Antimicrobial Resistance Surveillance Europe 2012

SURVEILLANCE REPORT
Antimicrobial resistance
surveillance in Europe
2012
www.ecdc.europa.eu
surveillance in Europe
Annual report of the European Antimicrobial
Resistance Surveillance Network (EARS-Net)
2012
Antimicrobial resistance surveillance in Europe 2012
The European Centre for Disease Prevention and Control (ECDC) wishes
to thank all EARS-Net participating laboratories and hospitals in the
Member States for providing data for this report.
Furthermore, all EARS-Net participants and National Epidemiological
Contact Points are acknowledged for facilitating data transfer
and providing valuable comments for this report. The ECDCs staff
members Catalin Albu, Gaetan Guyodo and Encarna Gimenez are
acknowledged for data management and providing helpdesk support
to the participating countries.
John Stelling is acknowledged for his dedicated technical support to
the WHONET users among the participating countries.
ECDC staff members Liselotte Diaz Hgberg and Ole Heuer are
acknowledged for the preparation of the report, and Christine Walton
at UK NEQAS is acknowledged for her contribution to Annex 1. In
addition, the ECDC wishes to thank EARS-Net Coordination Group
members Derek Brown, Jose Campos, Tim Eckmanns, Christian
Giske, Hajo Grundmann, Vincent Jarlier, Gunnar Kahlmeter, Jolanta
Miciuleviciene, Jos Monen, Gian Maria Rossolini, Gunnar Skov
Simonsen, Nienke van de Sande-Bruinsma and Helena Zemlickova
for providing valuable comments and scientific advice during the
production of the report.
Suggested citation for full report:

European Centre for Disease Prevention and Control. Antimicrobial
resistance surveillance in Europe 2012. Annual Report of the
European Antimicrobial Resistance Surveillance Network (EARS-Net).
Stockholm: ECDC; 2013.
Cover picture istockphoto
ISSN 1831-9491
ISBN 978-92-9193-511-6
doi 10.2900/93403
Catalogue number TQ-AM-13-001-EN-C
European Centre for Disease Prevention and Control, 2013.
Reproduction is authorised, provided the source is acknowledged.
ii
SURVEILLANCE REPORT
SURVEILLANCE REPORT
Contents
List of tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iv
List of figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iv
Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
vi
National institutions/organisations participating in EARS-Net. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
vii
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Data collection and analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.1 Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.2 Interpretation of the results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3 Antimicrobial resistance in Europe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3.1 Escherichia coli. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3.2 Klebsiella pneumoniae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.3 Pseudomonas aeruginosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.4 Acinetobacter species. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3.5 Streptococcus pneumoniae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3.6 Staphylococcus aureus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
3.7 Enterococci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Annex 1 External quality assessment 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Annex 2 EARS-Net laboratory/hospital denominator data 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Country summary sheets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
iii
SURVEILLANCE REPORT
List of tables
3.1. Escherichia coli. Total numbers of isolates tested and percentage susceptible to all antimicrobial groups under EARS-Net surveillance;
total numbers of isolates tested and percentages resistant to aminopenicillins, fluoroquinolones, third-generation cephalosporins,
aminoglycosides and combined resistance, including 95% confidence intervals, by country, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.2. Escherichia coli. Number of reporting laboratories, total numbers of invasive isolates resistant to third-generation cephalosporins
and percentage of extended-spectrum beta-lactamase-positive among these isolates, as ascertained by the participating laboratories,
EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.3. Escherichia coli. Total number of tested isolates and resistance combinations among invasive isolates tested against aminopenicillins,
third-generation cephalosporins, fluoroquinolones, aminoglycosides and carbapenems, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
3.4. Klebsiella pneumoniae. Total number of isolates tested and percentage susceptible to all antimicrobial groups under EARSNet surveillance, total number of isolates tested and percentage resistant to aminopenicillins, fluoroquinolones, third-generation
cephalosporins, aminoglycosides and combined resistance, including 95% confidence intervals, by country, EU/EEA countries, 2012. . . . . . . . . . .
25
3.5. Klebsiella pneumoniae. Number of reporting laboratories, total number of invasive isolates resistant to third-generation
cephalosporins and percentage of extended-spectrum beta-lactamase-positive among these isolates, as ascertained by participating
laboratories, by country, EU/EEA countries, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
3.6. Klebsiella pneumoniae. Total number of tested isolates and resistance combinations among invasive isolates tested against thirdgeneration cephalosporins, fluoroquinolones, aminoglycosides and carbapenems, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
3.7. Pseudomonas aeruginosa. Total number of isolates tested and percentage of invasive isolates susceptible to all antimicrobial groups
under EARS-net surveillance, total number of isolates tested and percentage with resistance to piperacillin (tazobactam), ceftazidime,
fluoroquinolones, aminoglycosides, carbapenems and combined resistance, including 95% confidence intervals, by country, EU/EEA
countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.8. Pseudomonas aeruginosa. Total number of tested isolates and resistance combinations among invasive isolates tested against at
least three antimicrobial classes among piperacillintazobactam, ceftazidime, fluoroquinolones, aminoglycosides and carbapenems,
EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38
3.9. Acinetobacter spp. Total number of tested isolates and percentages susceptible to all antimicrobial groups under EARS-Net
surveillance, total number of tested isolates and percentages of invasive isolates resistant to fluoroquinolones, aminoglycosides,
carbapenems and combined resistance, including 95% confidence intervals, by country, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
3.10. Acinetobacter spp. Overall resistance and resistance combinations among invasive isolates tested against fluoroquinolones,
aminoglycosides and carbapenems, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
3.11. Streptococcus pneumoniae. Total number of isolates tested for penicillin and macrolide susceptibility, percentage being penicillinnon-susceptible, penicillin-resistant, macrolide-non-susceptible, single penicillin-resistant, single macrolide-resistant and nonsusceptible to penicillin and macrolides, including 95% confidence intervals, by country, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
58
3.12. Staphylococcus aureus. Number and percentage of invasive isolates resistant to meticillin and rifampicin including 95% confidence
intervals, by country, EU/EEA countries, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.13. Total number of invasive isolates and percentages of high-level aminoglycoside-resistant E. faecalis and vancomycin-resistant
E.faecium, including 95% confidence intervals, by country, EU/EEA countries, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
65
A1.1. Enterococcus faecalis (1373). Minimum inhibitory concentration (MIC) and intended results reported by the reference laboratories
and the overall concordance of the participating laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
72
A1.2. Escherichia coli (1374). Minimum inhibitory concentration (MIC) and intended results reported by the reference laboratories and
the overall concordance of the participating laboratories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
73
A1.3. Klebsiella pneumoniae (1375). Minimum inhibitory concentration (MIC) and intended results reported by the reference
laboratories and the overall concordance of the participating laboratories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
73
A1.4. Pseudomonas aeruginosa (1376). Minimum inhibitory concentration (MIC) and intended results reported by the reference
laboratories and the overall concordance of the participating laboratories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
A1.5. Staphylococcus aureus (1377). Minimum inhibitory concentration (MIC) and intended results reported by the reference
A1.6. Streptococcus pneumoniae (1378). Minimum inhibitory concentration (MIC) and intended results reported by the reference
A2.1. Hospital denominator data for 2011 or 2012 (using the latest available data). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
A2.2. Hospital characteristics for 2011 or 2012 (using the latest available data). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A2.3. Laboratory denominator information for 2011 or 2012 (using the latest available data). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
80
80
List of figures
2.1. Countries contributing AMR data for 2012 to EARS-Net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.1. Escherichia coli. Percentage of invasive isolates with resistance to third-generation cephalosporins by country, EU/EEA countries, 2012 . . . . 9
3.2. Escherichia coli. Percentage of invasive isolates with resistance to fluoroquinolones, by country, EU/ EEA countries, 2012. . . . . . . . . . . . . . . . . . . . 10
3.3. Escherichia coli. Percentage of invasive isolates with resistance to aminoglycosides, by country, EU/EEA countries, 2012 . . . . . . . . . . . . . . . . . . . . . 10
3.4. Escherichia coli. Percentage of invasive isolates with combined resistance to third-generation cephalosporins, fluoroquinolones
and aminoglycosides, by country, EU/ EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.5. Escherichia coli. Trends of invasive isolates with resistance to aminopenicillins, by country, EU/EEA countries, 20092012. . . . . . . . . . . . . . . . . . . 14
3.6. Escherichia coli. Trends of invasive isolates with resistance to third-generation cephalosporins, by country, EU/EEA countries, 20092012. .
15
3.7. Escherichia coli. Trends of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA countries, 20092012 . . . . . . . . . . . . . . . . . 16
3.8. Escherichia coli. Trends of invasive isolates with resistance to aminoglycosides, by country, EU/EEA countries, 20092012 . . . . . . . . . . . . . . . . .
iv
17
SURVEILLANCE REPORT
3.9. Escherichia coli. Trends of invasive isolates with combined resistance (resistant to fluoroquinolones, third-generation cephalosporins
and aminoglycosides), by country, EU/EEA countries, 20092012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.10. Klebsiella pneumoniae. Percentage of invasive isolates with resistance to third-generation cephalosporins, by country, EU/EEA
countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
3.11. Klebsiella pneumoniae. Percentage of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA countries, 2012. . . . . . . . . . 21
3.13. Klebsiella pneumoniae. Percentage of invasive isolates with resistance to carbapenems, by country, EU/EEA countries, 2012 . . . . . . . . . . . . . .
22
22
3.14. Klebsiella pneumoniae. Percentage of invasive isolates with combined resistance (resistance to third-generation cephalosporins,
fluoroquinolones and aminoglycosides), by country, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
3.12. Klebsiella pneumoniae. Percentage of invasive isolates with resistance to aminoglycosides, by country, EU/EEA countries, 2012. . . . . . . . . .
3.15. Klebsiella pneumoniae. Trends of invasive isolates with resistance to third-generation cephalosporins, by country, EU and EEA
countries, 20092012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
29
3.17. Klebsiella pneumoniae. Trends of invasive isolates with resistance to aminoglycosides, by country, EU and EEA countries, 20092012 . . . 30
3.18. Klebsiella pneumoniae. Trends of invasive isolates with resistance to carbapenems, by country, EU and EEA countries, 20092012. . . . . . . 31
3.16. Klebsiella pneumoniae. Trends of invasive isolates with resistance to fluoroquinolones, by country, EU and EEA countries, 20092012 . .
3.19. Klebsiella pneumoniae. Trends of invasive isolates with combined resistance (third-generation cephalosporins, fluoroquinolones
and aminoglycosides), by country, EU and EEA countries, 20092012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32
3.20. Pseudomonas aeruginosa. Percentage of invasive isolates with resistance to piperacillin (tazobactam), by country, EU/EEA
countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
34
3.22. Pseudomonas aeruginosa. Percentage of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA countries, 2012 . . . . . 34
3.23. Pseudomonas aeruginosa. Percentage of invasive isolates with resistance to aminoglycosides, by country, EU/EEA countries, 2012. . . . . . 35
3.24. Pseudomonas aeruginosa. Percentage of invasive isolates with resistance to carbapenems, by country, EU/EEA countries, 2012. . . . . . . . . . 36
3.21. Pseudomonas aeruginosa. Percentage of invasive isolates with resistance to ceftazidime, by country, EU/EEA countries, 2012 . . . . . . . . . . . .
3.25. Pseudomonas aeruginosa. Percentage of invasive isolates with combined resistance (resistance to three or more antimicrobial
classes among piperacillin (tazobactam), ceftazidime, fluoroquinolones, aminoglycosides and carbapenems), by country, EU/EEA
countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
3.26. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to piperacillin (tazobactam), by country, EU/EEA countries,
20092012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40
3.27. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to ceftazidime, by country, EU/EEA countries, 20092012. . . . . . . . . . 41
3.28. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to fluoroquinolones, by country, EU/ EEA countries, 20092012. .
3.29. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to aminoglycosides, by country, EU/ EEA countries, 20092012. . .
3.30. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to carbapenems, by country, EU/EEA countries, 20092012. . . . . . . .
3.31. Pseudomonas aeruginosa. Trends of invasive isolates with combined (resistance to three or more antimicrobial classes among
piperacillintazobactam, ceftazidime, fluoroquinolones, aminoglycosides and carbapenems, by country, EU/EEA countries, 20092012. . . . . . .
3.32. Acinetobacter spp. Percentage of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA countries, 2012 . . . . . . . . . . . . . . .
3.33. Acinetobacter spp. Percentage of invasive isolates with resistance to aminoglycosides, by country, EU/EEA countries, 2012. . . . . . . . . . . . . . . .
3.34. Acinetobacter spp. Percentage of invasive isolates with resistance to carbapenems, by country, EU/ EEA countries, 2012 . . . . . . . . . . . . . . . . . . . .
3.35. Acinetobacter spp. Percentage of invasive isolates with combined resistance (resistance to fluoroquinolones, aminoglycosides and
carbapenems), by country, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.36. Streptococcus pneumoniae. Percentage of invasive isolates non-susceptible to penicillin (PNSP), by country, EU/EEA countries, 2012. . . .
3.37. Streptococcus pneumoniae. Percentage of invasive isolates non-susceptible to macrolides by country, EU/EEA countries, 2012. . . . . . . . . . . .
42
43
44
45
47
48
48
50
51
52
3.38. Streptococcus pneumoniae. Percentage of invasive isolates non-susceptible to penicillins and macrolides by country, EU/EEA
countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
3.39. Streptococcus pneumoniae. Trends of invasive isolates with non-susceptibility to penicillin, by country, EU/EEA countries, 20092012. .
54
3.40. Streptococcus pneumoniae. Trends of invasive isolates with non-susceptibility to macrolides, by country, EU/EEA countries, 20092012. . . 55
3.41. Streptococcus pneumoniae. Trends of invasive isolates non-susceptible to penicillins and macrolides, by country, EU/EEA
countries, 20092012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
3.42. Streptococcus pneumoniae. Distribution of serogroups and associated resistance profiles per serogroup, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
59
60
3.45. Enterococcus faecalis. Percentage of invasive isolates with high-level resistance to aminoglycosides, by country, EU/EEA countries, 2012 . . 62
3.46. Enterococcus faecium. Percentage of invasive isolates resistant to vancomycin, by country, EU/EEA countries, 2012. . . . . . . . . . . . . . . . . . . . . . . . . 63
3.43. Staphylococcus aureus. Percentage of invasive isolates resistant to meticillin (MRSA), by country, EU/ EEA countries, 2012. . . . . . . . . . . . . . . .
3.44. Staphylococcus aureus. Trends of invasive isolates resistant to meticillin (MRSA), by country, EU/EEA countries, 20092012 . . . . . . . . . . . . . .
3.47. Enterococcus faecalis. Trends of invasive isolates with high-level resistance to aminoglycosides, by country, EU/EEA countries,
20092012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
64
66
A1.1. Number of participating laboratories returning EQA reports 2012, per country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
A1.2. Guidelines reported to be used by laboratories: number of laboratories per country, 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
A2.1. Number of hospitals and laboratories reporting AMR and/or denominator data in 2011 or 2012 (using latest available data). . . . . . . . . . . . . . . . 78
3.48. Enterococcus faecium. Trends of invasive isolates with resistance to vancomycin, by country, EU/EEA countries, 20092012. . . . . . . . . . . . . . .
A2.2. Percentage of small, medium and large hospitals per country, based on number of beds, for all hospitals reporting both
antimicrobial resistance data and denominator data in 2011 or 2012 (using latest available data). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
SURVEILLANCE REPORT
Abbreviations and acronyms

3GCREC
Third-generation cephalosporin-resistant
Escherichia coli
3GCRKP
Third generation cephalosporin-resistant

Klebsiella pneumoniae
AMR
AmpC
Ampicillinase C
AST
Antimicrobial susceptibility testing
BSAC
British Society for Antimicrobial

Chemotherapy
BSI
Bloodstream infection
CC
Clonal complex
CLSI
Clinical and Laboratory Standards Institute
CMY
Cephamycinase
CPE
Carbapenemase-producing
Enterobacteriaceae
CRG
Commissie Richtlijnen
Gevoeligheidsbepalingen (Dutch)
DIN
Deutsche Industrie Norm (German)
DNA
Deoxyribonucleic acid
EARSS
European Antimicrobial Resistance

Surveillance System
EARS-Net
European Antimicrobial Resistance

Surveillance Network
ECDC
European Centre for Disease Prevention

and Control
EEA
European Economic Area
EU
European Union
EQA
External quality assessment
ESBL
Extended-spectrum beta-lactamase
vi
ICU
Intensive care unit
IMP
Imipenemase
KPC
Klebsiella pneumoniae carbapenemase
MIC
Minimum inhibitory concentration
MLS
Macrolide, lincosamide and streptogramin
MRSA
Meticillin-resistant Staphylococcus aureus
MSSA
Meticillin-susceptible Staphylococcus
aureus
NDM
New Delhi metallo-beta-lactamase
NWGA
Norwegian Working Group on

Antimicrobials
OXA
Oxacillinase gene
PBP
Penicillin-binding protein
PCV
Pneumococcal conjugate vaccine
RNA
Ribonucleic acid
SFM
Comit de lAntibiogramme de la Socit

Franaise de Microbiologie (French)
SIR
Susceptible, intermediate, resistant
SHV
Sulfhydryl-variable extended-spectrum
beta-lactamase gene
SRGA
Swedish Reference Group for Antibiotics
TESSy
The European Surveillance System (at

ECDC)
TEM
Temoneira extended-spectrum betalactamase gene
UK NEQAS
United Kingdom National External Quality

Assessment Scheme for Microbiology
VIM
Verona integron-encoded
metallo-beta-lactamase
SURVEILLANCE REPORT
National institutions/organisations
participating in EARS-Net
Austria
Germany
Federal Ministry of Health
Robert Koch Institute
Medical University Vienna
www.rki.de
Elisabethinen Hospital, Linz
Greece
www.elisabethinen.or.at
Hellenic Pasteur Institute
Belgium
National School of Public Health
Scientific Institute of Public Health

www.iph.fgov.be
National and Kapodistrian University of Athens, Medical

School
University of Antwerp
www.mednet.gr/whonet
Bulgaria
Hungary
Alexander University Hospital, Sofia

National Center of Infectious and Parasitic Diseases
Croatia
Reference Center for Antibiotic Resistance Surveillance,
Ministry of Health
Zagreb University Hospital for Infectious Diseases Dr.
Fran Mihaljevi
Cyprus
Nicosia General Hospital
Czech Republic
National Institute of Public Health
www.szu.cz
National Centre for Epidemiology

www.oek.hu
Iceland
National University Hospital of Iceland
Centre for Health Security and Infectious Disease
Control
Ireland
Health Protection Surveillance Centre (HPSC)
www.hpsc.ie
Italy
National Institute of Health
www.simi.iss.it/antibiotico_resistenza.htm
National Reference Laboratory for Antibiotics
Latvia
Denmark
Paul Stradins Clinical University Hospital
Statens Serum Institut, Danish Study Group for

