Aura 2016: first Australian report on antimicrobial use and resistance in human health
Chapter 4 Antimicrobial resistance
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- Bu səhifədəki naviqasiya:
- 4.1 Introduction
- Priority organisms for surveillance
- Data on priority organisms
Chapter 4 Antimicrobial resistanceKey messagesAcinetobacter baumannii – rates of resistance are low overall (<5%), and higher in hospitals than in the community. Enterobacteriaceae – extended-spectrum -lactamase-producing Escherichia coli, which are resistant to third-generation cephalosporins, are now a problem in community infections, as strains are often multidrug resistant. Enterococcus species – Australia has one of the highest rates of vancomycin resistance in Enterococcus faecium in the world. Rates of resistance to key antimicrobial agents are very low (<1%) in E. faecalis, but high (45–94.5%) in E. faecium. Mycobacterium tuberculosis – overall resistance rates have not changed significantly in the past decade. The rate of multidrug resistance is low, but has been gradually increasing (1.7% in 2014); extremely drug-resistant strains are occasionally found but remain rare. Neisseria gonorrhoeae – rates of resistance to benzylpenicillin and ciprofloxacin remain steady at around 30%. Rates of resistance to azithromycin and decreased susceptibility to ceftriaxone are low but gradually increasing. Neisseria meningitidis – rates of resistance to the four key antimicrobials remain very low (0–2%). Pseudomonas aeruginosa – overall rates of resistance to key antimicrobials are 10% or less; rates are higher in public hospitals than in other settings. Salmonella species – rates of resistance to fluoroquinolones are very low (1%) in nontyphoidal Salmonella species, but more than 12% in typhoidal Salmonella species. Shigella species – although data is limited, the presence of ciprofloxacin resistance in almost 10.6% of Shigella sonnei isolates is of concern. Staphylococcus aureus – between 15.8% and 17.4% of isolates are methicillin-resistant S. aureus (MRSA). Community strains of MRSA now cause a significant proportion of infections in both the community and hospitals. Streptococcus agalactiae – no isolates were resistant to benzylpenicillin, but resistance to erythromycin exceeds 20%. This means that protocols for prophylaxis may need to be reconsidered. Streptococcus pneumoniae – resistance (as defined for strains causing infections other than meningitis) to benzylpenicillin is low (around 2%), but resistance to other key antimicrobials is 21–26%. Streptococcus pyogenes – resistance to key antimicrobials used for treatment is absent or very low (3%). This chapter analyses data collected from passive and targeted surveillance systems for hospitals, residential aged care facilities and the community, for 13 priority organisms, as determined through the AURA project. 4.1 IntroductionResistant bacteria and their resistance genes can spread readily between people in the community, primary care services, hospitals and residential aged care facilities. This often happens quickly and can sometimes be unnoticed. The spread of these bacteria can have a significant impact on patients, health services and the health system. Therefore, it is critical that resistant bacteria with the highest risk of harm to humans are identified and monitored through enhanced surveillance, and managed appropriately. Priority organisms for surveillanceTo help focus Australia’s antimicrobial resistance (AMR) surveillance efforts, the Australian Commission on Safety and Quality in Health Care (the Commission) developed a list of organisms and key antimicrobials that are high priorities for Australia. Key experts involved in the Antimicrobial Use and Resistance in Australia (AURA) project helped to develop this list. Priority organisms are those of high public health importance and/or common pathogens where the impact of resistance is substantial in both the hospital and community settings. Surveillance of these organisms is being undertaken by a number of programs. In this report, the data on these organisms is being brought together for the first time at a national level, to give a clearer picture of the rates of resistance, an indication of some related outcome measures and, where available, an indication of trends over time. This work is being coordinated and reported on by the Commission to help improve Australia’s capacity to detect and respond to emerging AMR threats. Four sets of organisms are currently in the priority organism list (see Appendix 2). This first report on AMR and antimicrobial use (AU) for Australia provides data on the highest priority organisms. The organisms are:
Sets 3 and 4 include organisms that require further development of surveillance capacity and/or are identified for potential inclusion in future surveillance activity. The priority list will be regularly reviewed by the Commission, and new priority organisms may be added or changed across the sets as new data becomes available.
the Queensland Health OrgTRx system, which collects data from Queensland-based public hospitals and health services the Sullivan Nicolaides Pathology information system, which collects data from its own laboratories in Queensland and northern New South Wales; these laboratories service private hospitals, community-based services and residential aged care facilities the Australian Group on Antimicrobial Resistance (AGAR), which collects data on minimum inhibitory concentrations (MICs) of antimicrobials from laboratories across Australia for targeted organisms, a limited amount of demographic and outcome data, and undertakes additional characterisation of strains the National Neisseria Network, which collects data and undertakes confirmatory testing for all N. gonorrhoeae and N. meningitidis cases across Australia the National Notifiable Diseases Surveillance System, which collects data for all confirmed M. tuberculosis cases across Australia. Additional tables with more detailed information are provided in AURA 2016: supplementary data. The AURA Surveillance System will monitor changes in the nature of the AMR for each organism and include this information in future reporting. Table 4.1 provides a summary of the data sources for each organism, and Table 4.2 summarises the priority organisms and their AMR prevalence.
AGAR = Australian Group on Antimicrobial Resistance; NNDSS = National Notifiable Diseases Surveillance System; NNN = National Neisseria Network; NSW = New South Wales; OrgTRx = Queensland Health passive antimicrobial resistance surveillance system in hospitals; SNP = Sullivan Nicolaides Pathology a For antimicrobials where ≥75% of isolates were tested using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) interpretive criteria b National data from AGAR using EUCAST interpretive criteria (except for cefazolin, where Clinical and Laboratory Standards Institute [CLSI] interpretive criteria were used) c All Australian Mycobacterium Reference Laboratory Network laboratories that provide data to the NNDSS now use the same commercial broth system for susceptibility testing for Mycobacterium tuberculosis, but different susceptibility testing methods have been used in the past in some laboratories. For the purposes of reporting historical trend data, the results of other methods have been assumed to be equivalent. d All laboratories in the network test every isolate against the four first-line agents. Tests against additional antimycobacterial agents are conducted when (1) resistance to isoniazid and rifampicin is detected, (2) resistance to two or more first-line agents is detected, and (3) patients experience severe adverse reactions to first-line agents. Interpretive criteria for resistance are currently those of the CLSI. e Most cases of gonococcal infection are now diagnosed using nucleic acid techniques, and specimens for culture are not collected. Because current susceptibility testing methods depend on obtaining a culture of the organism, only a minority of cases undergo susceptibility testing. f There was insufficient data to report the prevalence of resistance for strains causing meningitis.
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