Preparing for the EARS-Net 2015
data call
Liselotte Diaz Högberg, Expert, Surveillance and Response Unit
European Centre for Disease Prevention and Control

1
• Results from 2014 EARS-Net data call
• Preparing for the EARS-Net 2015 data call:
- timeline and outputs
• The future of Acinetobacter spp surveillance
• Improving comparability of S. pneumoniae data

2
0
1
2
3
4
5
6
7
8
9
10
14-20
April
21-27
April
28 April -
4 May
5 -11
May
12-18
May
19-25
May
26 May-1
June
2-8 June 9-15
June
16-22
June
23-29
June
30 June -
6 July
7-13 July
Numberofreportingcountries
Overview of data call 2014
Active data call
Deadline
Cumulative number of reporting countries
2 3 4 5 6 12 19 28 30

3
Percentage isolates per pathogen, 2013
Data from EARS-Net
E. faecium
4%
E. facealis
7%
S. pneumoniae
7%
S. aureus
22%
Acinetobacter spp
2%
P. aeruginosa
6%
K. pneumoniae
10%
E. coli
42%

4
Number of reported isolates per pathogen.
By country, 2013
Data from EARS-Net
0
5000
10000
15000
20000
25000
FR SE UK DE ES IT NL AT BE DK PT CZ FI NO EL HU IE PL SK HR SI RO LT BG EE LU LV CY MT IS
E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp
S. aureus
S. pneumoniae
E. facealis
E. faecium

5
2014 data call in summary:
Reporting completeness
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age Gender Patient type Hospital unit type Date hosp
Data from EARS-Net

6
2014 data call in summary:
Reporting completeness
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age Gender Patient type Hospital unit type Date hosp
Mean 66.1 years
Median 71 years
Female 44.9%
Male 55.1%
Inpatients 86.5%
Outpatients 13.5%

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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
E. coli K. pneumoniae P. aeruginosa Acinetobacter
spp
S. aureus S. pneumoniae Enterococcus
PEDSICU
PEDS
URO
INFECT
OBGYN
ONCOL
SURG
INTMED
ED
ICU
2014 data call in summary:
Hospital unit type, by pathogen

8
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
E. coli K. pneumoniae P. aeruginosa Acinetobacter
spp
S. aureus S. pneumoniae Enterococcus
No info
Zone diameter
E-test
Mic
2014 data call in summary:
Quantitative susceptibility data, by pathogen

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Data call
Data
analysis,
report draft
Internal
ECDC
approval
MS report
approval
Re-analysis
Final ECDC
approval
Editing and
layout
Timeline 2015: from data call to finalised
report
1st
MS data
approval
2nd
MS report
approval
•Non-negotiable deadline: European Antibiotic Awareness Day on
November 18
• Two separate MS approval processes: during data call and the report
approval
TESSy
approval
Deadline 1
July
SeptemberAugust October

Data call outputs 2015
EARS-Net annual report
• online version with country summary sheets
• printed version without country sheets (tbc)
Summary for EAAD briefing kit
EARS-Net on-line database
• maps
• tables
• trend graphs
Published
18
November!

New design for
tables and trend
analysis results

Background data for all tables and graphs
can be downloaded from the ECDC website

Acinetobacter spp pilot
surveillance in EARS-Net
– experience and way forward

Background
• Concern for increasing AMR problem in Acinetobacter
raised at the Joint ARHAI Annual Meeting in Warsaw,
2010
• Survey sent out late 2010 to assess feasibility for
surveillance
• Agreed to include as 2-year pilot at 2nd network
meeting in 2011
• Data collection completed 2013 and 2014 - time for
evaluation
Acinetobacter spp surveillance in EARS-Net

EARS-Net 2010 Acinetobacter Survey
summary
• High participation in the survey: response received from 29/30 countries
• Acinetobacter was already included in national AMR surveillance in more than
half of the countries, but blood stream isolates constitute a small proportion
(<5%) of all isolates in most cases
• A relatively high number of antimicrobials were included in AST panels in more
than half of the countries having AST results for Acinetobacter
• Multidrug resistance in Acinetobacter was assessed in >50% of blood stream
isolates in 1/4 of the countries
• The importance of Acinetobacter was perceived as “significant “ by 1/3 of the
countries, while 1/3 considered Acinetobacter as being of “minor” importance
• 80% of the countries would like Acinetobacter included in EARS-Net
Acinetobacter spp surveillance in EARS-Net

EARS-Net Coordination Group advice
regarding feasibility of Acinetobacter
surveillance (February 2012)
• Number of isolates will be very low for some countries (blood
isolates only)
• Challenges of species identification and susceptibility testing to be
carefully considered – only include at spp level
• Limit the antimicrobial groups under surveillance
• Acinetobacter data collected in the HAI-PSS should be reviewed to
validate EARS-Net results
Acinetobacter spp surveillance in EARS-Net

Acinetobacter spp: Number of reporting
countries (green), 2012 and 2013
2012 2013
Acinetobacter spp surveillance in EARS-Net
18 countries 27 countries

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Frequency of Acinetobacter spp. as percentage of all
bacteria reported to EARS-Net, by country (n:4120),
2013
No data
<1%
1-<2 %
2-<4 %
4-<6 %
6-<8 %
>8 %
Acinetobacter spp surveillance in EARS-Net

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Relative frequency of Acinetobacter spp. as a
percentage of all microorganisms reported
for HAIs, by country (n=366 isolates), ECDC PPS
2011–2012
* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania and very poor in Denmark and Sweden. See table 18 for
total number of microorganisms by country.