Antimicrobial Resistance Surveillance (DANRES)
www.danmap.org
Estonia
Health Board
East-Tallinn Central Hospital
State Agency Infectology Centre of Latvia
Lithuania
National Public Health Surveillance Laboratory
www.nvspl.lt
Institute of Hygiene
www.hi.lt
Tartu University Hospital
Luxembourg
Finland
Microbiology Laboratory, Luxembourgs Hospital Centre
National Institute for Health and Welfare, Finnish

Hospital Infection Program (SIRO)
www.thl.fi/siro
Finnish Study Group for Antimicrobial Resistance (FiRe)

www.finres.fi
France
Piti-Salptrire Hospital
National Institute for Public Health Surveillance
National Health Laboratory
Malta
Mater Dei Hospital, Msida
Netherlands
National Institute for Public Health and the Environment
www.rivm.nl
Norway
www.invs.sante.fr
University Hospital of North Norway
French National Observatory for the Epidemiology of

Bacterial Resistance to Antimicrobials (ONERBA): AzayRsistance, le-de-France and Russir networks
Norwegian Institute of Public Health

St. Olav University Hospital, Trondheim
www.onerba.org
National Reference Centre for Pneumococci (CNRP)
vii
SURVEILLANCE REPORT
Poland
Slovenia
National Medicines Institute
National Institute of Public Health
Department of Epidemiology and Clinical Microbiology
University of Ljubljana
National Reference Centre for Antimicrobial Resistance

and Surveillance
Spain
Portugal
www.isciii.es
National Institute of Health Dr. Ricardo Jorge

www.insarj.pt
Ministry of Health
Directorate-General of Health
Romania
National Institute of Research and Development for
Microbiology and Immunology Cantacuzino
Health Institute Carlos lll

National Centre of Microbiology
Sweden
Swedish Institute for Communicable Disease Control
www.smi.se
United Kingdom
Public Health England
Institute of Public Health
https://www.gov.uk/government/organisations/
public-health-england
Slovakia
Health Protection Scotland
National Reference Centre for Antimicrobial Resistance

Public Health Authority of Slovakia
Regional Public Health Authority Banska Bystrica
viii
Public Health Agency Northern Ireland
SURVEILLANCE REPORT
Summary
The results presented in this report are based on antimicrobial resistance data from invasive isolates reported
to EARS-Net by 30 EU/EEA countries in 2013 (data referring to 2012), and on trend analyses of EARSS/EARS-Net
data reported by the participating countries during the
period 2009 to 2012.
A majority of the Escherichia coli and Klebsiella pneumoniae isolates reported to EARS-Net in 2012 was
resistant to at least one of the antimicrobials under surveillance, and many of these had combined resistance
to third-generation cephalosporins, fluoroquinolones
and aminoglycosides. This is consistent with the continuously increasing trends of antimicrobial resistance
seen in over a third of the reporting counties over the
last several years, and a high percentage of extendedspectrum beta-lactamase (ESBL)-positive isolates. The
increasing trends can be noted not only for countries
that have comparatively low resistance percentages, but
also countries with already very high levels.
The percentage of carbapenem resistance among
K. pneumoniae isolates increased during 2012, further reducing the number of available options for
antimicrobial therapy of serious infections with this
microorganism. Carbapenem resistance is often seen
in combination with resistance to several other antimicrobial groups. This type of combined resistance is most
commonly reported from southern Europe.
Carbapenem resistance and resistance to multiple antimicrobial groups were also common in Pseudomonas
aeruginosa
and
Acinetobacter
spp.
isolates.
Acinetobacter spp. were included in EARS-Net surveillance from 2012, after several Member States noticed
increasing resistance for this microorganism. Eighteen
out of 30 countries were able to report 2012 data and
inter-country variation for the percentage of carbapenem resistance in Acinetobacter spp. ranged from zero
to 88%.
Resistance trends in gram-positive bacteria showed

a more diverse pattern across Europe. The trends for
Streptococcus pneumoniae and enterococci are generally stable, but with large inter-country variations in the
percentage of resistant isolates.
For meticillin-resistant Staphylococcus aureus (MRSA),
the population-weighted EU/EEA mean decreased significantly over the last four years. Despite this, MRSA
remains a public health priority as the percentage is still
above 25% in seven of the 30 reporting countries, with a
population-weighted EU/EEA mean of 17.8%.
For several antimicrobial agentmicroorganism combinations, an overall north-to-south and west-to-east
gradient is evident in Europe. In general, lower resistance percentages are reported from the north and
higher percentages from the south and east of Europe.
These geographical differences may reflect differences
in infection control practices and antimicrobial use in
the reporting countries. Prudent use of antimicrobial
agents and comprehensive infection control practices
are the cornerstones of effective prevention and control
efforts aimed at reducing the selection and transmission
of resistant bacteria. The already high percentages and
increasing trends of antimicrobial resistance in gramnegative bacteria in Europe described in this report
illustrate the continuous loss of effective antimicrobial
therapy against these microorganisms and emphasise
the need for comprehensive strategies targeting all
health sectors.
SURVEILLANCE REPORT
1 Introduction
Antimicrobial resistance (AMR) is a serious threat to
public health in Europe, leading to mounting healthcare
costs, treatment failure, and deaths. The issue calls for
concerted efforts at Member State level but also close
international cooperation in order to preserve future
antimicrobial effectiveness and access to effective treatment for bacterial infections.
Surveillance of AMR is a fundamental part of an effective
response to this threat, and surveillance results constitute an essential source of information on the magnitude
and trends of resistance. Surveillance of AMR at EU level
has been assured by European law: AMR is listed as a
special health issue in Annex 1 of Commission Decision
2000/96/EC on the communicable diseases to be progressively covered by the Community network under
Decision No 2119/98/EC of the European Parliament
and of the Council1; surveillance of antimicrobial resistance within the EU/EEA is carried out in accordance with
Regulation (EC) No 851/2004 of the European Parliament
and of the Council of 21 April 2004 establishing a
European Centre for Disease Prevention and Control
(ECDC)2. Over the years, the need for the Member States
to collaborate on AMR surveillance has been reinforced
by several council conclusions including the Council
Conclusion on Antimicrobial Resistance of 10 June 2008
and the recent Council Conclusion on the impact of antimicrobial resistance in the human health sector and in
the veterinary sector a One Health perspective of
22 June 20123.
About EARS-Net
The European Antimicrobial Resistance Surveillance
Network (EARS-Net) is the continuation of the European
Antimicrobial Resistance Surveillance System (EARSS),
which was hosted by the Dutch National Institute for
Public Health and the Environment (RIVM). Established
in 1998, EARSS successfully created a multistate network for AMR surveillance and demonstrated how
international AMR data could be provided to inform
decisions and raise awareness among stakeholders and
policy makers. By 1 January 2010, the management and
administration of EARSS was transferred from RIVM to
the European Centre for Disease Prevention and Control
(ECDC), and the network was renamed EARS-Net. Data
collected by the network from EU/EEA Member States
since 1999 was transferred to The European Surveillance
System (TESSy) database at ECDC.
EARS-Net is based on a network of representatives
from the Member States collecting routine clinical
antimicrobial susceptibility data from national AMR surveillance initiatives (for details, please refer to the list
of national institutions and organisations participating
in EARS-Net: page vii). Scientific guidance and support
to the network is provided by the EARS-Net Coordination
Group. This is composed of individual experts selected
from among the nominated disease-specific contact
points and experts from other organisations that are
involved in surveillance of antimicrobial resistance.
EARS-Net activities are coordinated in close collaboration with two other major surveillance networks: the
European Surveillance of Antimicrobial Consumption
Network (ESAC-Net) and the Healthcare-associated
Infections Surveillance Network (HAI-Net). EARS-Net
collaborates with the European Society of Clinical
Microbiology and Infectious Diseases (ESCMID); in particular with the European Committee on Antimicrobial
Susceptibility Testing (EUCAST) which is supported by
ECDC/ESCMID.
The objectives of EARS-Net are:
to collect comparable, representative and accurate
AMR data;
to analyse temporal and spatial trends of AMR in
Europe;
to provide timely AMR data that constitute a basis for
policy decisions;

to encourage the implementation, maintenance
and improvement of national AMR surveillance programmes; and
to support national systems in their efforts to improve
diagnostic accuracy in the surveillance chain by offering an annual external quality assessment (EQA).
Since 1998, the participating laboratories have collected
AMR data on over one million unique invasive bacterial
isolates. Being the largest publicly funded system for
surveillance of antimicrobial resistance in Europe, data
from EARS-Net play an important role in documenting
the occurrence and spread of antimicrobial resistance
in Europe, and contribute to raising awareness of the
problem at the political level, among public health officials, in the scientific community and with the general
public. All participating countries have open access to
the EARS-Net database. Public access to descriptive
data (maps, graphs and tables) is also available through
a web-based data query tool4 and more detailed analyses are presented in the annual reports and in scientific
publications.
1 Official Journal of the European Communities. OJ L 28, 3.2.2000, p.

5053.
2 Official Journal of the European Union. OJ L 142, 30.4.2004, p. 1.
3 Official Journal of the European Union. OJ C 211, 18.7.2012, p. 25.
4 EARS-Net interactive database. Available at http://www.ecdc.

europa.eu/en/healthtopics/antimicrobial_resistance/database/
Pages/database.aspx
SURVEILLANCE REPORT
2 Data collection and analysis

All 28 EU Member States and two EEA countries (Norway
and Iceland) reported AMR data for 2012 to EARS-Net
(Figure 2.1). Croatia joined the EU on 1 July 2013 and
reported data (20092012) to EARS-Net for the first
time.
EARS-Net performs surveillance of AMR in eight bacterial microorganisms of public health importance:
Escherichia coli
Pseudomonas aeruginosa
Only data from invasive (blood and cerebrospinal fluid)

isolates are included. The panels of antimicrobial agent
combinations under surveillance for each bacterium are
defined in the EARS-Net Reporting Protocol 5.
Acinetobacter species
(data for 2012 and 2013 included as a pilot project).
Streptococcus pneumoniae
Staphylococcus aureus
Enterococcus faecalis
5 EARS-Net Reporting Protocol Version 3, 2013. Available from

http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/
Documents/2013_EARS-Net_Reporting-Protocol.pdf
Enterococcus faecium
Figure 2.1. Countries contributing AMR data for 2012 to EARS-Net

Participating countries
Non participating countries
IS
FI
NO
SE
EE
LV
DK
IE
LT
UK
NL
BE
PL
DE
LU
CZ
SK
FR
AT
HU
RO
SI HR
PT
ES
BG
IT
EL
MT
AT
BE
BG
CY
CZ
DE
DK
EE
EL
ES
Austria
Belgium
Bulgaria
Cyprus
Czech Republic
Germany
Denmark
Estonia
Greece
Spain
FI
FR
HR
HU
IE
IS
IT
LT
LU
LV
Finland
France
Croatia
Hungary
Ireland
Iceland
Italy
Lithuania
Luxembourg
Latvia
CY
MT
NL
NO
PL
PT
RO
SE
SI
SK
UK
Malta
Netherlands
Norway
Poland
Portugal
Romania
Sweden
Slovenia
Slovakia
United Kingdom
Routine antimicrobial susceptibility test results are

collected from clinical laboratories by the national representative in each participating country. National data
are uploaded directly by the national data manager to
a central database, TESSy, at ECDC on a yearly basis.
TESSy is a web-based system for collection, validation
and cleaning of data and is intended to be the single
point for Member States to submit and retrieve data on
all communicable diseases that are under EU surveillance. TESSy filters the uploaded records according to
the list of microorganism/specimen/antimicrobial combinations included in the AMR surveillance and obtains
one record per patient, organism, antimicrobial class
combination and year (for details please refer to the
EARS-Net Reporting Protocol). After uploading data, the
national data manager receives a validation report and
each country approves its own data before it is included
for analysis. Please note that data presented by EARSNet might diverge slightly from the data presented by
the Member States themselves, as data cleaning routines might differ.
In addition to collection of data on AMR, additional
reference information from the national networks is
collected through questionnaires distributed to participating laboratories and hospitals by the national
contact points. Information is collected on the total
number of blood culture sets processed in the laboratories, the number of hospital beds for each participating
hospital, the type of hospital, the bed occupancy and
the number of admissions. The national data managers
receive the completed questionnaires, compile them and
produce the final format suitable for uploading to TESSy.
For more information on denominator data, see Annex 2
and the Country Summary Sheets.
2.1 Data analysis

For the analysis, an isolate is considered resistant to
an antimicrobial agent when tested and interpreted as
resistant (R) in accordance with the clinical breakpoint
criteria used by the local laboratory. An isolate is considered non-susceptible to an antimicrobial agent when
tested and found resistant (R) or with intermediate susceptibility (I) using the same clinical breakpoints as
interpretive criteria. EARS-Net encourages the use of
EUCAST breakpoints but results based on other interpretive criteria used by the reporting countries are accepted
for the analysis.
As a general rule, data are expressed as a resistance
percentage, i.e. the percentage of R isolates out of all
isolates with antimicrobial susceptibility testing (AST)
information on that specific organismantimicrobial
agent combination, and for some bacteria as the percentage of non-susceptible (I+R) isolates out of all isolates
with the relevant information. For selected analyses, a
95% confidence interval is determined for the resistance
percentage by applying an exact confidence interval for
binomial data.
A population-weighted EU/EEA mean percentage was
determined by applying population-based weights to
SURVEILLANCE REPORT
each countrys data before calculating the arithmetic

mean for all reporting countries. Country weights were
used to adjust for imbalances in reporting propensity and population coverage, as the total number of
reported isolates per country in most cases does not
reflect the population size. The weight applied to each
national data point represented the proportion of the
countrys population out of the total population of all
countries included in the calculation. Annual population
data were retrieved from the Eurostat on-line database6.
If fewer than 10 isolates are reported for a specific
organismantimicrobial agent combination in a country, the results for this country are not displayed on the
maps presented in this report.
The statistical significance of temporal trends of antimicrobial resistance percentages by country is calculated
based on data from the last four years. Countries reporting fewer than 20 isolates per year, or not providing
data for all years within the considered period, are not
included in the analysis. The statistical significance of
trends is assessed by the CochranArmitage test. An
additional sensitivity analysis is performed by repeating
the CochranArmitage test only including laboratories
which consistently reported for the full four-year period
in order to exclude selection bias when assessing the
significance of the trends.
2.2 Interpretation of the results

Interpretation of the results, both for inter-country comparison and in some cases for interpretation of national
trends, should be undertaken with caution. A number of
factors might influence and introduce bias to the data,
resulting in over- as well as underestimation of resistance percentages. Some of the most important potential
sources of bias in EARS-Net are explained below.
Population coverage
Population coverage varies between reporting countries. Some countries report data from large national
surveillance systems with high national coverage, while
other countries report data from a smaller subset of
local laboratories and hospitals.
For countries only reporting data from a smaller number of hospitals and laboratories located in one specific
geographical area, the sample may not be representative for the whole country. Likewise, national trends may
not be representative for regional situations as pooled
data could mask variations at local level.
For some countries, the population under surveillance
is not constant and may change over the years due to
variations in the number of participating laboratories.
To control for this potential bias in trend analyses, an
additional sensitivity analysis including a subset of data
originating only from laboratories reporting for all the
6 http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/
home/
SURVEILLANCE REPORT
previous four years, is provided for all national trend

analyses.
For detailed information on the number of reporting
laboratories, characteristics of reported data and population under surveillance, see Annex 2 and Country
Summary Sheets.
The ability of the laboratory to identify the microorganism and its associated antimicrobial susceptibility
pattern may differ. All laboratories providing data for
EARS-Net are offered participation in an annual external quality assessment (EQA) to assess the reliability of
the laboratory test results. For more information on the
EARS-Net EQA and laboratory performance, see Annex 1.
Sampling
EARS-Net data are exclusively based on invasive isolates from blood or cerebrospinal fluid. The clinical
relevance of indicator organisms isolated from these
sites is indisputable. This restriction prevents some of
the inconsistencies that arise from differences in clinical
case definitions, different sampling frames or heterogeneous healthcare utilisation that would otherwise
confound the data analysis if isolates from all anatomical sources were accepted. However, invasive isolates
may, for biological reasons, not be representative for
isolates of the same bacterial species from other sites,
i.e. urinary tract infections, pneumonia, wound infections, etc.
Case ascertainment of patients with bloodstream infections (BSIs) is strongly linked to diagnostic habits and
the frequency with which blood cultures are taken.
Therefore, variations in blood culture frequency (nondifferential sampling) result in an increasing uncertainty
when comparing resistance percentages between different hospitals and countries. Extrapolations of EARS-Net
data as a measure of BSI incidence could therefore
underestimate the true value in countries with low blood
culture frequency.
Differential sampling can occur if blood cultures are typically only performed after empirical treatment shows
no adequate therapeutic response. Predictably, this
will lead to a serious overestimation of the percentage
resistance by not including susceptible BSI isolates in
the denominator.
For detailed information on national blood culture frequency, see Annex 2.
Laboratory routines and capacity

The use of guidelines for clinical breakpoints varies
between countries in Europe, and in some instances
even between laboratories in the same country. At
present, there is an ongoing shift among European
laboratories from using CLSI (Clinical and Laboratory
Standards Institute) to EUCAST clinical guidelines. As a
result the interpretation of AST results may vary, at least
for resistance mechanisms producing minimum inhibitory concentrations (MICs) close to the breakpoints.
In addition, the use of microbiological breakpoints
may change over time, when breakpoint protocols are
updated or changed. As data on quantitative measures
(i.e. zone diameters in disk diffusion tests or MIC values)
are not provided by all participating laboratories, only
the reported S, I, and R results are considered for the
analyses.
SURVEILLANCE REPORT
3 Antimicrobial resistance in Europe

3.1 Escherichia coli
3.1.1 Clinical and epidemiological importance
Escherichia coli is the gram-negative bacterium most
frequently isolated from blood cultures. It is the most
frequent cause of bloodstream infections, community- and hospital-acquired urinary tract infections,
is associated with spontaneous and post-surgical
peritonitis and with skin and soft tissue infections of
polymicrobial aetiology, causes neonatal meningitis
and is one of the leading causative agents in food-borne
infections worldwide.
3.1.2 Resistance mechanisms

