Enhanced EARS-Net Surveillance 2017 First Half

Transcription

1 1 Enhanced EARS-Net Surveillance 2017 First Half In this report Main results for 2017, first half Breakdown of factors by organism and resistance subtype Device-association Data quality assessment Key Points Sixteen microbiology laboratories provided enhanced data on 1,378 bloodculture isolates, representing 43% of all isolates reported to EARS-Net in Ireland in the first half of This is the same proportion as recorded for However, fewer laboratories contributed to the data compared to 2016 (n=21) reflecting a greater level of participation from larger hospitals and a decreased level from smaller hospitals for the first half of 2017 Factors related to Staphylococcus aureus bloodstream infections (BSI) such as demographics, length of stay, healthcare-association and primary source for the first half of 2017 remained in line with previous years. However, a higher proportion of Meticillin Resistant S. aureus (MRSA) BSI were acquired in the reporting hospital for the first half of 2017 (62%) compared to 2016 (54%), and there was a corresponding increase in the proportion of MRSA BSI detected five days after admission from 29% in 2016 to 47% in the first half of 2017 In the first half of 2017, 16% of S. aureus, 7% of enterococci, 5% of Escherichia coli, 1 of Klebsiella pneumoniae and 11% of Pseudomonas aeruginosa were reported as device-associated BSI. Overall deviceassociation was 8% for these organisms. The overall proportion of deviceassociated BSI decreased over the first two quarters of 2017 and the last quarter of 2016 Data quality has improved since 2014 overall and data consistency for the first half of 2017 was similar to 2016 From the HPSC website click on Topics A-Z, then on Enhanced Bacteraemia Surveillance for the appropriate page. Also visit the HPSC website for information on Antibiotic Resistance, and integrated reports on hospital Antibiotic Consumption and Hand Hygiene Introduction Enhanced data have been collected on European Antimicrobial Resistance Surveillance Network (EARS-Net) isolates since 2004 in Ireland. The enhanced programme aims to guide local and national preventative strategies for antimicrobial resistant infections. Enhanced data demonstrates trends in the association of infection with specific factors over time: community or healthcare-associated, potentially preventable sources of bloodstream infection (e.g., intravenous catheters and urinary catheters). The ultimate aim is to improve overall patient safety. In addition to the general analysis, this report includes a breakdown of bloodstream infections (BSI) that were categorised as device-associated. January 2018 On behalf of the Irish EARS-Net Steering Group with thanks to all the participating hospital-laboratories HSE Health Protection Surveillance Centre, Middle Gardiner Street, Dublin D01 A4A3, Ireland via Twitter

2 Results 2 Data from 16 laboratories were available. Enhanced data records collected for the first half of 2017 (n = 1,378) represented 43% of all the isolates of the core EARS-Net dataset for the same time period. Table 1. EARS-Net pathogen, antimicrobial resistance markers, patient age, gender and timing of BSI onset Total for 2017 Percent female Mean age in years Detected <48 hours after admission Detected >5 days after admission Staphylococcus aureus % % 25% Meticillin Resistant (MRSA) 58 (17%) 29% % 47% Meticillin Susceptible (MSSA) % % 21% Streptococcus pneumoniae 91 54% % 3% Penicillin non-susceptible 14 (15%) 57% % 21% Penicillin Susceptible 77 53% Enterococci % % 51% Vancomycin Resistant (VRE) 26 (17%) 38% % 69% Vancomycin Sensitive (VSE) % % 48% Escherichia coli % % 21% Fluoroquinolone Resistant (FQREC) Fluoroquinolone Susceptible (FQSEC) 178 (27%) 46% % 24% % % 2 Klebsiella pneumoniae 82 44% % Pseudomonas aeruginosa 63 33% % 49% Main findings Please see Appendix 1 for a complete breakdown for all organisms. See also table 2 for breakdown by device type. See page 1 for abbreviations. 1. S. aureus (Appendix 1A) Of 342 S. aureus BSI reported to enhanced EARS-Net surveillance in the first half of 2017, 187 (55%) were categorised as healthcare-associated, and 169 (49%) were categorised as likely acquired in the reporting hospital. A higher percentage of healthcare-associated MRSA (62%) than MSSA (47%) BSI was classified as likely acquired in the reporting hospital. The proportion of S. aureus BSI noted as acquired greater than five days has remained stable and was 55% for the first half of 2017 The most common reported primary source for both MRSA (22%) and MSSA (24%) BSI was non-surgical wound (skin and soft tissue infection) 2. Pneumococcal BSI (Appendix 1B) Enhanced surveillance for Streptococcus pneumoniae BSI has been discontinued, however, the data for 2017 and previous years are presented in appendix 1B Further information on Invasive Pneumococcal Disease can be found on the HPSC website: 3. Enterococcal BSI (Appendix 1C) Of 152 enterococcal BSI reported to enhanced EARS-Net surveillance in the first half of 2017 (Enterococcus faecium = 85, E. faecalis = 67), 106 (7) were categorised as healthcare-associated. Of these, 102 (67%) were categorised as likely acquired in the reporting hospital. A higher percentage of healthcare-associated VRE (88%) than VSE (63%) BSI was classified as likely acquired in the reporting hospital

