EARSS in Ireland, Results of invasive Streptococcus pneumoniae infection (blood/csf) surveillance

Transcription

1 EARSS in Ireland, 2007 Results of invasive Streptococcus pneumoniae infection (blood/csf) surveillance

2 Antibiotic codes and abbreviations: CTX, Ciprofloxacin ERY, Erythromycin OXA, Oxacillin TCY, Tetracycline CRO, Ceftriaxone NOR, Norfloxacin PEN, Penicillin VAN, Vancomycin SPN, Streptococcus pneumoniae PNSP, Penicillin-Non-Susceptible S. pneumoniae PSSP, Penicillin-Susceptible S. pneumoniae PEN-HLR, Penicillin High-level Resistant (MIC, 2mg/L) PEN-I, Penicillin Intermediate Resistant (MIC, 0.1-1mg/L)

3 EARSS S. pneumoniae: Objective and case definition Objective: To determine the proportions of S. pneumoniae isolates from blood or CSF that are resistant to penicillin (includes both intermediate and high-level resistance) and erythromycin Case definition: EARSS collects data on the first invasive isolate (from blood or CSF) of S. pneumoniae per patient per quarter

4 Caveats in interpreting EARSS data Care must be exercised when interpreting the raw figures, i.e. increases in numbers of isolates, as the numbers of laboratories reporting to EARSS has increased over the years EARSS data does not distinguish clinically significant isolates from contaminants

5 Annual proportions of invasive PNSP (bacteraemia/meningitis) with 95% Confidence Intervals (CI),

6 EARSS in Ireland: Invasive S. pneumoniae infection trends in PNSP, Number of laboratories participating by year-end indicated above the bars

7 EARSS in Ireland: Invasive S. pneumoniae infection trends in PNSP, % 25% Number of isolates Year Total S.pneumoniae PNSP %PNSP %Pen HLR %Pen I 20% 15% 10% 5% 0% %PNSP Number of laboratories participating by year-end indicated above the bars

8 Rates of invasive S. pneumoniae infection (or IPD),

9 EARSS in Ireland: Invasive S. pneumoniae infection trends in erythromycin resistance, Number of laboratories participating by year-end indicated above the bars

10 Age distribution of patients with invasive PNSP and PSP infection in Number of isolates Age Group PNSP PSP

11 Age-specific incidence rates of invasive PNSP and PSP infection in 2007 ASIR, Age-Specific Incidence Rate (per 100,000 population)

12 Age and sex distribution of patients with invasive PNSP infection in 2007

13 Age and sex-specific incidence rates of invasive PNSP infection in 2007 ASIR, Age-Specific Incidence Rate (per 100,000 population)

14 Age and sex distribution of patients with invasive PSP bacteraemia in 2007

15 Age and sex-specific incidence rates of invasive PSP bacteraemia in 2007 ASIR, Age-Specific Incidence Rate (per 100,000 population)

16 Age-specific incidence rates* of IPD in 2007 * Using age groups from UK study by Gungabissoon et al (2005) ASIR, Age-Specific Incidence Rate (per 100,000 population)

17 Mean, median, mode and range of ages of patients with invasive S. pneumoniae (PNSP and PSP) infection in 2007

18 Sex distribution of patients with invasive S. pneumoniae (PNSP and PSP) infection in 2007 In patients with laboratory-confirmed invasive S. pneumoniae infection in 2007, males were approximately 1.25-times more likely to get an infection (1.6-times for PNSP; 1.2-times for PSP) than females. Although these findings were significant (P=0.016) for S. pneumoniae overall (SPN), they were at best approaching borderline significance for PNSP and PSP

19 Susceptibility data for invasive S. pneumoniae isolates reported in 2007

20 Resistance profiles of S. pneumoniae isolates in 2007 Of the 76 of 438 pneumococcal isolates that were identified as PNSP: 48 were Pen-I (11.0%) 25 were Pen-R (5.7%) 3 were Pen-NS (0.7%) Of isolates tested against both Pen and Ery (n=403), 32, or 7.9%, were nonsusceptible to both