In E. coli, resistance to beta-lactams is mostly due to production of beta-lactamases. These enzymes hydrolyse
the beta-lactam ring of beta-lactam antimicrobials, and
are crucial for inhibition of the penicillin-binding protein
(PBP) targets. Resistance to broad-spectrum penicillins,
such as ampicillin or amoxicillin, is usually conferred by
plasmid coded beta-lactamases mainly of the TEM type
and to a lesser extent of the SHV type, (whereby TEM-1
accounts for up to 60% of aminopenicillin resistance),
while resistance to third-generation cephalosporins is
mostly conferred by extended-spectrum beta-lactamases
(ESBLs). The first ESBLs spreading in E. coli were variants of the TEM or SHV enzymes in which single or
multiple amino acid substitutions expand their hydrolysing ability to include third-generation cephalosporins
(in this report referring to cefotaxime, ceftriaxone and
ceftazidime), fourth-generation cephalosporins, and
monobactams. During the past decade, however, these
enzymes have largely been replaced by the CTX-M-type
ESBLs, which are now the most common ESBLs in E. coli.
Most ESBLs can be inhibited by beta-lactamase inhibitors such as clavulanic acid, sulbactam or tazobactam.
Hundreds of ESBL variants have been identified to date.
An important factor in their global dominance is the
wide dissemination of bacterial clones producing CTXM-type ESBLs (e.g., CTX-M-15). Other enzymes affecting
the susceptibility to third-generation cephalosporins
include plasmid-encoded variants derived from some
chromosomal AmpC-type beta-lactamases. CMY-2 is the
most widespread enzyme belonging to this group, which
is still less common than ESBLs in E. coli in Europe, but
more frequently seen in the United States. An important
threat that will require close surveillance in the future
is the emergence of carbapenem resistance in E. coli,
mediated by metallo-beta-lactamases (such as the VIM,
and NDM enzymes) or serine-carbapenemases (such as
the KPC enzymes), providing resistance to most or all
Figure 3.1. Escherichia coli. Percentage (%) of invasive isolates with resistance to third-generation cephalosporins by
country, EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
No data reported or less than 10 isolates
Not included
Non-visible countries
Liechtenstein
Luxembourg
Malta
SURVEILLANCE REPORT
Figure 3.2. Escherichia coli. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country, EU/
EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
Figure 3.3. Escherichia coli. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country,
EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
10
SURVEILLANCE REPORT
available beta-lactam agents. Another growing family

of beta-lactamases comprises the OXA-type enzymes
that confer resistance to ampicillin and cefalotin and are
characterised by their high hydrolytic activity against
oxacillin and cloxacillin and the fact that they are poorly
inhibited by clavulanic acid. This family also includes
some enzymes with carbapenemase activity (OXA-48like enzymes), which have recently emerged in E. coli
and other Enterobacteriaceae. When produced alone,
they confer reduced susceptibility to carbapenems
and resistance to penicillins, but not to the expandedspectrum cephalosporins. Unfortunately, the finding of
E. coli strains which produce multiple beta-lactamases
is becoming increasingly common, also leading to resistance to the latter cephalosporins.
membrane porins or from upregulation of efflux pumps,

resulting in lower outer membrane permeability and
higher efflux, respectively. In recent years, several plasmid-mediated quinolone resistance mechanisms have
also been identified, including the Qnr proteins, which
protect DNA topoisomerases from quinolone binding,
the AAC(6)-Ib-cr enzyme, which inactivates some fluoroquinolones by acetylation, and the QepA efflux pump,
which effluxes hydrophilic quinolones. These mechanisms are a concern because this type of resistance is
transferable and because of their frequent association
with CTX-M and CMY-type enzymes inactivating thirdgeneration cephalosporins. Additionally, their presence
is believed to facilitate evolution to resistance by chromosomal mutations.
Fluoroquinolones interact with DNA gyrase and

topoisomerase IV, which are enzymes that regulate
conformational changes in the bacterial chromosome
during replication and transcription. This interaction
leads to the irreversible inhibition of the enzyme activity followed by DNA fragmentation and eventually
to cell death. Resistance to fluoroquinolones arises
through stepwise mutations in some specific regions
(the so-called quinolone-resistance determining regions
(QRDRs)) of the DNA gyrase subunits (gyrA and gyrB) and
DNA topoisomerase IV subunits (parC). Accumulation of
mutations in several of these genes increases the MIC
in a stepwise manner. Low-level resistance to fluoroquinolones may also arise through changes in outer
Aminoglycosides block protein synthesis by binding to

the ribosomes, which are involved in the translation
of RNA into proteins, and are also able to damage the
outer membrane of gram-negative bacteria. Resistance
to aminoglycosides can be due to targeted modification
(methylation) of the 16S rRNA, which excludes aminoglycoside molecules from binding the small ribosomal
subunit, or by aminoglycoside-modifying enzymes that
acetylate, adenylate or phosphorylate their target molecules and thereby neutralise the biological effect of
aminoglycosides. Of particular concern are the 16S
ribosomal methylases that confer pan-resistance to
aminoglycosides, and are frequently accompanying
carbapenemases.
Figure 3.4. Escherichia coli. Percentage (%) of invasive isolates with combined resistance to third-generation
cephalosporins, fluoroquinolones and aminoglycosides, by country, EU/ EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
11
3.1.3 Antimicrobial susceptibility
SURVEILLANCE REPORT
consistently for all four years. Significantly decreasing trends were observed for four countries (the Czech
Republic, Germany, Lithuania and Luxembourg). For
Lithuania this trend was not significant when considering only laboratories reporting consistently for all
four years (Figure 3.5).
A majority of the E. coli isolates reported to

EARS-Net in 2012 was resistant to at least
one of the antimicrobial groups under surveillance. Aminopenicillin resistance was reported
in more than half of the isolates, followed by
fluoroquinolone resistance and resistance to
third-generation cephalosporins. Many of the isolates resistant to third-generation cephalosporins
were ESBL-positive and showed resistance to
additional antimicrobial groups.
Third-generation cephalosporins
During the last four-year period, an increase

in the percentages of resistant E. coli isolates
was observed throughout Europe. Especially
worrisome is the increase of resistance to thirdgeneration cephalosporins, aminoglycosides and
combined resistance to three major antimicrobial groups, for which a majority of the countries
reported significantly increasing trends.
The EU/EEA population-weighted mean percentage for

third-generation cephalosporin resistance was 11.8%
in 2012. The percentages of resistant isolates in the
reporting countries ranged from 4.4% (Sweden) to
38.1% (Bulgaria). Three countries reported resistance
percentages below 5%, 11 countries reported 510%,
11 countries reported 1025%, and five countries
reported above 25% (Table 3.1 and Figure 3.1).
Carbapenem-resistant E. coli remains generally

rare, but is reported from southern Europe. The
proportion of isolates with resistance to all antimicrobial groups under surveillance by EARS-Net
remains very low (< 0.1%).
Trends for the period 20092012 were calculated for

28 countries. Statistically significant increasing trends
were observed in 19 of 28 countries. For four countries
(the Czech Republic, Estonia, Italy and Poland), the
trends did not remain significant when considering
only data from laboratories reporting consistently for
all four years. The EU/EEA population-weighted mean
percentage also had a statistically significant increasing trend, from 8.2% in 2009 to 11.8% in 2012. Only
Lithuania had a statistically significant decreasing
trend of resistance to third-generation cephalosporins
during the same period (Figure 3.6).
Full susceptibility
For 2012, 74687 E. coli isolates were reported to
EARS-Net, of which 52526 isolates (70%) from 28
countries had complete AST information for all
antimicrobial groups under surveillance for the
bacteria (aminopenicillins, third-generation cephalosporins, fluoroquinolones, aminoglycosides and
carbapenems).
The population-weighted EU/EEA mean percentage
for isolates fully susceptible to all included antimicrobial groups was 39.5% in 2012, ranging from 22.3%
(Bulgaria) to 57.2% (Finland) (Table 3.1).
Aminopenicillins
For 2012, 29 countries reported 60138 isolates with
AST information for aminopenicillins. The number of
isolates with relevant AST information reported per
country ranged from 131 to 9599 (Table 3.1).
The EU/EEA population-weighted mean percentage
for aminopenicillin resistance was 57.4% in 2012.
The percentages of resistant isolates in the reporting countries ranged from 39.7% (Finland) to 71.0%
(Bulgaria). Seven countries reported resistant percentages of 2550%, while the remaining 22 countries
reported resistant percentages above 50% (Table 3.1).
were observed for six countries (Denmark, Finland,
Greece, Italy, the Netherlands and Norway). For
Denmark and Italy the trend was not significant when
considering only data from laboratories reporting
12

AST information for third-generation cephalosporins.
The number of isolates reported per country ranged
from 138 to 9563 (Table 3.1).
Extended-spectrum beta-lactamase (ESBL) production

Twenty-three countries were included in the calculation of ESBL percentages for E. coli. Data were only
included from laboratories reporting ESBL test results
for all isolates identified as resistant to third-generation cephalosporins, and only from countries with at
least 10 of such isolates.
Among E. coli isolates resistant to third-generation
cephalosporins, a large percentage was ascertained
as ESBL-positive. Sixteen of 23 countries reported
between 85% and 100% ESBL-positive isolates among
isolates resistant to third-generation cephalosporins
(Table 3.2).
Fluoroquinolones
relevant AST information for fluoroquinolones. The
number of isolates reported by the countries ranged
from 134 to 9470 (Table 3.1).
for fluoroquinolone resistance was 22.3% in 2012.
The percentages of resistant isolates in the reporting countries ranged from 9.7% (Iceland) to 42.0%
(Cyprus and Italy). One country reported a resistance
percentage below 10%, 18 countries reported 1025%
SURVEILLANCE REPORT
(Bulgaria). One country reported resistance percentages below 5%, 16 countries reported 510%, 13
countries reported above 10% (Table 3.1 and Figure
3.3).
and 11 countries reported above 25% (Table 3.1 and

Figure 3.2).
Trends for the period 20092012 were calculated
for 28 countries. Statistically significant increasing trends were observed for 10 countries. For Italy
and Poland, these trends were not significant when
considering only data from laboratories reporting consistently during all four years. Statistically significant
decreasing trends were observed for Germany and
Hungary; the trend for Hungary was not significant
when considering only data from laboratories reporting consistently for all four years (Figure 3.7).

for 28 countries. Statistically significant increasing
trends were observed for 14 countries. For Poland and
Romania the trends did not remain significant when
considering only data from laboratories consistently
reporting for all four years. The EU/EEA populationweighted mean percentage also had a statistically
significant increase during the same period, from
8.6% in 2009 to 10.3% in 2012. A statistically significant decreasing trend of aminoglycoside resistance
was observed for three countries (Germany, Lithuania
and Malta) (Figure 3.8).
Aminoglycosides
relevant AST information for aminoglycosides. The
number of isolates reported by the countries ranged
from 138 to 5750 (Table 3.1).
Carbapenems
relevant AST information for carbapenems. The number of isolates reported by the countries ranged from
153 to 9091 (Table 3.1).

for aminoglycoside resistance was 10.3% in 2012.
The percentages of resistant isolates in the reporting countries ranged from 3.6% (Iceland) to 26.5%
Table 3.1. Escherichia coli. Total numbers of isolates tested (N) and percentage susceptible to all antimicrobial groups
under EARS-Net surveillance*; total numbers of isolates tested (N) and percentages resistant to aminopenicillins,
fluoroquinolones, third-generation cephalosporins, aminoglycosides and combined resistance** (%R), including 95%
confidence intervals (95% CI), by country, EU/EEA countries, 2012
Country
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
United Kingdom
EU/EEA mean
percentage
(populationweighted)
Fully susceptible*
N
3140
3269
175
902
176
1725
1678
166
1921
5628
4140
1264
1251
0
2215
1929
150
442
333
205
4640
2805
665
2037
110
558
1168
5644
0
4190
% fully S
(95% CI)
45.5 (44-47)
40.1 (38-42)
22.3 (16-29)
43.1 (38-44)
26.1 (20-33)
41.9 (40-44)
50.5 (48-53)
47.6 (40-55)
57.2 (55-59)
42.1 (41-43)
47.2 (46-49)
40.7 (38-43)
31.0 (28-34)
30.4 (29-32)
29.3 (27-31)
45.3 (37-54)
45.5 (41-50)
46.8 (41-52)
42.9 (36-54)
48.1 (47-50)
54.9 (53-57)
34.4 (31-38)
37.4 (35-40)
36.4 (27-46)
29.4 (26-50)
47.3 (44-50)
30.9 (30-31)
35.0 (34-36)
39.5
Aminopenicillins
Third-gen.
cephalosporins
Fluoroquinolones
N
%R (95% CI)
3 625
3898
207
917
176
2811
3708
216
2090
9599
4162
1270
1328
131
2329
2121
153
461
335
205
4697
2995
736
2152
159
596
1168
5672
0
5846
50.6 (49-52)
56.3 (55-58)
71.0 (64-77)
51.3 (48-55)
70.5 (63-77)
56.8 (55-59)
45.2 (44-47)
48.1 (41-55)
39.7 (38-42)
55.2 (54-56)
49.6 (48-51)
55.0 (52-58)
63.9 (61-67)
44.3 (36-53)
67.4 (65-69)
67.5 (65-70)
54.2 (46-62)
52.5 (48-57)
50.7 (45-56)
54.1 (47-61)
49.0 (48-50)
43.2 (41-45)
63.3 (60-67)
59.4 (57-62)
62.3 (54-70)
64.9 (61-69)
50.4 (48-53)
65.4 (64-67)
62.7 (61-64)
3710
4097
223
900
176
2812
2519
305
3162
9563
4186
1393
1411
138
2288
2994
154
462
334
214
4702
3019
1037
2154
172
693
1168
5672
5536
5663
57.4
%R (95% CI)
%R (95% CI)
8.7 (8-10)
3610 20.6 (19-22)
6.9 (6-5)
3515 22.2 (21-24)
38.1 (32-45) 223 34.1 (28-41)
6.0 (3-9)
906 17.2 (15-20)
31.8 (25-39)
176 42.0 (35-50)
11.5 (10-13) 2809 21.0 (19-23)
7.9 (7-9)
3923 14.1 (13-15)
7.9 (5-11)
304 14.1 (10-19)
6.2 (5-7)
3162 11.7 (11-13)
10.0 (9-11) 9470 17.8 (17-19)
8.8 (8-10)
4188 21.1 (20-22)
16.2 (14-18) 1372 29.1 (27-32)
17.4 (15-20) 1393 28.9 (27-31)
5.1 (1-9)
134 9.7 (5-15)
9.2 (8-10) 2380 24.3 (23-26)
26.3 (25-28) 2917 42.0 (40-44)
14.9 (10-22)
152 14.5 (9-21)
4.8 (3-7)
456 14.7 (12-18)
11.4 (8-15)
334 24.0 (19-29)
13.6 (9-19)
214 31.3 (25-38)
6.0 (5-7)
4697 15.5 (14-17)
4.9 (4-6)
2843 11.3 (10-13)
12.9 (11-15) 1033 29.3 (27-32)
13.5 (12-15) 2158 30.3 (28-32)
25.6 (19-33)
133 27.1 (20-35)
30.7 (27-34)
695 41.3 (38-45)
9.5 (8-11)
1168 21.4 (19-24)
13.5 (13-14) 5654 33.9 (33-35)
4.4 (4-5)
5540 11.2 (10-12)
12.9 (12-14) 6241 16.6 (16-18)
11.8
22.3
Aminoglycosides
N
3713
3689
223
913
176
2812
3687
306
2993
5750
4190
1372
1409
138
2378
3091
154
461
334
214
4708
3023
1046
2155
167
694
1168
5675
5538
6390
%R (95% CI)
6.5 (6-7)
3340
5.9 (5-7)
4119
26.5 (21-33)
191
7.0 (6-9)
908
21.0 (15-28)
176
8.4 (7-10)
1729
7.3 (6-8)
2865
7.5 (5-11)
252
6.1 (5-7)
3161
8.2 (7-9)
9091
7.1 (6-8)
4184
17.9 (16-20) 1396
17.2 (15-19) 1307
3.6 (0-7)
0
11.1 (10-12) 2369
21.4 (20-23) 3018
11.7 (7-18)
153
9.5 (7-13)
450
6.3 (4-9)
333
13.6 (9-19)
214
7.2 (6-8)
4701
5.8 (5-7)
3023
11.9 (10-14)
970
16.3 (15-18) 2041
24.0 (18-31)
163
21.2 (18-24)
659
8.6 (7-10)
1168
15.6 (15-17) 5670
5.0 (4-6)
5532
8.6 (8-9)
5182
10.3
Combined**
resistance
Carbapenems
%R (95% CI)
%R (95% CI)
0.1 (0-0)
< 0.1 (0-0)
2.6 (1-6)
0.0 (0-0)
0.0 (0-2)
0.1 (0-0)
0.0 (0-0)
0.0 (0-1)
0.0 (0-0)
0.0 (0-0)
< 0.1 (0-0)
1.4 (1-2)
0.0 (0-0)
0.0 (0-0)
0.2 (0-0)
0.0 (0-2)
0.0 (0-1)
0.0 (0-1)
0.0 (0-2)
< 0.1 (0-0)
0.0 (0-0)
0.0 (0-0)
0.1 (0-0)
0.0 (0-0)
0.9 (0-2)
0.0 (0-0)
0.1 (0-0)
< 0.1 (0-0)
0.2 (0-0)
3579
3330
223
902
176
2809
2285
303
2993
5655
4179
1368
1387
130
2283
2684
152
455
334
214
4675
2835
1011
2152
127
692
1168
5651
5532
5577
2.5 (2-3)
1.8 (1-2)
16.1 (12-22)
2.1 (1-3)
14.8 (10-21)
4.5 (4-5)
2.6 (2-3)
1.7 (1-4)
3.1 (3-4)
3.3 (3-4)
3.2 (3-4)
10.7 (9-12)
10.5 (9-12)
0.7 (0-4)
4.0 (3-5)
14.5 (13-16)
6.6 (3-12)
1.3 (0-3)
2.7 (1-5)
7.9 (5-12)
1.8 (1-2)
1.9 (1-3)
5.8 (4-7)
9.2 (8-11)
14.2 (9-21)
13.6 (11-16)
5.1 (4-7)
5.9 (5-7)
1.8 (1-2)
4.1 (4-5)
< 0.1
4.4
** S
usceptible to aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems. Only isolates tested for all five
antimicrobial groups were included in the analysis.
** Resistance to fluoroquinolones, third-generation cephalosporins and aminoglycosides. Only isolates tested for all three antimicrobial groups were included in the
analysis.
13
SURVEILLANCE REPORT
Figure 3.5. Escherichia coli. Trends of invasive isolates with resistance to aminopenicillins, by country, EU/EEA
countries, 20092012
FI (>)
2009
NO (>)
2010
DK (>*)
2011
NL (>)
2012
DE (<)
SI
AT
LU (<)
HR
LT (<*)
BE
MT
Country code
LV
EL (>)
FR
CZ (<)
EU/EEA
PT
RO
UK
PL
HU
ES
IE
IT (>*)
CY
BG
0
20
40
60
80
% aminopenicillin resistance
Countries not reporting data for all four years were excluded from the analysis.
The symbols > and < indicate significant increasing and decreasing trends, respectively. Asterisks indicate a significant trend in the overall data which were not
supported when only data from laboratories consistently reporting for all four years were included.
EU/EEA refers to the population-weighted mean percentage.
14
100
SURVEILLANCE REPORT
Figure 3.6. Escherichia coli. Trends of invasive isolates with resistance to third-generation cephalosporins, by country,
SE (>)
2009
LT (<)
2010
NO (>)
2011
NL (>)
2012
HR
FI (>)
BE
DK (>)
EE (>*)
AT (>)
DE
IE (>)
SI (>)
Country code
FR (>)
LU
CZ (>*)
EU/EEA (>)
PL (>*)
UK (>)
ES (>)
PT (>)
MT
LV
EL (>)
HU
RO
IT (>*)
CY (>)
BG (>)
0
10
15
20
25
30
35
40
% third-generation cephalosporin resistance