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Relative frequency of Acinetobacter spp. as a
percentage of all microorganisms reported
for HAIs, by country (n=366 isolates), ECDC PPS
2011–2012
* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania and very poor in Denmark and Sweden. See table 18 for
total number of microorganisms by country.
EARS-Net

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Acinetobacter spp. Percentage (%) of invasive isolates with
resistance to carbapenems, by country, EU/EEA, 2013

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Percentage of Acinetobacter baumannii isolates non-
susceptible to carbapenems in HAIs in acute care
hospitals, ECDC PPS 2011-2012
ECDC PPS
* PPS data representativeness was poor in Austria, Croatia, Czech Republic, Estonia, Norway and Romania
and very poor in Denmark and Sweden. See table 18 for total number of microorganisms by country.

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Percentage of Acinetobacter baumannii isolates non-
susceptible to carbapenems in HAIs in acute care
hospitals, ECDC PPS 2011-2012
ECDC PPS
EARS-Net

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Occurrence of carbapenem-resistant Acinetobacter baumannii (CRAb)
(all types of isolates) based on self-assessment by national experts,
EuSCAPE project, 38 European countries, March 2013
The stage designations for CRAb should be taken with caution for all 38 participating countries. Most national experts highlighted that the exact
epidemiology of CRAb remains uncertain in their country, because at the time of the survey surveillance and reporting of CRAb are not

25
Occurrence of carbapenem-resistant Acinetobacter baumannii (CRAb)
(all types of isolates) based on self-assessment by national experts,
EuSCAPE project, 38 European countries, March 2013
The stage designations for CRAb should be taken with caution for all 38 participating countries. Most national experts highlighted that the exact
epidemiology of CRAb remains uncertain in their country, because at the time of the survey surveillance and reporting of CRAb are not
EARS-Net

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Summary: Reporting capacity
• Number of reporting countries increased from 18 in 2013 to
27 in 2014
• Most isolates had susceptibility information on all three
antimicrobial groups under regular surveillance
• Number of reported isolates were in most cases equal to or
higher than estimated in 2011
• Number of reported isolates increased in most countries
between 2013 and 2014
• Proportion Acinetobacter spp isolates varied between
countries, and was especially high in south-eastern
countries
• Frequency of Acinetobacter spp is similar as reported from
ECDC PPS

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Summary: Resistance situation
• Large variations in antimicrobial resistance of Acinetobacter
spp. isolates in Europe were reported, with generally higher
resistance percentages reported from countries in the south
of Europe than in the north.
• Carbapenem resistance was common, and in most cases
combined with resistance to fluoroquinolones and
aminoglycosides.
• Results are difficult to compare between EARS-Net and PPS
and EuSCAPE, but shows a similar geographical gradient

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Suggested way forward:
• Keep surveillance of Acinetobacter spp in
EARS-Net in current format:
• Reporting on genus level (i.e.,
Acinetobacter spp)
• Panel of antimicrobials: fluoroquinolones,
aminoglycosides, carbapenems and
polymyxins

Presenting penicillin susceptibility
data in S. pneumoniae
- improving comparability

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The problem
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• S. pneumoniae breakpoints for
penicillin susceptibility differ
depending on clinical guidelines
used and site of infection.
• The use of clinical breakpoints
differ between countries. Many
countries are now changing fro
use of CLSI to EUCAST.

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Penicillin susceptibility in S. pneumoniae:
Use of clinical breakpoints for 2012 data
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EUCAST non-menigitis
14%
EUCAST depending on
site of infection
40%
CLSI meningitis
13%
CLSI depending on site
of infection
13%
CLSI oral
13%
Mix
7%
Number of respondents: 14/29 countries

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Use of clinical guidelines, by year, 2008-2013
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012 2013
CLSI
EUCAST+

33

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Penicillin susceptibility in S. pneumoniae:
Reporting of quantitative information (2013)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AT BE BG CY CZ DE DK EE EL FI FR HR HU IE IS ES LT LU LV MT NL NO PL PT RO SE SI SK UK
No info
Zone diam results %
MIC result%
Gradient strip result %

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Suggested way forward
Present data according to fixed
breakpoints:
MIC S <= 0.06 mg/L (R>2 mg/L)
Limit results to non-susceptible (better harmonisation
between breakpoints)?
How to achieve this?
1. MS adjust their SIR interpretation before data upload
- If not possible, countries can still report data but need to inform
ECDC that the set breakpoints are not used
2. ECDC analyse according to reported quantitative data
- Reporting of quantitative data must increase to make this
meaningful