciprofloxacin 10 3 2 4 Trimetoprim 24 20 39 21 n 24735 2831 851 2116 * Change in methodology during the year Martti Vaara 2013 24
Salmonella typhi 2009-2012, susceptibility to ciprofloxacin HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate), n = 14 EUCAST 2011 Salmonella - there is clinical evidence for ciprofloxacin to indicate a poor response in systemic infections caused by Salmonella spp with low-level fluoroquinolone resistance (MIC>0.064 mg/l). Martti Vaara 2013 25
Salmonella spp 2012, susceptibility to ciprofloxacin HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate), n = 445 EUCAST 2011 Salmonella - there is clinical evidence for ciprofloxacin to indicate a poor response in systemic infections caused by Salmonella spp with low-level fluoroquinolone resistance (MIC>0.064 mg/l). Martti Vaara 2013 26
Salmonella ESBL, HUSLAB material 2011 2012* Proportion (%) 2011 2,6 2012 1,9 *Number of strains studied (one per patient): 2011 389 2012 432 Martti Vaara 2013 27
Shigella spp. 2012 (%R+I) HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate) n = 37 Ampicillin 30 Ceftriaxone* 0 Ciprofloxacin 49 Sulphatrimetoprim 95 Doxycycline 81 Martti Vaara 2013 28
H. influenzae & M. catarrhalis 2012 (%R+I) HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate). H. influenzae M. catarrh. Ampicillin 19 100 Amoxycill-clavul. 1 0 Cefuroxime 3 0 Doxycycline 2 2 Ciprofloxacin 0 1 Sulphameth-trim. 28 5 Azithromycin 97 10 n 679 359 * According to EUCAST breakpoints, the susceptibility of most isolates should be interpreted as I. Martti Vaara 2013 29
Neisseria gonorrhoeae, resistance to ciprofloxacin 2001-2011 HUSLAB material from Helsinki and Uusimaa Districts (2012, n = 80) % R+I 90 80 70 60 % R+I 50 40 30 20 10 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Martti Vaara 2013 30
Neisseria gonorrhoeae, MIC of ceftriaxone 2012 HUSLAB material from Helsinki and Uusimaa Districts (n = 80) Martti Vaara 2013 31
Neisseria gonorrhoeae, MIC of azithromycin 2012 HUSLAB material from Helsinki and Uusimaa Districts (n = 80) I+R = 14% Martti Vaara 2013 32
Neisseria meningitidis 2010-2012 (%R+I) HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate) Penicillin-I 11 Penicillin-R 3 Ceftriaxone 0 Meropenem 0 Ciprofloxacin 0 Chloramphenicol 0 n 38 Martti Vaara 2013 33
Bacteroides fragilis group 2012 (%R+I) HUSLAB material from Helsinki and Uusimaa Districts. One isolate per patient (the first isolate) n = 1031 Metronidazole 0 Piperacillin-tazobactam 1 Imipenem 1 Clindamycin 42 Doxycycline 21 Penicillin G 100 Martti Vaara 2013 34