15
SURVEILLANCE REPORT
Figure 3.7. Escherichia coli. Trends of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA
countries, 20092012
SE (>)
2009
NO (>)
2010
FI (>)
2011
DK
2012
EE (>)
LV
LT
NL (>)
HR
UK
FR
AT
CZ
Country code
DE (<)
SI
BE (>)
EU/EEA
LU
IE
RO
HU (<*)
EL (>)
PL (>*)
PT
MT
ES (>)
BG
IT (>*)
CY
0
10
20
30
40
% fluoroquinolone resistance
16
50
SURVEILLANCE REPORT
Figure 3.8. Escherichia coli. Trends of invasive isolates with resistance to aminoglycosides, by country, EU/EEA
countries, 20092012
SE (>)
2009
NO (>)
2010
BE
2011
FI (>)
2012
LU
AT
HR
DE (<)
NL (>)
DK (>)
EE
FR
CZ
Country code
SI
UK
LT (<)
EU/EEA (>)
IE (>)
LV
PL (>*)
MT (<)
ES (>)
PT (>)
HU
EL (>)
CY (>)
IT (>)
RO (>*)
BG (>)
0
10
15
20
25
30
% aminoglycoside resistance
17
SURVEILLANCE REPORT
Figure 3.9. Escherichia coli. Trends of invasive isolates with combined resistance (resistant to fluoroquinolones, thirdgeneration cephalosporins and aminoglycosides), by country, EU/EEA countries, 20092012
LT (<)
2009
EE
2010
BE
2011
NL
2012
SE (>)
NO (>)
AT
DK (>)
LU
FI (>)
DE
FR
Country code
IE (>)
UK
EU/EEA
CZ (>)
SI (>)
PL (>*)
ES (>)
LV
MT
PT (>)
HU
EL (>)
RO
IT (>)
CY (>)
BG (>)
0
10
15
% combined resistance
18
20
SURVEILLANCE REPORT
Table 3.2. Escherichia coli. Number of reporting

laboratories, total numbers of invasive isolates
resistant to third-generation cephalosporins (3GCREC)
and percentage of extended-spectrum beta-lactamase
(ESBL)-positive among these isolates, as ascertained
by the participating laboratories, EU/EEA countries,
2012
Country
Austria
Bulgaria
Croatia
Czech Republic
Denmark
Estonia
Finland
France
Germany
Hungary
Ireland
Italy
Latvia
Lithuania
Luxembourg
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
Number of
laboratories
29
14
12
40
3
6
17
52
15
5
30
3
8
10
5
8
33
16
6
14
10
38
17
Number of
3GCREC
233
69
79
322
45
24
196
915
260
27
198
63
23
22
38
79
134
269
31
213
111
764
241
%ESBL
92.7
94.2
89.9
81.4
91.1
83.3
91.8
70.5
81.9
100.0
82.3
95.2
87.0
100.0
92.1
96.2
85.8
95.9
100
68.1
91.0
82.2
97.1
Only data from laboratories consistently reporting ESBL tests results for all
isolates identified as resistant to third-generation cephalosporins and from
countries with at least 10 of such isolates were selected for the analysis.

carbapenem resistance was < 0.1% in 2012. Thirteen
countries reported one or more resistant isolate(s)
in 2012. The majority of the resistant isolates were
reported by Greece (20 isolates; 32% of all carbapenem-resistant E. coli isolates) and the United Kingdom
(11 isolates; 18%).
Combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides
For 2012, 30 countries reported 64861 E. coli isolates
tested for resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides. The
number of isolates with relevant AST information
reported by the countries ranged from 127 to 5655
(Table 3.1).
combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides was 4.4%
in 2012. The percentage of isolates with combined
resistance reported by individual countries ranged
from 0.7% (Iceland) to 16.1% (Bulgaria). One country
reported a resistance percentage below 1%, 16 countries reported 15%, six countries reported 510%,
and seven countries reported above 10% (Table 3.1
and Figure 3.4).
trends were observed for 14 countries. For Poland,
the trends did not remain significant when considering only data from laboratories reporting consistently
for all four years. A significantly decreasing trend was
observed for Lithuania (Figure 3.9).
Other resistance combinations
Of the total number of isolates tested for all antimicrobial groups under surveillance for E. coli, single
resistance was the most common resistance phenotype, of which single aminopenicillin resistance
predominated. Of those with resistance to two antimicrobial groups, combined aminopenicillin and
fluoroquinolone resistance was most common, and for
those with resistance to three antimicrobial groups,
aminopenicillin, fluoroquinolone and third-generation cephalosporin resistance was the majority. For
isolates with resistance to four antimicrobial groups,
combined resistance to aminopenicillin, fluoroquinolones, third-generation cephalosporins and
aminoglycosides predominated (Table 3.3).
As carbapenem resistance remained uncommon,
resistance combinations including this antimicrobial
group were rare. A total of 19 isolates with resistance to all antimicrobial groups under surveillance by
EARS-Net were reported, of which the majority were
reported from Greece and France.
3.1.4 Discussion and conclusions

Antimicrobial resistance in E. coli requires close attention as the percentages of isolates resistant to commonly
used antimicrobials continue to increase throughout
Europe. The increase of resistance to third-generation
cephalosporins, to aminoglycosides, and of combined
resistance to at least three antimicrobial classes, for
which many countries had significantly increasing
trends during recent years, is especially worrisome.
As E. coli is a common cause of bloodstream infections,
the high percentage of ESBL-producing isolates and isolates with combined resistance is a public health concern
since it limits the number of treatment alternatives for
patients with these life-threatening infections. In addition, the increase in combined resistance and spread of
ESBL may lead to increased use of carbapenems, thus
favouring the further dissemination of carbapenemaseproducing Enterobacteriaceae (CPE)7.
Prudent antimicrobial use and comprehensive infection
control measures are the cornerstones of interventions
aiming to prevent selection and transmission of resistant bacteria, including E. coli. A risk assessment of the
spread of CPE, published by ECDC in 2011 , emphasises
that the use of standard precautions, especially adherence to hand hygiene policies, is fundamental to prevent
transmission of any multidrug-resistant organism, not
only CPE, in healthcare settings.
7 European Centre for Disease Prevention and Control. Risk

assessment on the spread of carbapenemase-producing
Enterobacteriaceae (CPE) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer.
Stockholm: ECDC; 2011
19
SURVEILLANCE REPORT
Table 3.3. Escherichia coli. Total number of tested isolates and resistance combinations among invasive isolates tested
against aminopenicillins, third-generation cephalosporins, fluoroquinolones, aminoglycosides and carbapenems
(n=52526), EU/EEA countries, 2012
Resistance pattern
Fully susceptible
Single resistance (to indicated drug classes)
Total
Aminopenicillins
Fluoroquinolones
Aminoglycosides
Carbapenems
Resistance to two classes of antimicrobial drugs
Total (any two classes in combination)
Aminopenicillins + fluoroquinolones
Aminopenicillins + third-generation cephalosporins
Aminopenicillins + aminoglycosides
Fluoroquinolones + aminoglycosides
Aminopenicillins + carbapenems
Resistance to three classes of antimicrobial drugs
Total (any three classes in combination)
Aminopenicillins + third-generation cephalosporins +fluoroquinolones
Aminopenicillins + fluoroquinolones + aminoglycosides
Aminopenicillins + third-generation cephalosporins + aminoglycosides
Aminopenicillins + fluoroquinolones +carbapenems
Aminopenicillins + third-generation cephalosporin + carbapenems
Aminopenicillins + aminoglycosides + carbapenems
Resistance to four classes of antimicrobial drugs
Total (any four classes in combination)
Aminopenicillins + third-generation cephalosporins + fluoroquinolones + aminoglycosides
Aminopenicillins + third-generation cephalosporins + fluoroquinolones + carbapenems
Aminopenicillins + third-generation cephalosporins + aminoglycosides + carbapenems
Aminopenicillins + fluoroquinolones + aminoglycosides + carbapenems
Resistance to five classes of antimicrobial drugs
Aminopenicillins + third-generation cephalosporins + fluoroquinolones + aminoglycosides + carbapenems
Number of tested isolates

21532
% of total*
41.0
18031
16631
1273
121
6
34.3
31.7
2.4
0.2
<0.1
6440
4268
1277
810
83
2
12.3
8.1
2.4
1.5
0.2
<0.1
3957
1926
1721
301
4
3
2
7.5
3.7
3.3
0.6
<0.1
<0.1
<0.1
2547
2521
14
6
6
4.8
4.8
<0.1
<0.1
<0.1
19
<0.1
* Not adjusted for population differences in the reporting countries.

Only data from isolates tested against all five antimicrobial classes were included in the analysis.
Figure 3.10. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to third-generation
cephalosporins, by country, EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
20
SURVEILLANCE REPORT
3.2 Klebsiella pneumoniae

Bacteria of the genus Klebsiella are frequent colonisers
of the gastrointestinal tract in humans, but may also be
found on skin, in the oropharynx and upper airways in
hospitalised individuals. Klebsiella pneumoniae is associated with opportunistic infections in individuals with
impaired immune systems, such as newborns, cancer
patients, diabetic, alcoholic and hospitalised patients
with indwelling devices. The most common sites of
infection are the urinary tract and the respiratory tract.
Organisms such as K. pneumoniae can spread rapidly,
from the gastrointestinal tract of patients and via the
hands of hospital personnel to colonise other patients,
leading to nosocomial outbreaks. Klebsiella pneumoniae
is the second most frequent cause of gram-negative
bloodstream infections after E. coli. The mortality rates
for pneumonia caused by K. pneumoniae can be high
even when appropriate antimicrobial treatment is given.
However, this also depends on the severity of the underlying condition.

Similar to E. coli, K. pneumoniae can be resistant to multiple antimicrobials, and resistance traits are frequently
acquired through plasmids. However, in contrast to
E. coli, K. pneumoniae has a chromosomally encoded
SHV beta-lactamase and is thus intrinsically resistant
to aminopenicillins. Moreover, this organism readily
acquires plasmid-mediated resistance determinants.

Many novel ESBL variants were initially identified in
K. pneumoniae and were only subsequently found in
E. coli. Since the resistance mechanisms do not differ
significantly from those described for E. coli, readers
should refer to the E. coli section (3.1, above) for further
details. Carbapenems have been widely used in many
countries due to the increasing rate of ESBL-producing
Enterobacteriaceae with a consequent impact on the
emergence of resistance to these antimicrobials, especially in K. pneumoniae. KPC carbapenemase-producing
clones of K. pneumoniae have been observed in the
United States, Greece, Italy and Israel, and similar
strains are now spreading in several European countries,
while plasmids encoding the VIM metallo-carbapenemase are frequent in K. pneumoniae in Greece. More
recently, strains producing the NDM metallo-carbapenemase have been observed in patients returning from the
Indian subcontinent. The blaOXA-48 gene codes for an oxacillinase (OXA-48) that causes resistance to penicillin
and reduces susceptibility to carbapenems, but (when
produced alone), not to expanded-spectrum cephalosporins. The level of resistance is often low and such
strains are thus frequently missed in laboratories using
automated AST systems. A combination of OXA-48-like
enzymes (OXA-48 and some closely related variants
with similar properties) with ESBLs such as CTX-M15
can occur in Klebsiella spp. and can result in a highly
drug-resistant phenotype. Single clones with such combinations have caused hospital outbreaks in several
European countries. OXA-48-producing isolates have
Figure 3.11. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
21
SURVEILLANCE REPORT
Figure 3.12. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to aminoglycosides, by
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
Figure 3.13. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to carbapenems, by country,
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
22
SURVEILLANCE REPORT
often been observed in patients returning from endemic

areas (Turkey, North Africa and the Middle East). OXA48 has become the most common carbapenemase in
carbapenem-resistant Enterobacteriaceae in Spain.

A majority of the K. pneumoniae isolates reported
to EARS-Net in 2012 was resistant to at least one
of the antimicrobial agents under surveillance.
The most common resistance phenotype was
combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides.
ESBL was commonly reported for the isolates
with third-generation cephalosporin resistance.
A north-to-east/south gradient could be noted for
most antimicrobial groups, with lower resistance
percentages reported for the north and higher
from the eastern and southern parts of Europe.
The percentage of isolates resistant to thirdgeneration cephalosporins and with combined
resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides has
increased significantly in Europe over the last
four years. The increase was observed not only
for countries with comparatively low resistance
percentages, but also for countries with already
very high resistance levels.
Further complicating the situation is the increasing percentage of carbapenem resistance in
a number of countries, mainly in the south of
Europe.
The percentage of isolates resistant to all antimicrobial groups under surveillance by EARS-Net for
K. pneumoniae (including carbapenems) was 7%,
mainly reflecting isolates reported from Greece
and Italy.
Full susceptibility
For 2012, 17410 isolates were reported to EARS-Net,
for which 15059 isolates (86%) from 29 countries had
complete AST information for all antimicrobial groups
under surveillance for K. pneumoniae (third-generation
cephalosporins, fluoroquinolones, aminoglycosides
and carbapenems).
The population-weighted EU/EEA mean percentage for
isolates fully susceptible to all antimicrobials tested
was 47.3% in 2012, with national estimates ranging
from 20.4% (Bulgaria) to 96.3% (Finland) (Table 3.4).
For 2012, 30 countries reported 16704 K. pneumoniae
isolates with AST information for third-generation
cephalosporins. The number of isolates reported by
the countries ranged from 14 to 1711 (Table 3.4).

for third-generation cephalosporin resistance was
25.7% in 2012. The percentages of resistant isolates
in the reporting countries ranged from 1.7% (Finland)
to 74.8% (Bulgaria). Three countries reported resistance percentages below 5%, two countries reported
510%, 10 countries reported 1025%, seven countries reported 2550%, and eight countries reported
above 50% (Table 3.4, Figure 3.10).
were observed for eight countries. For Luxembourg,
the trend did not remain significant when considering
percentage also increased significantly from 21.5% in
2009 to 25.7% in 2012. None of the reporting countries had statistically significant decreasing trends of
resistance to third-generation cephalosporins (Figure
3.15).
Extended-spectrum beta-lactamase (ESBL)
Twenty countries were included in the calculation of
ESBL percentages for K. pneumoniae. Data were only
included from laboratories reporting ESBL test results
for all isolates identified as resistant to third-generation cephalosporins, and only from countries with at
least 10 of such isolates.
Among K. pneumoniae isolates resistant to thirdgeneration cephalosporins, a large percentage was
ascertained as ESBL-positive by the participating laboratories in 2012. Thirteen of 20 countries reported
between 85% and 100% ESBL-positive isolates among
isolates resistant to third-generation cephalosporins
(Table 3.5).
Fluoroquinolones
AST information for fluoroquinolones. The number of
isolates reported per country ranged from 14 to 1691
(Table 3.4).
for fluoroquinolone resistance was 25.3% in 2012.
The percentages of resistant isolates in the reporting countries ranged from 2.1% (Finland) to 69.7%
(Greece). Three countries reported resistance percentages below 5%, five countries reported 510%, seven
countries reported 1025%, nine countries reported
2550%, and six countries reported above 50% (Table
3.4, Figure 3.11).
trends were observed for ten countries. For Greece
and Luxembourg, the trend was not significant when
considering only data from laboratories reporting
consistently for all four years. Statistically significant
decreasing trends were observed for four countries
(the Czech Republic, Cyprus, Denmark and Norway)
(Figure 3.16).
23
Aminoglycosides
number of isolates reported per country ranged from
16 to 1432 (Table 3.4).
for aminoglycoside resistance was 22.2% in 2012.
The percentages of resistant isolates in the reporting countries ranged from zero (Iceland) to 63.4%
(Lithuania). Four countries reported resistance percentages below 5%, six countries reported 510%,
six countries reported 1025%, six countries reported
2550%, and eight countries reported above 50%
(Table 3.4, Figure 3.12).
were observed for ten countries. For Luxembourg and
France, the trends were not significant when considering only data from laboratories reporting consistently
for all four years. The EU/EEA population-weighted
mean percentage also increased significantly during the same period, from 18.2% in 2009 to 22.2% in
2012. A statistically significant decreasing trend was
only observed for Finland (Figure 3.17).
Carbapenems
relevant AST information for carbapenems. The number of isolates reported by the countries ranged from
SURVEILLANCE REPORT
48 to 1627. Twenty countries reported one or more

resistant isolate(s) in 2012. The majority of the resistant isolates (n=1221) were reported by Greece (883
isolates), followed by Italy (242 isolates) (Table 3.4).
for carbapenem resistance was 6.2% in 2012. The
percentages of resistant isolates in the reporting
countries ranged from zero (seven countries) to 60.5%
(Greece). Twenty countries reported resistance percentages below 1%, four countries reported 15%,
two countries 510%, one country reported 1025%,
and two countries reported above 25% (Table 3.4,
Figure 3.13).
were observed for five countries (France, Greece, Italy,
Norway and Spain). For France and Norway, the trend
was not significant when considering only data from
laboratories reporting consistently for all four years.
also increased significantly during the same period,
from 3.2% in 2009 to 6.2% in 2012. None of the reporting countries had statistically significant decreasing
trends of resistance to carbapenems (Figure 3.18).
Combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides
For 2012, 30 countries reported 15690 K. pneumoniae
isolates tested for resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides.
Figure 3.14. Klebsiella pneumoniae. Percentage (%) of invasive isolates with combined resistance (resistance to thirdgeneration cephalosporins, fluoroquinolones and aminoglycosides), by country, EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
24
SURVEILLANCE REPORT
Table 3.4. Klebsiella pneumoniae. Total number of isolates tested (N) and percentage susceptible to all
antimicrobial groups under EARS-Net surveillance*, total number of isolates tested (N) and percentage resistant to
aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and combined resistance**
(%R), including 95% confidence intervals (95% CI), by country, EU/EEA countries, 2012
Country
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
United Kingdom
EU/EEA mean percentage
(population-weighted)
Fully susceptible*
N
707
477
108
342
65
1307
473
74
516
1093
661
1426
466
0
326
743
76
183
48
56
665
593
344
745
81
329
254
1149
976
776
Third-gen.
cephalosporins
Fluoroquinolones
Aminoglycosides
% fully S
N
%R (95% CI)
N
%R (95% CI)
N
%R (95% CI)
N
%R (95% CI)
(95% CI)
81.0 (78-84) 859 11.8 (10-14)
829 15.4 (13-18)
858
5.4 (4-7)
738
0.8 (0-2)
75.7 (72-79) 540 16.5 (13-20)
532 17.3 (14-21)
503 10.7 (8.13)
545
0.7 (0-2)
20.4 (13-29)
127 74.8 (66-82)
127 47.2 (38-56)
127 54.3 (45-63) 108
1.9 (0-7)
40.0 (35-45) 342 44.0 (42-51) 342 43.0 (37-48) 344 45.0 (40-51) 343
0.3 (0-2)
67.7 (55-79)
65 23.1 (14-35)
65 21.5 (12-33)
65 18.5 (10-30)
65 9.2 (3-19)
39.6 (37-42) 1399 51.2 (49-54) 1399 50.4 (48-53) 1399 54.4 (52-57) 1307
0.3 (0-1)
84.1 (81-87)
621 10.5 (8-13)
941 8.8 (7-11)
902
6.0 (5-8)
680
0.3 (0-1)
77.0 (66-86)
90 17.8 (11-27)
87 17.2 (10-27)
91 13.2 (7-22)
79
1.3 (0-7)
96.3 (94-98) 536
1.7 (1-3)
536
2.1 (1-4)
516
0.4 (0-1)
536
0.0 (0-1)
67.6 (65-70) 1711 22.6 (21-25) 1691 24.4 (22-27) 1119 23.6 (21-26) 1627
0.5 (0-1)
82.8 (80-86) 664 13.0 (10-16)
663 13.7 (11-17)
663 8.3 (6-11)
661
0.0 (0-1)
25.9 (24-28) 1459 70.9 (68-73) 1428 69.7 (67-72) 1432 62.9 (60-65) 1460 60.5 (58-63)
52.6 (48-57) 500 43.0 (39-47) 485 41.6 (37-46) 500 41.0 (37-45)
481
2.9 (2-5)
14 21.4 (0-43)
14 7.1 (0-21)
16 0.0 (0-22)
0
86.2 (82-90) 326 9.5 (7-13)

