Antibiotic resistance in bacteria from outpatients

Transcription

1 Antibiotic resistance in bacteria from outpatients In France Vincent Jarlier Bacteriology-Hygiene Pitié-Salpêtrière hospital, Paris ONERBA : non profit organization supported by AFSSAPS (French drug agency)

2 Antibiotic consumption in the community winter months, per age classes France Courtesy D. Guillemot - 23 % overall - 34 % 0-5 years - 35 % 6-15 years - 18 % >15 years

3 Antibiotic consumption in the community winter months, per ATB classes France % penicillins - 23 % overall Courtesy D. Guillemot - 26% cephalosp - 32 % macrolides + 14 % quinolones

4 What about resistance rates? Good news and Bad news!

5 Good news

6 Streptococcus pneumoniae and penicillin, erythromycin

7 % Penicillin non susceptible S. pneumoniae Courtesy E. Varon % PNSP in France strains 0,5 0, National plan for rational use of antibiotics PCV : GEEP - P. Geslin ; : ORP - E. Varon, L. Gutmann CNRP, Annual report 2007

8 Courtesy E. Varon Children 15 years S. pneumoniae : evolution of antibiotic resistance in France % 70% 60% 50% 40% 30% 20% 10% 51% 32% 31% 2001 (n=419) 2002 (n=299) 2003 (n=499) 2004 (n=324) 2005 (n=482) 2006 (n=333) 15% 18% 4% 51% 38% Adults > 15 years 0% 80% 70% 60% 50% 40% 30% 20% 10% penicillin amox cefotaxime 45% Pénicilline Amoxicilline Céfotaxime Erythromycine 35% 28% 2001 (n=1041) 2002 (n=892) 2003 (n=893) 2004 (n=441) 2005 (n=755) 2006 (n=523) 16% 14% 4% 48% erythromycin 38% 0% Pénicilline Amoxicilline Céfotaxime Erythromycine Courtesy ORP - E. Varon, L. Gutmann ; CNRPreport 2007

9 Streptococcus pyogenes (StrepA) and erythromycin

10 100 Decrease of erythromycin susceptibility in Streptococcus pyogenes France % % Networks : Aforcopi-Bio Armées Col-BVH Ile de France Réussir Azay years 75 %

11 % of erythromycin susceptibility in Streptococcus pyogenes 12 years survey in France Courtesy H. Chardon Network REUSSIR 500 to 700 strains / year 88 % in % in % in

12 Staphylococcus aureus in community acquired bacteremias

13 Susceptibility to non β-lactams in MSSA isolated from CA bacteremias (standard definition) Network Ile -de-france (~ 100 cases /year) % susceptible % 85% 92% Erythromycin Rifampicin Fusidic a. Fquinolones Gentamicin Courtesy Y. Péan

14 Staphylococcus aureus in community acquired Skin soft tissue infections

15 % susceptibility in MSSA causing CA SSTIs Network Col-BVH 2006 prospective study (285 cases) Erythromycin Rifampicine Fusidic acid Tetracyclines Gentamicin F.quinolones Courtesy JW Decousser

16 CA MRSA producing PVL toxin in the community

17 MRSA PVL : retrospective study ONERBA MRSA PVL pattern 21 (0.8%) 17 (0.8%) 9 (0,7%) Available strains PVL strains Robert CMI 2005

18 MRSA PVL : prospective study ONERBA 2004 Total inpatients outpatients N % N % N % MRSA PVL pattern 56 (1.4) 55 (1.7)* 1 (0.1) PVL strains 48* 47 1 * 6 strains not tested National extrapolation : 1.7% x MRSA cases /year >> ~ 1000 cases MRSA PVL cases/year Robert 2008 submitted

19 Resistant tuberculosis

20 Cases of MDR and XDR tuberculosis in France MDR : 40 to 70 / year (1% of TBs) XDR : 1 to 2 / year (0,02% of TBs) Robert and Kanitz, National Reference Center for TB

21 Curbing MRSA in French hospitals : decreasing the risk of H-MRSA spread into the community

22 MRSA control Programme Univ. hospitals Paris area (AP-HP) 1993

23 Alcool based hand rub solutions campaign at AP-HP

24 Alcool based hand rub solutions Paris area hospitals (AP-HP) Liters per 1,000 days of hospitalisation <2 ml/dh campaign 21 ml/dh Years

25 % MRSA in S.aureus and MRSA incidence (per 100 admissions or 1,000 DHs) Univ. hospitals of Paris area (n=39) % decrease in 15 years V. Jarlier, D. Trystram, AP-HP 2008