3 3 4. E. coli BSI (Appendix 1D) Of 648 E. coli BSI reported to enhanced EARS-Net surveillance in the first half of 2017, 266 (41%) were categorised as healthcare-associated. Of these, 222 (34%) were categorised as likely acquired in the reporting hospital. A slightly higher percentage of healthcare-associated fluoroquinolone resistant E. coli (39%) than fluoroquinolone susceptible (32%) BSI was classified as likely acquired in the reporting hospital The most common reported primary source for E. coli BSI was the urinary tract 43% (46% of FQREC and 42% of FQSEC) 5. K. pneumoniae BSI (Appendix 1E) Of 82 K. pneumoniae BSI reported to enhanced EARS-Net surveillance in the first half of 2017, 45 (55%) were categorised as healthcare-associated. Of these, 39 (48%) were categorised as likely acquired in the reporting hospital. Devices accounted for 1 of K. pneumoniae BSI 6. P. aeruginosa BSI (Appendix 1F) Of 63 P. aeruginosa BSI reported to enhanced EARS-Net surveillance in the first half of 2017, 47 (75%) were categorised as healthcare-associated. Of those, 44 (7) were categorised as likely acquired in the reporting hospital. Devices accounted for 11% of P. aeruginosa BSI Further information on EARS-Net can be found on the HPSC website: Device-association The enhanced EARS-Net surveillance protocol defines device-associated BSI as a case of intra-vascular line and other indwelling medical devices where the isolate is clinically significant AND the device has been present within 48 hours of detection of the organism from blood culture AND where the organism is not related to an infection at another site. The proportion of device-associated BSI has decreased over the first two quarters of 2017 and the last quarter of The downward trend in the latest quarters remained when the proportion was expressed as number of deviceassociated BSI over all BSI where the Device/Implant/Procedure association status was known (see table 2 and figure 1 and 2). Table 2. Breakdown of bloodstream infections that were noted as device, implant or procedure-associated along with number of BSI records that were noted as not Device/Implnt/Proc associated and those records were with the Device/Implnt/Proc association was unknown. Also shown are the percentage of BSI that were device-associated over all records where the association was known and the percentage of device-associated over all records. Device Implant Procedure None Unknown Total Known % Device of all known All records % Device of all records 2014 Q % % 2014 Q % % 2014 Q % % 2014 Q % % 2015 Q % % 2015 Q % % 2015 Q % % 2015 Q % % 2016 Q % % 2016 Q % % 2016 Q % % 2016 Q % % 2017 Q % 639 9% 2017 Q % 648 8%

4 4 CVC / CVC- PICC Figure 2. Graph showing association with device, implant or procedure by quarter. Also shown are the percentage of BSI that were device-associated over all records where the association was known and the percentage of device- associated over all records. In the first half of 2017, 16% of S. aureus, 7% of enterococci, 5% of E. coli, 1 of K.. pneumoniae and 11% of P. aeruginosa were reported as device-associated BSI. Overalll device-association was 8% of records for these organisms. Table 3. Breakdown of bloodstream infections that were noted as device-associated withh details of device type. Staphylococcus aureus Total for Total Number Device-Associated (%) 55 (16%) 4% PVC Dialysis Catheter Urinary Catheter Other 6% 3% 2% 1% Meticillin Resistant (MRSA) 58 6 (1) 2% 2% 5% 2% Meticillin Susceptible (MSSA) (17%) 5% 7% 4% 1% 1% Enterococci (7%) 3% 1% 2% Vancomycin Resistant (VRE) 26 0 () Vancomycin Sensitive (VSE) (8%) 4% 2% 2% Escherichia coli (4%) 4% Fluoroquinolone Resistant (FQREC) Fluoroquinolone Susceptible (FQSEC) (5%) 18 (4%) 4% 1% 3% Klebsiella pneumoniae 82 8 (1) 5% 5% Pseudomonas aeruginosa 63 7 (11%) 3% 8% CVC: : Central venous catheter; PICC: peripherally inserted central catheter; PVC: Peripheral venous catheter