338 7.4 (5-11)
338 9.2 (6-13)
338
0.0 (0-1)
46.2 (43-90) 847 47.7 (44-51)
830 49.6 (46-53) 863 42.2 (39-46) 841 28.8 (26-32)
35.5 (25-47)
78 64.1 (52-75)
78 46.2 (35-58)
78 51.3 (40-63)
76
0.0 (0-5)
32.8 (26-40) 186 64.0 (57-71)
184 55.4 (48-63) 186 63.4 (56-70)
185
0.0 (0-2)
56.3 (41-71)
50 34.0 (21-49)
50 32.0 (20-47)
50 26.0 (15-40)
48
0.0 (0-7)
67.9 (54-80)
56 26.8 (16-40)
56 25.0 (14-38)
56 26.8 (16-40)
56 3.6 (0-12)
89.3 (87-92) 683
6.7 (5-9)
670
5.4 (4-7)
685
6.3 (5-8)
684
0.1 (0-1)
94.1 (92-96) 621
3.2 (2-5)
596
4.0 (3-6)
622
2.4 (1-4)
623
0.5 (0-1)
34.6 (30-40) 362 60.5 (55-66)
359 60.2 (55-65) 369 51.8 (47-57)
359
0.8 (0-2)
53.7 (50-57) 781 38.7 (35-42) 777 35.8 (32-39) 780 31.8 (29-35)
749
0.7 (0-2)
35.8 (25-47)
95 57.9 (47-68)
85 51.8 (41-63)
92 54.3 (44-65)
95 13.7 (7-22)
29.8 (25-35)
378 62.7 (58-68) 376 66.8 (62-72) 378 63.0 (58-68) 331
6.3 (4-9)
65.4 (59-71)
254 28.3 (23-34) 254 33.1 (27-39)
254 20.5 (16-26)
254
0.4 (0-2)
76.8 (74-79) 1153 16.7 (15-19) 1150 16.5 (14-19) 1153 14.1 (12-16) 1152
0.8 (0-1)
92.1 (90-95) 976
2.8 (2-4)
976
3.7 (3-5)
976
2.5 (2-4)
976
0.0 (0-0)
83.9 (81-86) 931 11.7 (10-14) 1036
7.4 (6-9)
1059
6.1 (5-8)
888
0.5 (0-1)
47.3
25.7
25.3
Combined
resistance**
Carbapenems
22.2
6.2
%R (95% CI)
828
477
127
342
65
1399
577
86
516
1097
663
1427
485
14
326
753
78
184
50
56
667
593
353
776
82
376
254
1150
976
913
4.2 (3-6)
8.2 (6-11)
36.2 (28-45)
26.0 (21-31)
10.8 (4-21)
41.8 (39-44)
3.1 (2-5)
10.5 (5-19)
0.2 (0-1)
19.4 (17-22)
6.2 (4-8)
59.9 (57-62)
37.5 (33-42)
0.0 (0-23)
3.4 (2-6)
40.0 (36-44)
42.3 (31-54)
52.2 (45-60)
20.0 (10-34)
19.6 (10-32)
2.7 (2-4)
1.5 (1-3)
48.4 (43-54)
25.1 (22-28)
41.5 (31-53)
55.3 (50-60)
17.3 (13-23)
8.9 (7-11)
1.4 (1-2)
2.4 (2-4)
18.5
** S
usceptible to fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems. Only isolates tested for all four antimicrobial groups were
included in the analysis.
** Resistance to fluoroquinolones, third-generation cephalosporins and aminoglycosides. Only isolates tested for all four antimicrobial groups were included in the
analysis.
The number of isolates with relevant AST information reported by the countries ranged from 14 to 1427
(Table 3.4).
combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides was 18.5%
in 2012. The percentage of isolates with combined
resistance to the above-mentioned antimicrobial
groups reported by the countries ranged from zero
(Iceland) to 59.9% (Greece). Two countries reported
a resistance percentage below 1%, seven countries
reported 15%, three countries reported 510%, six
countries reported 1025%, nine countries reported
2550% and three countries reported percentages
above 50% (Table 3.4 and Figure 3.14).
were observed for 11 countries. For Luxembourg, the
trends did not remain significant when considering
percentage also showed a significant increasing trend
during the same period, from 14.3% in 2009 to 18.5%

in 2012. A statistically significant decreasing trend
was observed for Denmark. (Figure 3.19).
Other resistance combinations
Of the total number of K. pneumoniae isolates tested
for all antimicrobial groups under surveillance, combined resistance to third-generation cephalosporins,
fluoroquinolones and aminoglycosides was the most
common resistance phenotype, more frequent than
isolates with single resistance or resistance to two
antimicrobial groups together (Table 3.6).
Close to seven percent of the isolates were resistant to
all four antimicrobial groups under surveillance. The
majority of these isolates was reported from Greece
and Italy (73% and 20%, respectively, of all isolates
resistant to all four antimicrobial groups).
3.2.4 Discussion and conclusion

Antimicrobial resistance in K. pneumoniae is a public health concern of increasing importance in Europe.
Widespread resistance to multiple antimicrobial classes
25
and a high percentage of ESBL-producing isolates are

complicating the treatment of serious infections caused
by these bacteria. More than half of the K. pneumoniae
isolates reported in 2012 were resistant to at least one
antimicrobial group, and among all the resistant isolates
the most common phenotype was a combined resistance
to third-generation cephalosporins, fluoroquinolones
and aminoglycosides.
Further diminishing the available options for antimicrobial treatment is the increasing percentage of
carbapenem-resistant K. pneumoniae in some European
countries. This increasing trend of carbapenem resistance in K. pneumoniae has been confirmed by a
separate and more detailed analysis of EARSS/EARS-Net
data from 2005 to 2010, showing an increase in progressively more countries in Europe8. Even if the increase is
currently only observed in a few countries, this is of particular concern as the carbapenems are among the few
effective antimicrobials available for the treatment of
infections caused by multidrug-resistant K. pneumoniae.
Although information on carbapenemase production is
very limited in EARS-Net, data from scientific publications and enhanced surveillance established by some
EU Member States indicate an increase in the spread
of carbapenemase-producing Enterobacteriaceae (CPE)
in Europe in recent years, with reports of travel-related
cases, autochthonous cases and outbreaks. A recent
online survey performed as part of the ECDC-funded
European Survey on CPE (EuSCAPE) showed that CPE
continue to spread in Europe. Although most countries
reported only single hospital outbreaks, the epidemiological situation has deteriorated over the past three
years9.
ECDC issued two risk assessments targeting CPE during 201110,11, emphasising the need for implementation
of infection control measures such as active patient
screening and additional hygiene precautions for the
care of CPE-positive patients. In addition, countries
are encouraged to develop national guidance on how
to stop the spread of CPE within their country, and to
actively report cases of CPE by making confirmed cases
notifiable to national public health authorities. These
interventions would not only target CPE but also affect
the general spread of AMR.
8 Magiorakos AP, Suetens C, Monnet DL, Gagliotti C, Heuer OE;

EARS-Net Coordination Group and EARS-Net participants. The rise
of carbapenem resistance in Europe: just the tip of the iceberg?
Antimicrob Resist Infect Control. 2013 Feb 14;2(1):6.
9 Glasner C, Albiger B, Buist G, Tambi Andrasevi A, Canton R,
Carmeli Y, et al; European Survey on Carbapenemase-Producing
Enterobacteriaceae (EuSCAPE) working group. Carbapenemaseproducing Enterobacteriaceae in Europe: a survey among national
experts from 39 countries, February 2013. Euro Surveill. 2013 Jul
11;18(28).
10 European Centre for Disease Prevention and Control. Risk
assessment on the spread of carbapenemase-producing
Enterobacteriaceae (CPE) through patient transfer between
healthcare facilities, with special emphasis on cross-border transfer.
11 European Centre for Disease Prevention and Control. Updated risk
assessment on the spread of NDM and its varint within Europe.
26
SURVEILLANCE REPORT
Table 3.5. Klebsiella pneumoniae. Number of reporting

laboratories, total number of invasive isolates resistant
to third-generation cephalosporins (3GCRKP) and
percentage of extended-spectrum beta-lactamase
(ESBL)-positive among these isolates, as ascertained
by participating laboratories, by country, EU/EEA
countries, 2012
Country
Austria
Bulgaria
Croatia
Czech Republic
Estonia
France
Germany
Hungary
Ireland
Latvia
Lithuania
Luxembourg
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
Number of
laboratories
24
9
12
45
7
48
14
11
13
6
11
4
15
32
17
6
14
9
33
9
Number of
3GCRKP
58
44
175
675
16
338
59
60
31
45
119
17
33
219
274
47
237
72
193
27
%ESBL
77.6
95.5
99.4
91.1
81.3
70.7
84.7
100
77.4
97.8
99.2
100
100
97.3
94.9
95.7
62
100
81.9
88.9
Only data from laboratories consistently reporting ESBL tests results for all
isolates identified as resistant to third-generation cephalosporins and from
countries with at least 10 of such isolates were selected for the analysis.
SURVEILLANCE REPORT
Table 3.6. Klebsiella pneumoniae. Total number of tested isolates and resistance combinations among invasive
isolates tested against third-generation cephalosporins, fluoroquinolones, aminoglycosides and carbapenems
(n=15059), EU/EEA countries, 2012
Resistance pattern
Fully susceptible
Total (all single resistance)
Fluoroquinolones
Aminoglycosides
Carbapenems
Third-generation cephalosporins + aminoglycosides
Third-generation cephalosporins + fluoroquinolones
Third-generation cephalosporins + carbapenems
Fluoroquinolones + carbapenems
Third-generation cephalosporins + fluoroquinolones + aminoglycosides
Third-generation cephalosporins + fluoroquinolones + carbapenems
Third-generation cephalosporin + aminoglycosides + carbapenems
Third-generation cephalosporins + fluoroquinolones + aminoglycosides + carbapenems

9410
% of total*
62.5
879
401
369
107
2
5.8
2.7
2.5
0.7
<0.1
1019
398
372
233
14
2
6.8
2.6
2.5
1.5
0.1
<0.1
2722
2573
127
22
18.1
17.1
0.8
0.1
1029
6.8

Only data from isolates tested against all four antimicrobial classes were included in the analysis.
27
SURVEILLANCE REPORT
Figure 3.15. Klebsiella pneumoniae. Trends of invasive isolates with resistance to third-generation cephalosporins, by
country, EU and EEA countries, 20092012
FI
2009
SE
2010
NO
2011
NL
2012
IE
DK
UK (>)
AT (>)
DE
BE
ES (>)
EE
Country code
FR (>)
CY
IS
EU/EEA (>)
MT (>)
SI
LU (>*)
PT (>)
HU
HR
IT (>)
CZ
PL
LT
LV
EL
BG
0
20
40
60
80

28
100
SURVEILLANCE REPORT
Figure 3.16. Klebsiella pneumoniae. Trends of invasive isolates with resistance to fluoroquinolones, by country, EU and
EEA countries, 20092012
FI
2009
SE
2010
NO (<*)
2011
NL
2012
IS
IE
UK
DK (<)
DE
AT (>)
ES
EE
BE
Country code
CY (<)
FR
MT (>)
EU/EEA
LU (>*)
SI (>)
PT (>)
HU (>)
HR
LV
BG
IT (>)
CZ (<)
LT (>)
PL (>)
EL (>*)
0
10
20
30
40
50
60
70
80
29
SURVEILLANCE REPORT
Figure 3.17. Klebsiella pneumoniae. Trends of invasive isolates with resistance to aminoglycosides, by country, EU and
FI (<)
2009
NO
2010
SE (>)
2011
AT
2012
DK
UK
NL
DE
IE
BE
EE
Country code
ES (>)
CY
SI
EU/EEA (>)
FR (>*)
LU (>*)
MT (>)
PT (>)
HU
IT (>)
HR
LV
PL (>)
BG
CZ (>)
EL (>)
LT
0
10
20
30
40
50
60
70
30
80
SURVEILLANCE REPORT
Figure 3.18. Klebsiella pneumoniae. Trends of invasive isolates with resistance to carbapenems, by country, EU and
DE
2009
SE
2010
IE
2011
LV
2012
FI
NL
HR
DK
CZ
SI
UK
Country code
NO (>*)
FR (>*)
BE
PT
PL
ES (>)
AT
EE
BG
HU
MT
EU/EEA (>)
CY
IT (>)
EL (>)
0
10
20
30
40
50
60
70
80
% carbapenem resistance
31
SURVEILLANCE REPORT
Figure 3.19. Klebsiella pneumoniae. trends of invasive isolates with combined resistance (third-generation
cephalosporins, fluoroquinolones and aminoglycosides), by country, EU and EEA countries, 20092012
FI
2009
SE
2010
NO
2011
UK
2012
NL
DK (<)
IE
AT (>)
DE
BE
ES (>)
Country code
EE
CY
SI
EU/EEA (>)
FR (>)
MT (>)
LU (>*)
PT (>)
BG
HU (>)
IT (>)
CZ (>)
LV
PL
LT (>)
EL (>)
0
10
20
30
40
50
60
70
32
80
SURVEILLANCE REPORT
3.3 Pseudomonas aeruginosa

Pseudomonas aeruginosa is a non-fermentative gramnegative bacterium that is ubiquitous in aquatic
environments in nature. It is an opportunistic pathogen for plants, animals and humans, and is a major and
dreaded cause of infection in hospitalised patients with
localised or systemic impairment of immune defences,
being a common cause of hospital-acquired pneumonia
(including ventilator-associated pneumonia), bloodstream and urinary tract infections. Because of its
ubiquity, its enormous versatility and intrinsic tolerance
to many detergents, disinfectants and antimicrobial
compounds, it is difficult to control P. aeruginosa in
hospitals and institutional environments. Moreover,
P.aeruginosa is a frequent cause of skin infections such
as folliculitis and otitis externa among recreational and
competitive swimmers. In patients with cystic fibrosis,
P. aeruginosa causes severe bacterial complication
leading to chronic colonisation and intermittent exacerbation of the condition with, for example, bronchiolitis
and acute respiratory distress syndrome. Finally, P. aeruginosa is commonly found in burn units, and in these
locations it is almost impossible to eradicate colonising
strains with classic infection control procedures.
3.3.2 Resistance mechanism

Pseudomonas aeruginosa is intrinsically resistant to
the majority of antimicrobial agents due to its selective
ability to exclude various molecules from penetrating its
outer membrane. The antimicrobial classes that remain

active include some fluoroquinolones (e.g. ciprofloxacin
and levofloxacin), aminoglycosides (e.g. gentamicin,
tobramycin and amikacin), some beta-lactams (piperacillintazobactam, ceftazidime, cefepime, imipenem,
doripenem and meropenem) and polymyxins (polymyxin
B and colistin)). Resistance of P. aeruginosa to these
agents can be acquired through one or more of several
mechanisms:
mutational modification of antimicrobial targets such
as topoisomerases or ribosomal proteins, which
confer resistance to fluoroquinolones and aminoglycosides, respectively;

mutational derepression of the chromosomally
coded AmpC beta-lactamase, that can confer resistance to penicillins and cephalosporins active against
Pseudomonas spp., and which is not inhibited by
tazobactam;
mutational loss of outer membrane proteins preventing the uptake of antimicrobial agents such as
carbapenems;
mutational upregulation of efflux systems, that can
confer resistance to beta-lactams, fluoroquinolones
and aminoglycosides; and
acquisition of plasmid-mediated resistance genes
coding for various beta-lactamases and aminoglycoside-modifying enzymes that can confer resistance
to various beta-lactams including carbapenems (e.g.
metallo-beta-lactamases) and aminoglycosides, or
Figure 3.20. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to piperacillin
(tazobactam), by country, EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
33
SURVEILLANCE REPORT
Figure 3.21. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to ceftazidime, by country,
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
Figure 3.22. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
34
SURVEILLANCE REPORT
coding for 16S rRNA ribosomal methylases that can

confer high-level resistance to all aminoglycosides.