21 Trends in co-resistance to penicillin and erythromycin among invasive S. pneumoniae isolates,

22 Pneumococcal serotyping project 7-valent pneumococcal conjugate vaccine (PCV7) to be introduced to childhood immunisation schedule Sept 2008 Collaborative initiative between RCSI/Beaumont, Children s University Hospital, Temple St and HPSC National pilot project commenced 1 st April 2007 Aim: to provide baseline serotyping data on invasive S. pneumoniae isolates prior to PCV7 introduction. Serotype data were available on 219* pneumococcal isolates from 26 laboratories (of 33 that reported pneumococcal isolates to EARSS in 2007) Representing 81% of all pneumococcal isolates reported to EARSS, Q Overall for 2007, data on 238 pneumococcal isolates representing 70% of total * Data provided by The Pneumococcal Typing Project, a joint collaboration between RCSI/Beaumont, The Children s University Hospital, Temple St and HPSC

23 Pneumococcal serotype data in * 4* 19A* 9V* 7F* 23F* 6B* 1* 3* 18C* 19F* 6A 22F* 8* 33F* 12F* 20* 9N* 11A* 16F 17F* * 7C 10A* 15A 15C 18B 21 23A 23B 28A B 36 serogroup 7 serogroup 28 Number of isolates Serotype/serogroup PEN HLR PEN I PEN S * Serotypes included in PPV23; serotypes in PCV7

24 Pneumococcal serotype data and coverage by vaccines: All isolates (PSSP and PNSP) PCV7 recommended for children <2 years (=target population); PPV23 recommended for adults 65 years and other at risk groups but not children <2 years PCV7 to be introduced into routine childhood vaccination schedule in Ireland in September 2008 PCV7, 7-valent Pneumococcal Conjugate Vaccine; PPV23, 23-valent Pneumococcal Polysaccharide Vaccine

25 Pneumococcal serotype data and coverage by vaccines: PNSP isolates only PCV7 recommended for children <2 years (=target population); PPV23 recommended for adults 65 years and other at risk groups but not children <2 years PCV7 to be introduced into routine childhood vaccination schedule in Ireland in September 2008 PCV7, 7-valent Pneumococcal Conjugate Vaccine; PPV23, 23-valent Pneumococcal Polysaccharide Vaccine

26 PNSP isolates: data by serotype and age * Serotypes 9V, 14, 6B, 14 and 23F are covered by both PCV7 and PPV23; ** serotypes 8, 19A and 22F are covered by PPV23 only

27 Distribution of PNSP in EARSS countries in 2007 Map downloaded from on 26/08/08

28 Distribution of PNSP in EARSS countries in 2006 Map downloaded from on 22/08/07

29 Distribution of penicillin-hlr in EARSS countries in 2007 HLR, high-level resistant (MIC to pencillin 2mg/L) Map downloaded from on 26/08/08

30 Distribution of penicillin-hlr in EARSS countries in 2006 HLR, high-level resistant (MIC to pencillin 2mg/L) Map downloaded from on 24/09/08

31 Distribution of erythromycin resistance in EARSS countries in 2007 Map downloaded from on 26/08/08

32 Distribution of erythromycin resistance in EARSS countries in 2006 Map downloaded from on 22/08/07

33 Distribution of penicillin (PNSP) and erythromycin co-resistance in S. pneumoniae in EARSS countries in 2006 Map downloaded from on 26/08/08

34 Distribution of penicillin (PNSP) and erythromycin co-resistance in S. pneumoniae in EARSS countries in 2006 Map downloaded from on 22/08/07

35 Distribution of pen-hlr + eryth co-resistance in S. pneumoniae EARSS countries in 2007 Map downloaded from on 26/08/08

36 Distribution of pen-hlr + eryth co-resistance in S. pneumoniae EARSS countries in 2006 Map downloaded from on 22/08/07