5 Appendix 1A. Breakdown for Staphylococcus aureus, MRSA Meticillin Resistant S. aureus and MSSA Meticillin Sensitive S. aureus S. aureus MRSA MSSA * * * Gender Female 37% 4 38% 34% 42% 36% 3 29% 36% 4 39% 35% Mean age in years Less than or equal to 2 days 61% 65% 67% 63% 58% 53% 64% 41% 62% 68% 68% 67% Greater than 5 days 26% 25% 22% 25% 32% 38% 29% 47% 25% 22% 21% 21% Community 34% 29% 39% 4 25% 24% 25% 21% 36% 3 41% 44% HCA: not in reporting hospital 7% 7% 6% 5% 13% 14% 1 14% 5% 5% 5% 4% HCA: in reporting hospital 5 47% 47% 49% 5 57% 54% 62% 5 45% 45% 47% Unknown 1 17% 9% 5% 13% 5% 1 3% 9% 2 9% 6% Association Device 27% 19% 21% 16% 19% 26% 24% 1 29% 17% 2 17% Implant 4% 3% 1% 3% 4% 4% 7% 4% 3% 1% 2% Procedure 3% 6% 3% 2% 2% 9% 2% 2% 4% 5% 4% 2% Device/Implnt/Proc Unkown 1 28% 31% 43% 12% 25% 32% 48% 1 28% 31% 42% Not Device/Implnt/Proc Assoc. 56% 45% 43% 36% 63% 36% 42% 33% 54% 47% 44% 37% Intra abdominal / GI tract 1% 1% 1% 1% 1% Respiratory tract 7% 7% 5% 8% 11% 8% 9% 1 6% 6% 4% 7% Surgical wound 2% 1% 2% Primary source Non surg. wound / Skin tisue 26% 25% 2 23% 22% 32% 25% 22% 27% 24% 2 24% Urinary tract without catheter 3% 2% 2% 3% 6% 5% 1% 5% 2% 2% 2% 2% Other source 19% 18% 13% 15% 18% 13% 6% 9% 2 19% 14% 16% Unknown 45% 46% 59% 5 44% 4 58% 53% 45% 47% 59% 49% Yes 25% 24% 18% 28% 27% 32% 2 24% 25% 22% 18% 29% Antibiotic Exposure No 6% 2% 7% 2% 6% 2% Unknown 69% 74% 82% 72% 66% 66% 8 76% 69% 76% 82% 71% Total Appendix 1B. Breakdown for Streptococcus pneumoniae, PNSP Penicillin non-susceptible S. pneumoniae and PSSP Penicillin Susceptible S. pneumoniae S. pneumoniae PNSP PSSP * * * Gender Female 52% 47% 48% 54% 52% 38% 28% 57% 51% 49% 51% 53% Mean age in years Less than or equal to 2 days 94% 95% 92% 97% 9 96% 89% 79% 95% 95% 92% 10 Greater than 5 days 2% 5% 6% 3% 5% 4% 6% 21% 2% 5% 6% Community 64% 56% 65% 76% 48% 42% % 6 67% 81% HCA: not in reporting hospital 2% 4% 7% 3% 5% 4% 17% 7% 1% 4% 5% 3% HCA: in reporting hospital 7% 5% 1 5% 19% 4% 22% 21% 5% 5% 9% 3% Unknown 28% 35% 18% 15% 29% 5 11% 21% 28% 31% 19% 14% Association Device 1% 1% 5% 1% Implant 1% Procedure 1% Device/Implnt/Proc Unkown 27% 52% 51% 63% 19% 75% 44% 64% 27% 47% 51% 62% Not Device/Implnt/Proc Assoc. 73% 48% 48% 37% 76% 25% 56% 36% 72% 53% 47% 38% Intra abdominal / GI tract Respiratory tract 54% 59% 56% 66% 57% 46% 67% 5 53% 62% 55% 69% Surgical wound Primary source Non surg. wound / Skin tisue 1% 5% Urinary tract without catheter 1% Other source 13% 11% 6% 1 1 8% 6% 7% 14% 12% 6% 1 Unknown 33% 3 37% 24% 29% 46% 28% 43% 33% 25% 39% 21% Yes 17% 7% 6% 11% 5% 4% 21% 2 8% 7% 9% Antibiotic Exposure No 9% 1% 19% 6% 7% 1% Unknown 73% 93% 93% 89% 76% 96% 94% 79% 73% 92% 92% 91% Total