High percentages of resistance in P. aeruginosa isolates were reported, with a majority of
the countries reporting resistance percentages
above 10% for all antimicrobial groups under
surveillance.
Carbapenem resistance was common, with an
EU/EEA population-adjusted mean percentage of
17.1% and national estimates reported between
3.2% and 51.2%.
Combined resistance was also common; 13.8% of
the isolates were resistant to at least three antimicrobial groups and 5.8% of the isolates were
resistant to all five antimicrobial classes under
surveillance.
A north-to-east and east/south gradient was
noted for most antimicrobials, with generally
lower resistance percentages reported from the
north and higher in the eastern and southern
parts of Europe.
Full susceptibility
For 2012, 13218 isolates were reported to EARS-Net,
for which 8996 isolates (68%) had complete AST
information for all antimicrobial groups under surveillance for P. aeruginosa (piperacillin tazobactam,
ceftazidime, fluoroquinolones, aminoglycosides and
carbapenems).
The population-weighted EU/EEA mean percentage
for isolates fully susceptible to all antimicrobials
tested was 63.9% in 2012, ranging from 87.8% (the
Netherlands and Sweden) to 33.1% (Slovakia) (Table
3.7).
Piperacillin (tazobactam)
AST information for piperacillin (tazobactam). The
number of isolates with relevant AST information
reported per country ranged from 10 to 1627.
for piperacillin (tazobactam) resistance was 19.8%.
The percentages of resistant isolates in the reporting
countries ranged from 3.1% (the United Kingdom) to
47.5% (Romania). Two countries reported resistance
percentages lower than 5%, eight countries reported
510%, 13 countries reported 1025% and seven countries reported 2550% (Table 3.7 and Figure 3.20).
were observed for five countries (Austria, Denmark,
Ireland, Italy and Sweden). For Italy, the trend was not
significant when considering only data from laboratories reporting consistently throughout the period.
Figure 3.23. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to aminoglycosides, by
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
35
SURVEILLANCE REPORT
Figure 3.24. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to carbapenems, by
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
Figure 3.25. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with combined resistance (resistance to
three or more antimicrobial classes among piperacillin (tazobactam), ceftazidime, fluoroquinolones, aminoglycosides
and carbapenems), by country, EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
36
SURVEILLANCE REPORT

were observed for four countries (Austria, Ireland, Italy
and Hungary). For Italy, the trend was not significant
when considering only data from laboratories reporting consistently throughout the period. Statistically
significant decreasing trends were observed for the
Czech Republic and Malta (Figure 3.27).
also increased significantly during the same period,

from 15.8% in 2009 to 19.8% in 2012. Statistically
significant decreasing trends were observed for two
countries (Slovenia and Malta) (Figure 3.26).
The ongoing shift from the use of antimicrobial susceptibility breakpoints from the CLSI clinical guidelines to
EUCAST guidelines in many countries might introduce
bias in trend analyses, as the breakpoint for piperacillin (tazobactam) resistance is considerably lower in
EUCAST than in CLSI (Annex 1).
Fluoroquinolones
10 to 1723.
Ceftazidime
For 2012, 30 countries reported 10318 isolates, with
relevant AST information for ceftazidime. The number
of isolates reported per country ranged from 10 to
1607.

fluoroquinolone resistance was 21.0%. The percentages of resistant isolates in the reporting countries
ranged from zero (Malta) to 56.3% (Slovakia). Two
countries reported resistance percentages lower
than 5%, five countries 510%, 15 countries reported
1025%, six countries reported 2550%, and two
countries reported above 50% (Table 3.7 and Figure
3.22).

ceftazidime resistance was 13.5%. The percentages
of resistant isolates reported by the countries ranged
from 2.8% (the Netherlands) to 48.6% (Romania).
Four countries reported resistance percentages lower
than 5%, nine countries reported 510%, 12 countries
reported 1025% and five countries reported 2550%
(Table 3.7 and Figure 3.21).
Table 3.7. Pseudomonas aeruginosa. Total number of isolates tested (N) and percentage (%) of invasive isolates
susceptible to all antimicrobial groups under EARS-net surveillance*, total number of isolates tested (N) and
percentage (%R) with resistance to piperacillin (tazobactam), ceftazidime, fluoroquinolones, aminoglycosides,
carbapenems and combined resistance**, including 95% confidence intervals, by country, EU/EEA countries, 2012
Country
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
United Kingdom
Fully susceptible*
N
430
306
49
196
50
489
304
26
313
1036
427
790
600
10
208
467
17
28
31
31
370
180
144
564
34
133
134
816
271
542
% fully S
(95% CI)
71.2 (67-75)
76.1 (71-81)
51.0 (36-66)
50.5 (43-58)
74.0 (60-85)
60.5 (56-65)
85.2 (81-89)
57.7 (37-77)
(85.9 (82-90)
56.1 (53-59)
68.1 (63-73)
41.9 (38-45)
50.0 (46-54)
80.0 (44-97)
68.3 (61-75)
48.8 (44-53)
64.7 (38-86)
78.6 (59-92)
71.0 (52-86)
80.6 (63-93)
87.8 (84-91)
84.4 (78-89)
50.7 (42-59)
61.0 (57-65)
41.2 (25-65)
33.1 (25-91)
69.4 (61-91)
66.4 (63-70)
87.8 (83-91)
87.3 (84-90)
63.9
Piperacillin
tazobactam
N
588
342
50
201
50
489
389
31
314
1627
432
849
610
10
216
537
17
28
31
31
386
198
157
586
40
195
134
835
271
636
%R (95% CI)
Ceftazidime
N
%R (95% CI)
Fluoroquinolones
Aminoglycosides
%R (95% CI)
%R (95% CI)
Combined
resistance**
Carbapenems
N
%R (95% CI)
%R (95% CI)
18.2 (15-22) 572 14.0 (11-17) 487 14.4 (11-18) 592 11.5 (9-14) 562 14.6 (12-18) 595 10.8 (8-14)
9.7 (7-13)
326 8.3 (6-12)
329 18.2 (14-22) 286 11.2 (8-15) 391 9.7 (7-13)
346 8.7 (6-12)
26.0 (15-40)
52 34.6 (22-49)
52 32.7 (20-47)
52 32.7 (20-47)
51 31.4 (19-46)
52 34.6 (22-49)
18.4 (13-25) 196 12.8 (9-19) 201 23.9 (18-31) 203 26.1 (20-33) 201 21.9 (17-28) 196
6.1 (3-9)
10.0 (3-22)
52 15.4 (7-28)
52 15.4 (7-28)
52 15.4 (7-28)
52 19.2 (10-33)
52 17.3 (8-30)
26.4 (23-31) 489 20.4 (17-24) 489 30.9 (27-35) 489 23.7 (20-28) 489 15.1 (12-19) 489 21.7 (18-26)
4.6 (3-7)
325
4.9 (3-8)
389
4.1 (2-7)
372
3.8 (2-6)
355
3.7 (2-6)
388
1.8 (1-4)
16.1 (5-34)
29 17.2 (6-36)
32 15.6 (5-33)
33 24.2 (11-42)
32 12.5 (4-29)
33 9.1 (2-24)
7.6 (5-11)
317
5.0 (3-8)
327 8.0 (5-11)
326
2.5 (1-5)
327
6.1 (4-9)
327
4.6 (3-7)
19.9 (18-22) 1607 14.1 (12-16) 1723 22.2 (20-24) 1229 20.0 (18-22) 1722 18.0 (16-20) 1723 14.7 (13-17)
15.5 (12-19) 437 9.6 (7-13)
434 19.6 (16-24) 436 10.6 (8-14) 438 10.7 (8-14) 438 8.4 (6-11)
34.3 (31-38) 883 31.0 (28-34) 864 44.3 (41-48) 897 40.7 (37-44) 907 47.7 (44-51) 898 40.2 (37-43)
19.2 (16-23) 608 18.1 (15-21) 618 22.3 (19-26) 619 26.7 (23-30) 619 27.5 (24-31) 619 17.6 (15-21)
10.0 (0-44)
10 10.0 (0-44)
10 10.0 (0-44)
10 0.0 (0-26)
10 10.0 (0-44)
10 10.0 (0-44)
16.2 (12-22) 210 14.3 (10-20) 215 14.9 (10-20) 215 9.8 (6-15)
213 11.3 (7-16) 215 10.2 (7-15)
30.0 (26-34) 599 25.5 (22-29) 671 31.3 (28-35) 697 30.1 (27-34) 678 25.1 (22-29) 644 23.9 (21-27)
11.8 (1-36)
18 22.2 (6-48)
18 22.2 (6-48)
18 22.2 (6-48)
18 11.1 (1-35)
18 11.1 (1-35)
10.7 (2-28)
28 7.1 (1-24)
28 10.7 (2-28)
28 14.3 (4-33)
28 17.9 (6-37)
28 14.3 (4-33)
16.1 (5-34)
31 3.2 (0-17)
31 19.4 (7-37)
31 6.5 (1-21)
31 6.5 (1-21)
31 6.5 (1-21)
9.7 (2-26)
31 6.5 (1-21)
31 0.0 (0-11)
31 6.5 (1-21)
31 3.2 (0-17)
31 0.0 (0-11)
5.2 (3-8)
398
2.8 (1-5)
395
6.1 (4-9)
404
4.0 (2-6)
397
3.3 (2-6)
402
2.5 (1-5)
7.1 (4-12)
202 6.4 (3-11)
209 5.7 (3-10)
197
2.0 (1-5)
208 6.7 (4-11)
209
3.3 (1-7)
29.9 (23-38) 156 23.7 (17-31) 175 26.9 (20-34) 176 24.4 (18-31) 171 22.8 (17-30) 176 21.6 (16-28)
19.8 (17-23) 587 15.3 (13-19) 587 25.6 (22-29) 586 14.7 (12-18) 568 20.4 (17-24) 587 18.1 (15-21)
47.5 (32-64)
37 48.6 (32-66)
39 51.3 (35-68)
41 48.8 (33-65)
41 51.2 (35-67)
41 46.3 (31-63)
38.5 (32-46) 154 35.1 (28-43) 199 56.3 (49-63) 199 41.7 (35-49) 179 40.8 (34-48) 199 39.2 (32-46)
7.5 (4-13)
134 6.7 (3-12)
134 14.9 (9-22) 134 9.7 (5-16)
134 21.6 (15-30) 134 9.7 (5-16)
6.7 (5-9)
839 8.9 (7-11)
848 21.0 (18-24) 853 16.5 (14-19) 853 16.4 (14-19) 853 10.8 (9-13)
5.9 (3-9)
357
6.2 (4-9)
357 6.7 (4-10)
357
1.7 (1-4)
357
5.3 (3-8)
357
2.8 (1-5)
3.1 (2-5)
634
3.9 (3-6)
664
5.0 (3-7)
667
2.2 (1-4)
603
6.3 (4-9)
666
1.7 (1-3)
19.8
13.5
21.0
18.4
17.1
13.8
** S
usceptible to piperacillin (tazobactam), ceftazidime, fluoroquinolones, aminoglycosides and carbapenems. Only isolates tested for all five antimicrobial groups
were included in the analysis.
** Combined resistance defined as being resistant to three or more antimicrobial classes among piperacillin (tazobactam), ceftazidime, fluoroquinolones,
aminoglycosides and carbapenems.
37

for 25 countries. A statistically significant increasing trend was observed for Portugal. Statistically
significant decreasing trends were observed for four
countries (the Czech Republic, Hungary, Italy and
Malta). For Italy, the trend was not significant when
considering only data from laboratories reporting consistently for all four years (Figure 3.28).
Aminoglycosides
number of isolates per country ranged from 10 to
1229.
The EU/EEA population-weighted mean for aminoglycoside resistance was 18.4%. The percentages of
resistant isolates in the reporting countries ranged
from 0% (Iceland) to 48.8% (Romania). Seven countries reported resistance percentages lower than 5%,
four countries reported 510%, 12 countries reported
SURVEILLANCE REPORT
1025% and seven countries reported 2550% (Table

3.7 and Figure 3.23).
25 countries. Significantly increasing trends were
observed for four countries (Cyprus, Denmark, Norway
and Sweden). For Norway and Sweden, the trends
were not significant when considering only data from
Significantly decreasing trends were observed for two
countries (the Czech Republic and Hungary) (Figure
3.29).
Carbapenems
relevant AST information for carbapenems. The number of isolates per country ranged from 10 to 1722.
The EU/EEA population-weighted mean for carbapenem resistance was 17.1%. The percentages of
resistant isolates in the reporting countries ranged
Table 3.8. Pseudomonas aeruginosa. Total number of tested isolates and resistance combinations among
invasive isolates tested against at least three antimicrobial classes among piperacillintazobactam, ceftazidime,
fluoroquinolones, aminoglycosides and carbapenems (n=10750), EU/EEA countries, 2012
Resistance pattern
Fully susceptible (to tested antibiotics)
Total (all single resistance types)
Carbapenems
Fluoroquinolones
Aminoglycosides
Piperacillin (tazobactam)
Ceftazidime
Total any two classes in combination)
Piperacillin (tazobactam) + ceftazidime
Aminoglycosides +carbapenems
Piperacillin (tazobactam) +fluoroquinolones
Piperacillin (tazobactam) + carbapenems
Piperacillin (tazobactam) + aminoglycosides
Ceftazidime + carbapenems
Fluoroquinolones + ceftazidime
Ceftazidime + aminoglycosides
Fluoroquinolones + aminoglycosides + carbapenems
Piperacillin (tazobactam) + ceftazidime + carbapenems
Piperacillin (tazobactam) + fluoroquinolones +aminoglycosides
Piperacillin (tazobactam) + fluoroquinolones + ceftazidime
Fluoroquinolones +ceftazidime +aminoglycosides
Piperacillin (tazobactam) + fluoroquinolones + carbapenems
Piperacillin (tazobactam) + aminoglycosides + carbapenems
Piperacillin (tazobactam) + ceftazidime +aminoglycosides
Ceftazidime + aminoglycosides + carbapenems
Fluoroquinolones + ceftazidime + carbapenems
Total (any four classes in combination)
Piperacillin (tazobactam) + fluoroquinolones + aminoglycosides + carbapenems
Piperacillin (tazobactam) + fluoroquinolones + ceftazidime + aminoglycosides
Fluoroquinolones + ceftazidime + aminoglycosides + carbapenems
Piperacillin (tazobactam) + fluoroquinolones + ceftazidime + carbapenems
Piperacillin (tazobactam) + ceftazidime + aminoglycosides + carbapenems
Resistance to five classes of antimicrobial drugs
Piperacillin (tazobactam) + fluoroquinolones + ceftazidime + aminoglycosides + carbapenems
38

6693
% of total*
62.3
1532
620
401
241
198
72
14.3
5.8
3.7
2.2
1.8
0.7
778
309
242
73
46
38
33
14
9
6
8
7.2
2.9
2.3
0.7
0.4
0.4
0.3
0.1
0.1
0.1
0.1
556
191
106
88
68
29
30
12
17
8
7
5.2
1.8
1.0
0.8
0.6
0.3
0.3
0.1
0.2
0.1
0.1
569
187
162
107
75
38
5.3
1.7
1.5
1.0
0.7
0.4
622
5.8
SURVEILLANCE REPORT
from 3.2% (Malta) to 51.2% (Romania). Three countries

reported resistance percentages below 5%, six countries reported 510%, 15 countries reported 1025%,
five countries reported 2550% and one country
reported above 50% (Table 3.7 and Figure 3.24).
observed for four countries (Austria, Cyprus, Greece
and Portugal). For Portugal, the trend was not significant when considering only data from laboratories
reporting consistently for all four years. A significantly
decreasing trend was observed for the Czech Republic
(Figure 3.30).
Combined resistance (resistance to at least three
antimicrobial groups out of piperacillintazobactam,
ceftazidime, fluoroquinolones, aminoglycosides and
carbapenems)
For 2012, 30 countries reported 10750 isolates tested
for susceptibility to at least three antimicrobial groups
under surveillance by EARS-Net for P. aeruginosa. The
number of isolates with relevant information reported
per country ranged from 10 to 1723 (Table 3.7).
In 2012, 37.7% of the isolates were resistant to one
or more of the five considered antimicrobial classes,
while 16.3% (population-weighted mean 13.8%) were
resistant to three or more. While single resistance
was the most common, the most frequent individual
resistance phenotype was resistance to all five antimicrobial classes (5.8%) (Table 3.8).
The percentages of isolates with combined resistance,
i.e. resistant to at least three of the five considered
antimicrobial groups, were below 1% in one country,
15% in six countries, 510% in six countries, 1025%
in 13 countries and 2550% in four countries (Table
3.7 and Figure 3.25).
23 countries. Significantly increasing trends of combined resistance were observed for four countries
(Austria, Ireland, Portugal and Sweden). For Portugal,

the trend was not significant when including only data
from laboratories consistently reporting for all four
years (Figure 3.31). Significantly decreasing trends of
combined resistance were observed for two countries
(the Czech Republic and Hungary).

It is important to note that the ongoing change in the use
of antimicrobial susceptibility breakpoints from CLSI to
EUCAST in many European countries makes trend analysis difficult and sensitive to bias, as there are differences
between the antimicrobial breakpoints for P. aeruginosa used by the two systems. The change from CLSI to
EUCAST guidelines within a country is often gradual and
not all laboratories change at the same time.
However, despite use of clinical guidelines, high resistance percentages have been reported from many
European countries during the last couple of years. This
is a concern as P. aeruginosa carries intrinsic resistance
to a number of antimicrobial classes and any additional
acquired resistance severely limits the therapeutic
options for treatment of serious infections.
P. aeruginosa is recognised as a major cause of healthcare-associated infection, and in the recent Point
prevalence survey of healthcare-associated infections
and antimicrobial use in European acute care hospitals
20112012, P. aeruginosa was among the five most common bacteria in health-care associated infections, with
almost a third of the reported isolates being carbapenem
resistant 12. Due to its ubiquitous nature and potential
virulence, P. aeruginosa is a challenging pathogen to
control in healthcare settings. Prudent antimicrobial use
and high standards of infection control are essential to
prevent the situation from deteriorating.
12 European Centre for Disease Prevention and Control. Point

prevalence survey of healthcare-associated infections and
antimicrobial use in European acute care hospitals. Stockholm:
ECDC; 2013.
39
SURVEILLANCE REPORT
Figure 3.26. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to piperacillin (tazobactam), by
UK
2009
DK (>)
2010
NL
2011
2012
SE (>)
ES
NO
SI (<)
FI
MT (<)
CY
LT
Country code
DE
LU
IE (>)
EU/EEA (>)
BE
AT (>)
HU
PT
FR
BG
CZ
PL
IT (>*)
EL
0
10
15
20
25
30
35
% piperacillintazobactam resistance
40
40
SURVEILLANCE REPORT
Figure 3.27. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to ceftazidime, by country, EU/EEA
countries, 20092012
NL
2009
LU
2010
UK
2011
DK
2012
FI
SE
NO
MT (<)
SI
LT
BE
Country code
ES
DE
HR
EU/EEA
AT (>)
FR
IE (>)
PT
CY
HU (>)
CZ (<)
PL
IT (>*)
EL
BG
0
10
20
30
40
50
% ceftazidime resistance
41
SURVEILLANCE REPORT
Figure 3.28. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to fluoroquinolones, by country, EU/
MT (<)
2009
DK
2010
UK
2011
NO
2012
NL
SE
FI
LT
AT
IE
SI
Country code
CY
BE
LU
DE
EU/EEA
ES
FR
HU (<)
HR
PT (>)
PL
CZ (<)
IT (<*)
BG
EL
0
10
20
30
40
42
50
SURVEILLANCE REPORT
Figure 3.29. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to aminoglycosides, by country, EU/
SE (>*)
2009
NO (>*)
2010
UK
2011
FI
2012
DK (>)
NL
MT
LU
SI
IE
DE
Country code
BE
AT
LT
PT
CY (>)
ES
EU/EEA
FR
CZ (<)
PL
HR
HU (<)
IT
BG
EL
0
10
20
30
40
50
43
SURVEILLANCE REPORT
Figure 3.30. Pseudomonas aeruginosa. Trends of invasive isolates with resistance to carbapenems, by country, EU/EEA
countries, 20092012
MT
2009
NL
2010
DK
2011
SE
2012
FI
UK
LU
NO
BE
DE
IE
Country code
AT (>)
CZ (<)
ES
EU/EEA
LT
FR
CY (>)
PT (>*)
SI
HR
PL
IT
HU
BG
EL (>)
0
10
20
30
40
50
% carbapenem resistance
44
60
SURVEILLANCE REPORT
Figure 3.31. Pseudomonas aeruginosa. trends of invasive isolates with combined (resistance to three or more
antimicrobial classes among piperacillintazobactam, ceftazidime, fluoroquinolones, aminoglycosides and
carbapenems, by country, EU/EEA countries, 20092012
MT
2009
UK
2010
2011
DK
2012
NL
SE (>)
NO
FI
LU
DE
SI
Country code
IE (>)
AT (>)
ES
EU/EEA
LT
FR
CY
HU (<)
PT (>*)
PL
CZ (<)
IT
BG
EL
0
10
20
30
40
50
45
3.4 Acinetobacter species