26 MRSA control national programme 1999

27 % MRSA in S. aureus from bacteremias in 3 French networks participating in EARSS (19 Univ Hosp, 9 GH Paris area, 25 GH all country) % Global decrease 21 % 26 % Networks : Azay, Ile de France, REUSSIR

28 1 MRSA rates per 1,000 DHs 227 French hospitals Networks C-CLIN - RAISIN , Geographic areas 0,8 0,6 0,4 0,2 0 Global decrease 25 % Paris North East West S-East S-west Total National extrapolation : still 50,000 MRSA cases / year!!

29 VRE control in univ.hospitals of Paris area : decreasing the risk of H-VRE spread into the community

30 VRE cases per month university hospitals, Paris area (AP-HP) Classical MDR measure ( ) Reinforced measures ( ) Nombre Date Nouveaux cas Infection Founier 2008 BEH

31 Bad news

32 Escherichia coli and fluoroquinolones in bactereriemas

33 100 Susceptibility of E.coli to major drugs in CA bacteremias (standard definition) Network Ile-de-France (~ 500 cases /year) % cefotaxime gentamicin % ciprofloxacin Courtesy Y. Péan

34 ESBL enterobacteria

35 1,4 1,2 1 0,8 0,6 0,4 0,2 ESBL incidence rates per 1,000 DHs 227 French hospitals Networks C.CLIN - RAISIN Medical activities Rate x 2 to 3 in 4 years Acute ICU LCF TOTAL

36 0,6 ESBL incidence rates per 1,000 DHs 227 French hospitals Networks C.CLIN - RAISIN Geographic areas 0,5 0,4 0,3 0,2 0,1 Rate x 2 to 8 in 4 years Paris North East West S. East S. West Now : 1 case of ESBL for 2 cases of MRSA

37 ESBL Escherichia coli

38 Proportion of E.coli among ESBL enterobacteria 227 French hospitals Networks C.CLIN - RAISIN % E.coli Geographic areas Paris North East West S. East S. West

39 Incidence rate of ESBL E.coli per 1,000 DHs 227 French hospitals Networks C.CLIN - RAISIN Geographic areas 0,3 0,25 0,2 0,15 0,1 0,05 0 Incidence rate x 2 to 10 in 4 years Paris North East West S. East S. West Now : 1 case of ESBL E.coli for 4 cases of MRSA

40 Rate of incidence (per 1,000DHs) of different species of ESBL enterobacteria Univ. hospitals of Paris area densité d'incidence (1000jh) 0,30 0,25 0,20 0,15 0,10 0,05 0,00 incidence E.coli BLSE incidence K.pneumoniae BLSE incidence E.cloacae BLSE incidence autres entérobact. BLSE E.coli K.pneumoniae année

41 % susceptibility to cefotaxime in E.coli bacteremias in France % susceptible % (EARSS) Networks : Azay Ile de France National extrapolation : 1,500 ESBL E.coli bacteremias /year 96 % Réussir TOTAL

42 Susceptibility of E.coli to cefotaxime in CA and HA bacteremias (standard def.) Network Ile-de-France (~ 600 cases /year) National extrapolation : 1,000 HA and 500 CA ESBL E. coli bacteremias /year Cefotax CA Cefotax HA Courtesy Y. Péan

43 ESBL enterobacteria in outpatients Prospective study ONERBA labs for GPs 2 months 6,771 strains included 72 ESBL ESBL global proportion 1% 10/72 patients : no previous hospitalisation nor medical care at home P.mir K.pneu others E. coli

44 Controlling antibiotic resistance in the community Decrease ATB consumption Vaccinations ATB resistance community

45 Controlling antibiotic resistance in the community Decrease ATB consumption Vaccinations ATB resistance community MRSA, VRE ESBL ATB resistance hospital Prevent cross transmission

46 Controlling antibiotic resistance in the community Decrease ATB consumption Vaccinations ATB resistance community Vaccinations MRSA, VRE ESBL Decrease ATB consumption ATB resistance hospital Prevent cross transmission

47 Controlling antibiotic resistance in the community Decrease ATB consumption Vaccinations ATB resistance community Vaccinations MRSA, VRE ESBL Decrease ATB consumption ATB resistance hospital Prevent cross transmission in schools, families (ABHRSs) Prevent cross transmission

48 Antibiotic policy campaign at AP-HP Thank you..