6 Appendix 1C. Breakdown for Enterococci, VRE Vancomycin Resistant Enterococci and VSE Vancomycin Sensitive Enterococci Enterococci VRE VSE * * * Gender Female 44% 4 39% 37% 41% 36% 39% 38% 46% 41% 4 37% Mean age in years Less than or equal to 2 days 33% 35% 34% 45% 9% 16% 4% 27% 41% 43% 43% 48% Greater than 5 days 56% 55% 58% 51% 81% 75% 84% 69% 47% 47% 49% 48% Community 14% 12% 21% 2 3% 7% 4% 19% 16% 25% 24% HCA: not in reporting hospital 4% 4% 4% 3% 3% 3% 1% 4% 4% 5% 5% 2% HCA: in reporting hospital 7 71% 68% 67% 92% 93% 91% 88% 62% 62% 61% 63% Unknown 12% 13% 7% 1 5% 3% 4% 14% 17% 9% 11% Association Device 23% 16% 21% 7% 38% 24% 3 18% 13% 18% 8% Implant 1% 3% 1% 1% 3% Procedure 3% 2% 2% 2% 4% 1% 6% 4% 3% 2% 1% 2% Device/Implnt/Proc Unkown 28% 46% 42% 63% 21% 43% 27% 54% 31% 47% 48% 64% Not Device/Implnt/Proc Assoc. 45% 34% 34% 29% 36% 31% 37% 42% 48% 35% 33% 26% Intra abdominal / GI tract 13% 15% 1 13% 1 23% 13% 15% 13% 12% 8% 12% Respiratory tract 1% 2% 1% 1% 1% 3% 1% 2% 1% 1% Surgical wound 1% Primary source Non surg. wound / Skin tisue 4% 3% 4% 5% 5% 5% 6% 12% 4% 3% 3% 3% Urinary tract without catheter 7% 8% 1 7% 1% 4% 1 8% 9% 1 8% Other source 11% 18% 15% 17% 1 16% 15% 8% 11% 19% 15% 19% Unknown 65% 53% 61% 59% 72% 49% 55% 65% 63% 55% 62% 57% Yes 21% 15% 7% 11% 28% 2 1 8% 19% 13% 6% 12% Antibiotic Exposure No 5% 2% 1% 4% 1% 5% 3% 1% Unknown 74% 83% 93% 88% 68% 79% 9 92% 76% 84% 94% 87% Total Appendix 1D. Breakdown for Escherichia coli, FQREC Fluoroquinolone Resistant E. coli and FQSEC Fluoroquinolone Sensitive E. coli Escherichia coli FQREC FQSEC * * * Gender Female 54% 56% 54% 54% 45% 46% 47% 46% 57% 59% 56% 57% Mean age in years Less than or equal to 2 days 74% 77% 78% 76% 73% 76% 72% 74% 74% 78% 79% 76% Greater than 5 days 2 17% 18% 21% 22% 19% 21% 24% 19% 17% 17% 2 Community 39% 39% 52% 46% 31% 29% 41% 31% 42% 42% 56% 52% HCA: not in reporting hospital 6% 7% 8% 7% 12% 12% 14% 15% 4% 5% 6% 4% HCA: in reporting hospital 33% 3 29% 34% 39% 37% 36% 39% 31% 28% 27% 32% Unknown 22% 25% 1 13% 19% 22% 8% 14% 23% 26% 11% 12% Association Device 9% 7% 8% 4% 16% 11% 11% 5% 6% 6% 7% 4% Implant 1% Procedure 4% 3% 3% 3% 5% 5% 6% 5% 3% 2% 2% 2% Device/Implnt/Proc Unkown 19% 39% 37% 53% 19% % 19% 39% 39% 53% Not Device/Implnt/Proc Assoc. 68% 5 52% % 53% 37% 71% 53% 52% 42% Intra abdominal / GI tract 1 8% 5% 5% 6% 5% 3% 2% 11% 9% 5% 6% Respiratory tract 2% 2% 1% 3% 1% 3% 2% 4% 2% 1% 1% 3% Surgical wound Primary source Non surg. wound / Skin tisue 1% 1% 1% 1% 2% 1% 1% 1% Urinary tract without catheter 44% 43% 45% 43% 49% 49% 48% 46% 43% 41% 44% 42% Other source 11% 13% 12% 11% 1 11% 11% 13% 12% 13% 13% 11% Unknown 32% 34% 36% 36% 32% 3 36% 34% 32% 35% 36% 37% Yes 23% 8% 9% 15% 27% 12% 16% 19% 21% 6% 7% 14% Antibiotic Exposure No 6% 3% 4% 3% 6% 3% 1% Unknown 72% 89% 9 85% 69% 85% 84% 81% 72% 91% 92% 86% Total