The Acinetobacter genus consists of a large number
of species that can be roughly divided between the
Acinetobacter baumannii-group (consisting of the species A. baumannii, A. pittii and A. nosocomialis), and
the Acinetobacter non-baumannii-group (consisting
of a large number of environmental species with low
pathogenicity). The correct identification of isolates at
species level within the Acinetobacter genus is challenging and is usually only possible with genotypic methods.
Recently, mass spectrometry offers the possibility of at
least identifying isolates that belong to the A. baumannii group, which is by far the most clinically important
group of species within this genus.
SURVEILLANCE REPORT
Acinetobacter species are gram-negative, strictly aerobic, non-fastidious, non-fermentative, catalase-positive,

oxidase-negative opportunistic pathogens. Species
belonging to the A. baumannii group have been identified as pathogens in nosocomial pneumonia (particularly
ventilator-associated pneumonia), central line-associated bloodstream infections, urinary tract infections,
surgical site infections and other types of wound infection. While many members of the Acinetobacter genus
are considered ubiquitous in nature, this is not the case
with the species that belong to the A. baumannii group.
Acinetobacter species other than A. baumannii have
been isolated from the skin and mucous membranes
of people in the community; however, carriage rates of
species belonging to the A. baumannii group on the skin
and in the faeces have been reported as very low.
The A. baumannii group has a limited number of virulence factors, which is why infections due to this
Table 3.9. Acinetobacter spp. Total number of tested isolates (N) and percentages susceptible to all antimicrobial
groups under EARS-Net surveillance*, total number of tested isolates (N) and percentages of invasive isolates
resistant to fluoroquinolones, aminoglycosides, carbapenems and combined resistance**, including 95% confidence
intervals (95% CI), by country, EU/EEA countries, 2012
Country
Bulgaria
Cyprus
Denmark
France
Germany
Greece
Hungary
Iceland
Italy
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovenia
United Kingdom
Fully susceptible*
N
58
23
58
272
119
1 203
394
2
214
5
5
10
25
197
168
48
25
79
% fully S
(95% CI)
17.2 (9-29)
39.1 (20-61)
81.0 (69-90)
82.0 (77-86)
88.2 (81-93)
6.4 (5-8)
20.6 (17-25)
11.2 (7-16)
100.0 (69-100)
96.0 (80-100)
20.8 (15-27)
19.0 (13-26)
4.2 (1-14)
68.0 (46-85)
93.7 (86-98)
Fluoroquinolones
Aminoglycosides
Carbapenems
Combined resistance**
%R (95% CI)
%R (95% CI)
%R (95% CI)
%R (95% CI)
65
23
83
385
121
1 204
405
2
233
6
6
10
25
209
168
50
25
105
69.2 (57-80)
56.5 (34-77)
12 (6-21)
15.6 (12-20)
8.3 (4-15)
93.1 (92-94)
78 (74-82)
86.3 (81-90)
0.0 (0-31)
0.0 (0-14)
78 (72-83)
77.4 (70-83)
90.0 (78-97)
28.0 (12-49)
2.9 (1-8)
65
23
77
278
119
1 234
407
2
231
6
5
59
25
205
169
48
25
108
58.5 (46-71)
52.2 (31-73)
10.4 (5-19)
12.9 (9-17)
5.9 (2-12)
78.1 (76-80)
68.8 (64-73)
83.1 (78-88)
1.7 (0-9)
4.0 (0-20)
63.4 (56-70)
65.1 (57-72)
54.2 (39-69)
20.0 (7-41)
2.8 (1-8)
58
23
64
389
121
1 254
418
2
228
5
6
67
25
209
168
48
25
80
60.3 (47-73)
56.5 (34-73)
9.4 (4-19)
3.3 (2-6)
6.6 (3-13)
87.8 (86-90)
48.1 (43-53)
83.3 (78-88)
6.0 (2-15)
0.0 (0-14)
38.3 (32-45)
79.2 (72-85)
81.3 (67-91)
24.0 (9-45)
2.5 (0-9)
58
23
58
272
119
1 203
394
2
214
5
5
10
25
197
168
48
25
79
32.8 (21-46)
47.8 (27-69)
8.6 (3-19)
4.0 (2-7)
4.2 (1-10)
74.5 (72-77)
41.6 (37-47)
78 (72-83)
0.0 (0-31)
0.0 (0-14)
35.0 (28-42)
64.3 (57-72)
45.8 (31-61)
12.0 (3-31)
1.3 (0-7)
- Percentage resistance not calculated as number of isolates was below 10.

* Susceptible to fluoroquinolones, aminoglycosides and carbapenems. Only isolates tested for all three antimicrobial groups were included in the analysis
** Resistance to fluoroquinolones, aminoglycosides and carbapenems. Only isolates tested for all three antimicrobial groups were included in the analysis.
Table 3.10. Acinetobacter spp. Overall resistance and resistance combinations among invasive isolates tested against
fluoroquinolones, aminoglycosides and carbapenems (n=2 905), EU/EEA countries, 2012
Resistance pattern
Fully susceptible
Total (any single resistance)
Fluoroquinolones
Aminoglycosides
Carbapenems
Aminoglycosides + carbapenems
Fluoroquinolones + aminoglycosides + carbapenems
46

788
% of total*
27.1
143
100
27
16
4.9
3.4
0.9
0.6
493
237
247
9
17.0
8.2
8.5
0.3
1 481
51.0
SURVEILLANCE REPORT
bacterium are more likely to occur in critically ill or

otherwise debilitated individuals. In fact, outside of
the organisms lipopolysaccharide layer, which serves
an unknown purpose, the majority of virulence factors,
including bacteriocin, encapsulation and a prolonged
viability under dry conditions, seem to favour a prolonged survival rather than invasive disease. It can
survive for up to five months, and this is likely to be a
major contributing factor to nosocomial spread, particularly in intensive care units (ICUs).
Risk factors for infection with the A. baumannii group
include advanced age, presence of serious underlying
diseases, immune suppression, major trauma or burn
injuries, invasive procedures, presence of indwelling
catheters, mechanical ventilation, extended hospital
stay and previous administration of antibiotics. The risks
for acquiring a multidrug-resistant (MDR) strain of
the A.baumannii group are similar, and also include
prolonged mechanical ventilation, prolonged ICU or hospital stay, exposure to infected or colonised patients,
increased frequency of interventions, increased disease severity and receipt of broad-spectrum antibiotics,
especially third-generation cephalosporins, fluoroquinolones and carbapenems.

Acinetobacter species, particularly those belonging to
the A. baumannii group, are intrinsically resistant to
most antimicrobial agents due to their selective ability to exclude various molecules from penetrating their
outer membrane. The antimicrobial classes that remain

active include some fluoroquinolones (e.g., ciprofloxacin and levofloxacin), aminoglycosides (e.g., gentamicin,
tobramycin and amikacin), carbapenems (imipenem,
doripenem and meropenem), polymyxins (polymyxin
B and colistin) and, possibly, sulbactam and tigecycline. Resistance of Acinetobacter spp. to these agents
can be acquired through one or more of the following
mechanisms:
mutational modification of antimicrobial targets such
as topoisomerases or ribosomal proteins, which
confers resistance to fluoroquinolones and aminoglycosides, respectively;
mutational loss of outer membrane proteins preventing the uptake of antimicrobial agents such as
carbapenems;
mutational upregulation of efflux systems, that can
confer resistance to beta-lactams, fluoroquinolones
and aminoglycosides, and reduced susceptibility to
tigecycline; and
acquisition of plasmid-mediated resistance genes
coding for various beta-lactamases, that can confer
resistance to carbapenems (OXA carbapenemases
and metallo-beta-lactamases), for aminoglycosidemodifying enzymes that may confer resistance to
various aminoglycosides, or for 16S rRNA ribosomal
methylases that can confer high-level resistance to all
aminoglycosides.
Figure 3.32. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country,
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
47
SURVEILLANCE REPORT
Figure 3.33. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country,
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
Figure 3.34. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to carbapenems, by country, EU/
EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
48
SURVEILLANCE REPORT
3.4.3 Inclusion of Acinetobacter spp. in EARSNet 2012

Acinetobacter spp. were included in EARS-Net for the
first time this year. Data were collected for 2012, and will
be collected for 2013, to test the feasibility of including
this bacterium in EARS-Net surveillance. Surveillance is
restricted to genus level (i.e., Acinetobacter spp.) due to
the difficulties of species identification, and the antibiotics under surveillance are limited to a panel for which
clear guidelines on susceptibility testing and interpretive criteria exist.
Due to the fact that this was the first year data on
Acinetobacter were requested from the countries and
due to the low number of isolates reported, the results
should be interpreted with caution.

More than half of Acinetobacter spp. isolates
reported to EARS-Net in 2012 were resistant to
all antibiotic groups included for surveillance.
Carbapenem resistance was high, and in most
cases combined with resistance to the two other
antimicrobial groups under surveillance (fluoroquinolones and aminoglycosides).

However, large inter-country variation was
observed, with generally higher resistance levels reported from southern Europe than northern
Europe.
in Figure 3.32 or the resistance calculations in Table

3.9.
The percentages of resistant isolates in countries that
reported more than 10 isolates ranged from zero (the
Netherlands and Norway) to 93.1% (Greece). Among
these, two countries reported resistance percentages
lower than 1%, one country 15%, one country 510%,
two countries 1025%, one country 2550% and eight
countries more than 50% (Table 3.9 and Figure 3.32).
The three countries (Iceland, Luxembourg and Malta)
that reported fewer than 10 isolates did not report any
resistant isolates.
Aminoglycosides
two to 1234. Iceland, Luxembourg and Malta reported
fewer than 10 isolates and are therefore not included
in Figure 3.33 or the resistance calculations in Table
3.9.
The percentages of resistant isolates in countries that
reported more than 10 isolates ranged from 1.7% (the
Netherlands) to 83.1% (Italy). Among these, three
countries reported resistance percentages of 15%,
one country 510%, three countries 1025% and eight
countries more than 50% (Table 3.9 and Figure 3.33).
The three countries (Iceland, Luxembourg and Malta)
that reported less than 10 isolates did not report any
resistant isolate.
Carbapenems
Full susceptibility
For 2012, 3
277 isolates from 18 countries were
reported to EARS-Net, for which 2905 (89%) isolates
had complete AST information for all antimicrobial
groups under surveillance for Acinetobacter spp. (fluoroquinolones, aminoglycosides and carbapenems).
The percentage of fully susceptible isolates (out
of those tested for all antimicrobials under surveillance) in countries that reported more than 10
isolates, ranged from 100% (the Netherlands) to 4.2%
(Romania) (Table 3.9). However, the 100% full susceptibility reported from the Netherlands refers only to
the group of isolates tested against the full panel of
antimicrobial groups under surveillance by EARS-Net.
Resistance to aminoglycosides and carbapenems were
reported, but these isolates were not tested against
all antimicrobial groups. All isolates reported by the
three countries (Iceland, Luxembourg and Malta) that
reported fewer than 10 isolates were fully susceptible.
Fluoroquinolones
two to 1204. Iceland, Luxembourg and Malta reported
fewer than 10 isolates and are therefore not included
For 2012, 18 countries reported 3190 isolates with relevant AST information for carbapenems. The number
of isolates reported per country ranged from two to
1234. Iceland, Luxembourg and Malta reported fewer
than 10 isolates and are therefore not included in
Figure 3.34 or the resistance calculations in Table 3.9.
The percentages of resistant isolates in countries
that reported more than 10 isolates ranged from zero
(Norway) to 87.8% (Italy). Among these, one country reported resistance percentages lower than 1%,
two countries 15%, three countries 510%, one
country 1025%, two countries 2550% and six countries more than 50% (Table 3.9 and Figure 3.34). The
reported fewer than 10 isolates did not report any
resistant isolates.
Combined resistance (fluoroquinolones, aminoglycosides and carbapenems)
Single resistance was uncommon (4.9% of all isolates)
and resistance to two classes of antimicrobial agents
was reported for 17% of all isolates. Within the groups
of single resistance and resistance to two antimicrobial groups, single fluoroquinolone resistance and
resistance to fluoroquinolones combined with resistance to aminoglycosides or to carbapenems were the
most common.
49
SURVEILLANCE REPORT
Overall, the most common resistance phenotype was

resistance to all three antimicrobial groups, and was
present in 51% of the isolates. The percentage of
isolates with this resistance phenotype ranged from
zero (the Netherlands and Norway) to 78.0% (Italy).
Two countries reported resistance percentages lower
than 1%, three countries 15%, one country 510%,
one country 1025%, five countries 2550% and three
countries more than 50% (Figure 3.35, Table 3.9). The
reported fewer than 10 isolates did not report any isolates with combined resistance.

More than half of the EARS-Net participating countries
were able to report data for Acinetobacter spp. for 2012.
As this is the first year that Acinetobacter spp. have
been included in EARS-Net and the number of isolates
reported from some countries is very low, results must
be interpreted with caution.
Nevertheless, there seems to be a large variation in
antimicrobial resistance of Acinetobacter spp. isolates
in Europe, with generally higher resistance percentages reported from countries in the south of Europe
than in the north. The high percentage of isolates with
combined resistance to fluoroquinolones, aminoglycosides and carbapenems is a concern as it severely limits
options for patient treatment.
Figure 3.35. Acinetobacter spp. Percentage (%) of invasive isolates with combined resistance (resistance to
fluoroquinolones, aminoglycosides and carbapenems), by country, EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
50
SURVEILLANCE REPORT
3.5 Streptococcus pneumoniae

Streptococcus pneumoniae is a common cause of disease, especially among young children, elderly people
and patients with compromised immune functions. The
clinical spectrum ranges from upper airway infections,
such as sinusitis, and otitis media to pneumonia and
bloodstream infections and meningitis. Since S.pneumoniae is the most common cause of pneumonia
worldwide, morbidity and mortality are high and approximately three million people are estimated to die each
year of pneumococcal infections.
Pneumococci carry a variety of virulence factors that
facilitate adherence and transcytosis of epithelial cells.
The cell wall of pneumococci is coated with a viscous
polysaccharide slime layer termed the capsule. This is
the most important virulence factor because it protects
the bacteria from the adhesion of opsonising antibodies
and the destruction by leucocytes. Capsular polysaccharides are highly diverse and play an important role
in immune evasion. To date, almost 100 different serotypes have been described. The serotype distribution
varies with age, disease and geographical region.
Interestingly, serotypes most frequently involved in
pneumococcal disease or colonisation in infants are
also most frequently associated with AMR. However,
serotype replacement due to increased use of the pneumococcal conjugate vaccine (PCV) has been reported.

Beta-lactam antimicrobials bind to cell wall synthesising
enzymes, so-called penicillin-binding proteins (PBPs),
and interfere with the biosynthesis and remodelling of
the bacterial cell wall during cell growth and division.
The mechanism of penicillin resistance in S. pneumoniae
consists of alterations in PBPs, which result in reduced
affinity to this class of antimicrobial. Alterations in PBPs
are due to transformation with PBP gene sequences
originating from commensal streptococci, and construction of mosaic PBP causes different degrees of
resistance proceeding from reduced susceptibility
through low-level clinical resistance conventionally
termed intermediate13 (I) to full clinical resistance
(R). Intermediately susceptible strains are clearly less
susceptible than susceptible strains. However, in the
absence of meningitis, infections with intermediately
resistant strains are often successfully treated with high
doses of benzyl penicillin or aminopenicillins.
Macrolide, lincosamide and streptogramin (MLS) antimicrobials are chemically distinct, but all bind to a
ribosomal subunit inhibiting the initiation of mRNA binding and thus act as protein synthesis inhibitors. There
are two predominant resistance mechanisms against
MLS antimicrobials in S. pneumoniae:
13 Microorganisms are defined as intermediate by a level of
antimicrobial activity with uncertain clinical effect. Occasionally, this
can be overcome if antibiotics can be administered at a higher dose
and/or are concentrated at the infected body site.
Figure 3.36. Streptococcus pneumoniae. Percentage (%) of invasive isolates non-susceptible to penicillin (PNSP), by
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
51
The acquisition of an erythromycin ribosomal methylation gene (erm) results in a post-transcriptional

modification of the 23S subunit of ribosomal RNA,
which blocks the binding of the macrolide to the
ribosome. Once expression of the gene is induced,
this often results in high-level resistance (MICs > 128
mg/L) to macrolides, lincosamide and streptogramin
B, termed MLSB resistance.
The acquisition of a macrolide efflux system gene
(mef ) results in the excretion of the antimicrobial,
and effectively reduces intracellular erythromycin,
azithromycin and clarithromycin to sub-inhibitory
concentrations. In contrast to beta-lactam resistance,
macrolide resistance via these mechanisms (particularly for MLSB) results in very high MICs, and cannot be
overcome by increasing the dosages of antimicrobials.
The two fluoroquinolones with acknowledged clinical
activity against pneumococci are levofloxacin and moxifloxacin. Resistance to fluoroquinolones is mediated
by the mutations in parC (subunit of topoisomerase IV)
and/or gyrA (subunit of DNA gyrase/topoisomerase IV).
Additionally, resistance may be conferred by efflux.
Since S. pneumoniae is the most frequent cause of
community-acquired pneumonia and cannot clinically
be easily distinguished from lower airway infections
caused by other pathogens, empirical treatment of
SURVEILLANCE REPORT
community-acquired lower respiratory infections needs

to be active against pneumococci and should take the
local prevalence of AMR into account. Prescription of
non-beta-lactam compounds is therefore typical in
countries where penicillin non-susceptibility has been
frequently reported. Such prescribing patterns increase
the selection pressure of alternative antimicrobials such
as macrolides and fluoroquinolones. It is therefore no
surprise to see a dynamic AMR picture emerge in different European countries. At the same time, the existence
of frequent dual beta-lactam/macrolide resistance, particularly among serotypes commonly found in children,
means that in practice the use of agents from either of
these classes will result in increasing percentages of
resistance to the other class and frequent use of macrolides has been considered as a major driver for the
increase in beta-lactam resistance.
Even though a certain small decrease in penicillin resistance had been detected in some countries before the
introduction of the PCV, the widespread use of this vaccine is an important factor that may have influenced the
decrease in AMR levels, eliminating the infections (and
more importantly, the childrens carriage) of frequent
classic resistant serotypes 14, 6B, 19F and 23F all
of them covered by the current multivalent PCVs on the
market.
Figure 3.37. Streptococcus pneumoniae. Percentage (%) of invasive isolates non-susceptible to macrolides by country,
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
52
SURVEILLANCE REPORT

As in previous years, the reported susceptibility of S. pneumoniae showed large variations
between European countries.
A majority of the reporting countries had percentages of penicillin non-susceptibility below 10%,
but four countries reported percentages above
25%.

