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Pseudomonas aeruginosa in French hospitals between 2001 and 2011: back to susceptibility
C Slekovec1, J Robert, D Trystram
1Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire de Besançon, 3, Boulevard Fleming, 25030, Besançon Cedex, France.
Abstract:
The European Antimicrobial Resistance Surveillance Network (EARS-Net) reported an increase in the rates of resistance of Pseudomonas aeruginosa to antimicrobials between 2008 and 2011 in France. This alarming report was based on data collected during the harmonisation of breakpoints by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) committee. However, these data were not supported by the findings of other national surveillance networks. In this study, we assessed the trends in P. aeruginosa antimicrobial drug resistance at six French hospitals over a longer period of time (2001-2011) and with a constant definition of resistance. After the exclusion of incomplete data and duplicates, we sorted 34,065 isolates into the antimicrobial resistance patterns defined by the European Centre for Disease Prevention and Control (ECDC). The proportion of isolates with a resistant pattern (non-susceptible to one or two antimicrobial categories), a multidrug-resistant pattern (non-susceptible to three or four antimicrobial categories) or an extensively drug-resistant pattern (non-susceptible to five or six antimicrobial categories) decreased significantly over time. Logically, the proportion of isolates with a wild-type resistance pattern has increased significantly over the same period. No significant changes in the rates of resistance to cephalosporins and penicillins were observed, whereas carbapenem resistance rates increased. By contrast, the proportion of isolates resistant to fluoroquinolones, aminoglycosides and monobactams decreased significantly over time. In conclusion, our data do not confirm the EARS-net data, suggesting instead that antimicrobial drug resistance in P. aeruginosa might not have increased in French hospitals over the last decade.
Insights
Antimicrobial resistance in Pseudomonas aeruginosa did not increase in French hospitals between 2001-2011. Multidrug resistance and extensively drug-resistant patterns significantly decreased, contrary to previous surveillance network reports.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health Surveillance
Background:
- European Antimicrobial Resistance Surveillance Network (EARS-Net) reported increased Pseudomonas aeruginosa resistance in France (2008-2011).
- Data harmonization by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) influenced EARS-Net findings.
- Contradictory findings from other national surveillance networks prompted further investigation.
Purpose of the Study:
- To assess long-term trends (2001-2011) in Pseudomonas aeruginosa antimicrobial drug resistance in French hospitals.
- To utilize a consistent definition of resistance for accurate trend analysis.
- To evaluate the validity of EARS-Net findings regarding P. aeruginosa resistance.
Main Methods:
- Analysis of 34,065 P. aeruginosa isolates from six French hospitals (2001-2011).
- Exclusion of incomplete data and duplicates.
- Classification of isolates into resistance patterns (resistant, multidrug-resistant, extensively drug-resistant, wild-type) based on European Centre for Disease Prevention and Control (ECDC) criteria.
Main Results:
- A significant decrease in resistant, multidrug-resistant, and extensively drug-resistant P. aeruginosa isolates over the study period.
- A significant increase in wild-type P. aeruginosa isolates.
- Carbapenem resistance rates increased, while resistance to fluoroquinolones, aminoglycosides, and monobactams significantly decreased. No significant changes in cephalosporin and penicillin resistance.
Conclusions:
- The study's findings do not support the EARS-Net report of increased P. aeruginosa antimicrobial resistance in France.
- Antimicrobial drug resistance in P. aeruginosa may have decreased or remained stable in French hospitals over the decade studied.
- Consistent resistance definitions are crucial for accurate surveillance data interpretation.