7 Appendix 1E. Breakdown for KPN Klebsiella pneumonia KPN * Gender Female 44% 37% 38% 44% Mean age in years Less than or equal to 2 days 51% Greater than 5 days 36% 33% 33% 37% Community 23% 25% 35% 39% HCA: not in reporting hospital 6% 5% 7% 7% HCA: in reporting hospital 54% 52% 48% 48% Unknown 17% 18% 1 6% Association Device 19% 15% 15% 1 Implant 1% 1% 1% Procedure 1% 4% 2% Device/Implnt/Proc Unkown 15% 36% 4 57% Not Device/Implnt/Proc Assoc. 65% 44% 42% 33% Intra abdominal / GI tract 15% 12% 2% 6% Respiratory tract 6% 8% 8% 6% Surgical wound 1% Primary source Non surg. wound / Skin tisue 1% 2% 1% 1% Urinary tract without catheter 26% 22% 24% 32% Other source 18% 17% 18% 22% Unknown 35% 38% 47% 33% Yes 14% 6% 8% 2 Antibiotic Exposure No 4% 2% Unknown 82% 92% 92% 8 Total Appendix 1F. Breakdown for PAE Pseudomonas aeruginosa PAE * Gender Female 44% 41% 36% 33% Mean age in years Less than or equal to 2 days 68% 6 59% 48% Greater than 5 days 23% 35% 32% 49% Community 34% 13% 23% 14% HCA: not in reporting hospital 4% 6% 4% 5% HCA: in reporting hospital 39% 61% 59% 7 Unknown 23% 2 15% 11% Association Device 13% 22% 23% 11% Implant 1% Procedure 4% 4% 2% 3% Device/Implnt/Proc Unkown 21% 41% 38% 57% Not Device/Implnt/Proc Assoc. 62% 32% 36% 29% Intra abdominal / GI tract 13% 4% 5% 6% Respiratory tract 11% 9% 14% 8% Surgical wound Primary source Non surg. wound / Skin tisue 6% 2% 9% 5% Urinary tract without catheter 27% 19% 18% 17% Other source 4% 7% 3% 5% Unknown 39% 59% 51% 59% Yes 23% 1 8% 11% Antibiotic Exposure No 4% Unknown 73% 9 92% 89% Total

8 Appendix 2. Data Quality Analysis 8 Sixteen microbiology laboratories provided enhanced data on 1,378 blood-culture isolates, representing 43% of all isolates reported to EARS-Net in Ireland in the first half of 2017, which is the same proportion as recorded for 2016, however, fewer laboratories have contributed to the data compared to 2016 (n = 21). This reflects a greater level of participation from larger hospitals and a decreased level from smaller hospitals for the first half of Data quality has improved since 2014 overall and data consistency for the first half of 2017 was similar to Full Year Participation Participation metric Value 2016 data Number of laboratories Proportion of total EARS Net 42.8% 42.8% Consistency Proportion of records in the core dataset with enhanced data from participants Proportion of matched records Number of participants Number of participants 10 95% % <9 4 6 Data Completion Availability of data (usually Y or N, or dates) for key fields Field name % records completed % records completed Date of admission 99% 99% Probable contaminant 66% 68% Healthcare association 88% 89% Device related 62% 67% Implant related 51% 65% Procedure related 5 65% Source organ site 8 76% ICU acquired 47% 47% Outcome 98% 96% Antibiotic exposure 18% 12%