Macrolide non-susceptibility was, for most
countries, higher than percentages for penicillin non-susceptibility. Dual non-susceptibility to
penicillin and macrolides was below 10% in more
than half of the reporting countries.
During the last couple of years, serogroups 1, 3,
7 and 19 have dominated among pneumococcal
isolates reported to EARS-Net. A large majority
of serogroups 1, 3 and 7 were susceptible to both
penicillin and macrolides, but for serogroup 19,
27% of the isolates had a decreased susceptibility to penicillin and/or macrolides.
Penicillin
relevant AST information for penicillin. The number of
isolates reported from the countries ranged between

eight (Cyprus) and 1658 (Belgium) (Table 3.11). As
Cyprus reported fewer than 10 isolates, it is not
included in Figure 3.36 and the resistance calculation
in Table 3.11.
Among countries reporting 10 isolates or more, the
percentage of isolates reported as non-susceptible
was below 1% in one country, 15% in seven countries, 510% in seven countries, 1025% in nine
countries and 2550% in four countries (Figure 3.36
and Table 3.11).
for 25 countries. Five countries (Belgium, Denmark,
Finland, Norway and the United Kingdom) had significantly increasing trends. For Finland, the trend did not
remain significant when considering only data from
Significantly decreasing trends were observed for
three countries (France, Luxembourg and Portugal)
(Figure 3.39).
Susceptibility breakpoints for penicillin treatment
of S. pneumoniae infections differ depending on use
of clinical guidelines (EUCAST and CLSI) and type of
infection (blood infection or meningitis). This might
influence both inter-country data comparability and
trend analyses. An overview of use of breakpoints for
determining penicillin susceptibility in EARS-Net data
is given in Table 3.11.
Figure 3.38. Streptococcus pneumoniae. Percentage (%) of invasive isolates non-susceptible to penicillins and
macrolides by country, EU/EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
53
SURVEILLANCE REPORT
Figure 3.39. Streptococcus pneumoniae. Trends of invasive isolates non-susceptible to penicillin, by country, EU/EEA
countries, 20092012
EE
2009
BE (>)
2010
NL
2011
CZ
2012
LU (<)
IS
LV
UK (>)
SE
DK (>)
DE
Country code
AT
NO (>)
PT (<)
HU
SI
EU/EEA
IT
LT
FI (>*)
IE
PL
HR
FR (<)
ES
BG
0
10
15
20
25
30
35
% penicilllin non-susceptibility
The symbols > and < indicate significant increasing and decreasing trends, respectively. The asterisks indicate significant trends in the overall data that were not
supported by data from laboratories consistently reporting for all four years.
54
40
SURVEILLANCE REPORT
Figure 3.40. Streptococcus pneumoniae. Trends of invasive isolates non-susceptible to macrolides, by country, EU/EEA
countries, 20092012
NL
2009
SE
2010
NO
2011
2012
EE
DK (>)
UK (>)
DE
IS
CZ
LU
IE
Country code
EU/EEA
AT
PT
HU
BG
SI
PL
FI (<)
BE
LT (>)
ES (>)
HR
FR
IT (>*)
0
10
15
20
25
30
35
% macrolide non-susceptibility
55
SURVEILLANCE REPORT
Figure 3.41. Streptococcus pneumoniae. Trends of invasive isolates non-susceptible to penicillins and macrolides, by
EE
2009
LV
2010
NL
2011
2012
BE (<)
DE
CZ
UK (>*)
SE (>)
NO (>)
LU
DK (>)
Country code
IS
AT
SI
PT (<)
HU
EU/EEA
IT
FI
IE
LT (>)
ES (>)
PL
FR (<)
BG
0
10
15
20
% non-susceptibility to penicillins and macrolides

56
25
SURVEILLANCE REPORT
Macrolides
relevant AST information for macrolides. The number of isolates reported from the countries ranged
between seven (Cyprus) and 1662 (Belgium) (Table
3.11). As Cyprus reported fewer than 10 isolates, it is
not included in Figure 3.37 or the resistance calculation in Table 3.11.
ranged from 3.5% (Latvia) to 50% (Malta), and was
below 5% in three countries, 510% in seven countries, 1025% in eight countries, and 2550% in ten
countries (Figure 3.37, Table 3.11).
observed for Denmark, Italy, Lithuania, Spain and the
United Kingdom. For Italy, the trend did not remain
significant when considering only data from laboratories reporting consistently throughout the period.
A significantly decreasing trend was observed for one
country (Finland) (Figure 3.40).
Non-susceptibility to penicillins and macrolides
For 2012, 29 countries reported 9928 isolates tested
for both penicillin and macrolides. The number of
reported S. pneumoniae isolates with relevant AST
information for both penicillins and macrolides ranged
between seven (Cyprus) and 1614 (Belgium) (Table
3.11). As Cyprus reported fewer than 10 isolates, it is
not included in Figure 3.38 or the resistance calculation in Table 3.11.

to both penicillins and macrolides ranged from zero
(Estonia and Latvia) to 38.9% (Malta), and were below
1% in three countries, 15% in 11 countries, 510%
in three countries, 1025% in nine countries, and
2550% in two countries (Figure 3.38 and Table 3.11).
Trends for 20092012 were calculated for 24 countries.
A significant increase was observed for six countries
(Denmark, Lithuania, Norway, Spain, Sweden and the
UK). For the UK, the trend did not remain significant
when considering only data from laboratories reporting consistently throughout the period. Significant
decreasing trends were observed for two countries
(France and Portugal) (Figure 3.41).
Fluoroquinolones
For 2012, 24 countries reported susceptibility data
for fluoroquinolones in 6263 isolates (57% of all
reported S. pneumoniae isolates). Among them,
5.2% were resistant to fluoroquinolones, and 4.4%
of the fluoroquinolone-resistant isolates were also
penicillin-non-susceptible.
Serogroups
Fifteen countries reported S. pneumoniae isolates
with identification of the serotype/serogroup for 2012.
Figure 3.42. Streptococcus pneumoniae. Distribution of serogroups and associated resistance profiles per serogroup, 2012
1
Fully susceptible*
Single penicillin non-susceptible
7
19
Single macrolides non-susceptible
22
Dual non-susceptibility**
9
8
Serogroups
23
6
14
15
12
4
10
35
11
33
24
18
Other
0
10
12
Proportion (%)
Only countries that reported serogroup information for more than 30 isolates were included in the figure.
** Susceptible to at least penicillin and macrolides.
** Non-susceptible to penicillin and macrolides.
57
In 2012, serogroups 1 and 3 were the most prevalent

(accounting for 12% and 10% of the isolates, respectively), followed by serogroup 7 (8%) and serogroup
19 (7%). These four serogroups have been dominant
among EARS-Net isolates during the last couple of
years.
Among the most commonly reported serogroups,
dual non-susceptibility to both penicillin and macrolides was mainly observed in serogroups 19, 6, 15
and 14 (by order of decreasing percentage). Single
non-susceptibility to penicillin was most common in
serogroups 23, 14, 9 and 35, and single non-susceptibility to macrolides was most common in serogroups
14, 19, 33 and 6 (Figure 3.42).

Although large inter-country variations can be noted,
the overall percentages of S. pneumoniae with non-susceptibility to commonly used antimicrobials reported to
EARS-Net have remained relatively stable in Europe during recent years.
It is important to note that the differences and changes in
clinical breakpoints used for determining penicillin susceptibility in S. pneumoniae might introduce bias when
comparing national data reported to EARS-Net, but also
SURVEILLANCE REPORT
when interpreting trends in countries that changed clinical breakpoints during the observation period. Similar
surveillance artefacts have been reported from the
United States when S. pneumoniae data were analysed
with new breakpoints14. There is an ongoing shift among
many European laboratories from using CLSI guidelines
to EUCAST.
Although the number of countries reporting data on serotype distribution to EARS-Net is increasing, data remain
incomplete. However, data reported for 2012 support
previous observations that most penicillin non-susceptible isolates belong to a few serogroups. Most EU/
EEA Member States have, in recent years, implemented
routine immunisation for children with the multivalent
PCVs15. As a limited number of S. pneumoniae serotypes
are responsible for a considerable percentage of serious
pneumococcal infections in both adults and children,
introduction of PCVs is likely to change the epidemiology of invasive pneumococcal disease in many European
countries.
14 Centers for Disease Control and Prevention (CDC). Effects of
new penicillin susceptibility breakpoints for Streptococcus
pneumoniae United States 2006-2007. MMWR Morb Mort Wkly Rep
2008;57(50):1353-5.
15 EUVAC-Net. Pneumococcal vaccination (PCV) overview in European
countries. [Internet]. Available from http://www.euvac.net/graphics/
euvac/vaccination/pcv.html
Table 3.11. Streptococcus pneumoniae. Total number of isolates tested for penicillin and macrolide susceptibility,
percentage (%) being penicillin-non-susceptible (PNSP), penicillin-resistant (PRSP), macrolide-non-susceptible
(MNSP), single penicillin-resistant (PENR), single macrolide-resistant (MACR) and non-susceptible to penicillin and
macrolides (DUAL), including 95% confidence intervals, by country, EU/EEA countries, 2012
Country
Austria
Belgium
Bulgaria2b
Croatia
Cyprus2c
Czech Republic1a
Denmark
Estonia
Finland1a
France
Germany
Hungary1c
Iceland
Ireland2d
Italy
Latvia
Lithuania2b
Luxembourg
Malta1c
Netherlands
Norway1c
Poland1c
Portugal2c
Romania
Slovakia1c
Slovenia2d
Spain
Sweden1c
United Kingdom3
Number of
isolates tested for
(PEN/MACR/both)
291/319/262
1658/1662/1614
21/20/20
98/98/98
8/7/7
274/274/274
867/867/867
53/52/34
553/586/545
824/824/824
310/324/308
160/147/147
27/27/26
319/307/307
141/243/116
64/57/57
37/35/35
31/38/30
18/18/18
1063/1153/972
576/533/533
121/110/110
299/308/278
43/43/40
20/22/20
251/250/250
590/579/562
1030/947/947
1153/1114/627
% PNSP (95% CI)
% PRSP (95% CI)
% MNSP (95% CI)
% single PENR
(95% CI)
% single MACR
(95% CI)
% DUAL (95% CI)
5.2 (3-8)
1.5 (1-2)
28.6 (11-52)
22.5 (15-37)
*
2.9 (1-6)
5.1 (4-7)
0.0 (0-7)
17.0 (14-20)
23.4 (21-26)
5.2 (3-8)
10.0 (6-16)
3.7 (0-19)
19.1 (15-24)
12.1 (7-19)
4.7 (1-13)
16.2 (6-32)
3.2 (0-17)
38.9 (17-64)
1.5 (1-2)
5.9 (4-8)
21.5 (15-30)
8.4 (5-12)
37.2 (23-53)
5.0 (0-25)
10.0 (7-14)
26.6 (23-30)
5.0 (4-6)
4.9 (4-6)
1.4 (0-3)
0.5 (0-1)
28.6 (11-52)
0.0 (0-6)
*
0.4 (0-2)
0.2 (0-1)
0.0 (0-7)
0.5 (0-2)
0.0 (0-0)
1.3 (0-3)
2.5 (1-6)
3.7 (0-19)
4.7 (3-8)
5.7 (2-11)
4.7 (1-13)
13.5 (5-29)
3.2 (0-17)
0.0 (0-19)
0.3 (0-1)
1.0 (0-2)
5.0 (2-10)
5.4 (3-9)
37.2 (23-53)
5.0 (0-25)
1.2 (0-3)
26.1 (23-30)
4.8 (4-6)
0.7 (0-1)
17.9 (14-23)
25.4 (23-28)
20.0 (6-44)
28.6 (20-40)
*
7.7 (5-11)
6.0 (5-8)
5.8 (1-16)
22.0 (19-26)
28.9 (26-32)
7.4 (5-11)
19.7 (14-27)
7.4 (1-24)
16.9 (13-22)
34.2 (28-40)
3.5 (0-12)
25.7 (12-43)
15.8 (6-31)
50.0 (26-74)
4.4 (3-6)
5.3 (4-8)
27.3 (19-37)
18.5 (14-23)
37.2 (23-53)
27.3 (11-50)
21.2 (16-27)
26.4 (23-30)
4.9 (4-6)
6.8 (5-8)
1.1 (0-3)
0.3 (0-1)
10.0 (1-32)
1.0 (0-3)
*
1.1 (0-3)
1.6 (1-3)
0.0 (0-10)
7.0 (5-9)
6.2 (5-8)
3.9 (2-7)
2.7 (1-7)
0.0 (0-13)
6.5 (4-10)
1.7 (0-6)
3.5 (0-12)
2.9 (0-15)
0.0 (0-12)
0.0 (0-19)
0.7 (0-1)
3.0 (2-5)
6.4 (3-13)
1.8 (1-4)
5.0 (1-17)
0.0 (0-17)
5.2 (3-9)
11.9 (9-15)
1.7 (1-3)
1.3 (1-2)
13.0 (9-18)
24.5 (22-27)
0.0 (0-17)
28.5 (20-37)
*
5.8 (3-9)
2.5 (2-4)
5.9 (1-20)
11.6 (9-15)
11.7 (10-14)
5.8 (4-9)
12.2 (7-19)
3.8 (0-20)
4.6 (3-8)
27.6 (20-37)
3.5 (0-12)
11.4 (3-27)
16.7 (6-35)
11.1 (1-35)
3.9 (3-5)
2.1 (1-4)
10.9 (6-18)
12.2 (9-17)
7.5 (2-20)
15.0 (3-38)
16.4 (12-22)
10.9 (8-14)
1.9 (1-3)
4.5 (3-6)
4.2 (2-7)
1.2 (1-2)
20.0 (6-44)
16.3 (9-24)
*
1.8 (1-4)
3.5 (2-5)
0.0 (0-10)
11.2 (9-14)
17.2 (15-20)
1.3 (0-3)
7.5 (4-13)
3.8 (0-20)
12.4 (9-17)
10.3 (5-17)
0.0 (0-6)
14.3 (5-30)
3.3 (0-17)
38.9 (17-64)
0.8 (0-2)
3.2 (2-5)
16.4 (10-25)
6.5 (4-10)
32.5 (19-49)
5.0 (0-25)
4.8 (3-8)
14.8 (12-18)
3.0 (2-4)
2.2 (1-4)
11.6
3.9
16.9
4.6
8.5
8.7
* Fewer than 10 isolates, percentage not calculated

Use of clinical guidelines and breakpoints for penicillin susceptibility testing: 1a: EUCAST non-meningitis: S 0.06 g/ml, R > 2.0 g/ml. 1b: EUCAST meningitis: S
0.06 g/ml, R 0.12 g/ml (no intermediate category). 1c: EUCAST non-meningitis/meningitis depending on site of infection. 2a: CLSI non-meningitis: S 2 g/ml, R
8.0 g/ml. 2b: CLSI meningitis: S 0.06 g/ml, R 0.12 g/ml (no intermediate category). 2c: CLSI non-meningitis/meningitis depending on site of infection. 2d: CLSI
oral: S 0.06 g/ml, R 2.0 g/ml. 3: Mix of EUCAST, CLSI or national guidelines.
58
SURVEILLANCE REPORT
3.6 Staphylococcus aureus

Staphylococcus aureus is a gram-positive bacterium that
colonises the skin of about 30% of healthy humans.
Although mainly a harmless coloniser, S. aureus can
cause severe infection. Its oxacillin-resistant form
(meticillin-resistant S. aureus, MRSA) has been the
most important cause of antimicrobial-resistant
healthcare-associated infections worldwide. Since
healthcare-associated MRSA infections add to the
number of infections caused by meticillin-susceptible
S.aureus, a high incidence of MRSA adds to the overall
burden of infections caused by S. aureus in hospitals.
Moreover, infections with MRSA may result in prolonged
hospital stay and in higher mortality, owing mainly to
a delay in the initiation of appropriate therapy and the
inferior effectiveness of alternative treatment regimens.
MRSA is still the most commonly identified antimicrobial-resistant pathogen in hospitals in many parts of the
world, including Europe, the Americas, North Africa and
the Middle- and Far East.

S. aureus acquires resistance to meticillin and all other
beta-lactam antimicrobials through expression of the
exogenous mecA gene that codes for a variant penicillin-binding protein PBP2 (PBP2a) with low affinity for
beta-lactams, thus preventing the inhibition by betalactams of cell wall synthesis. A new mec gene has
been discovered, mecC (formerly called mecAlga251),
encoding PBP2c, which like PBP2a does not allow for

binding of beta-lactams.
The level of meticillin resistance, as defined by the MIC
depends on the amount of PBP2 production, which is
influenced by various genetic factors. Resistance levels
of mec-positive strains can thus range from phenotypically susceptible to highly resistant. Upon challenge with
beta-lactam antimicrobials, a population of a heterogeneously resistant MRSA strain may quickly be outgrown
by a sub-population of highly resistant variants.
For rifampicin, the mechanism of resistance is mutation
in the rpoB gene, leading to production of RNA polymerase with low affinity for rifampicin and other rifamycins.
Such resistance easily occurs with rifampicin monotherapy, for which reason the drug should only be used in
combination therapy.
Resistance to fluoroquinolones is mediated by the mutations in parC or parE (subunits of topoisomerase IV)
and/or gyrA (subunit of DNA gyrase/topoisomerase IV).
Additionally, resistance may be conferred by efflux.
The most common mechanism of linezolid resistance
is mutation in the 23S rRNA target site. A more recent
mechanism is non-mutational and involves acquisition of
a natural resistance gene, cfr (chloramphenicolflorfenicol resistance). The cfr gene has been found primarily in
plasmids that can be spread horizontally. The product of
the cfr gene is a methyltransferase that catalyses methylation of the 23S rRNA gene.
Figure 3.43. Staphylococcus aureus. Percentage (%) of invasive isolates resistant to meticillin (MRSA), by country, EU/
EEA countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
59
SURVEILLANCE REPORT
Figure 3.44. Staphylococcus aureus. Trends of invasive isolates resistant to meticillin (MRSA), by country, EU/EEA
countries, 20092012
SE
2009
NO (>)
2010
NL
2011
DK
2012
IS
EE
AT
LV
LT
SI
UK (<)
CZ
Country code
LU
DE (<)
BE (<)
EU/EEA (<)
FR (<)
BG
HR (<)
IE (<)
ES
HU (<)
PL (>*)
IT
CY
GR
MT
PT (>)
RO (>)
0
10
20
30
40
50
% MRSA
60
60
SURVEILLANCE REPORT
five countries reported 2550%, and two countries

reported above 50% (Figure 3.43 and Table 3.12).
The occurrence of MRSA in Europe displays large

inter-country variations. A majority of the countries reported percentages of below 20%. The
EU/EEA population-weighted average was 17.8%
in 2012, and has decreased significantly over the
last four years.
MRSA percentages are generally lower in northern
Europe and higher in the south and south-eastern
parts.
Beta-lactams
relevant information for MRSA classification. The
58 to 5228.
MRSA was 17.8%. The percentage of isolates reported
as MRSA ranged from 0.7% (Sweden) to 53.9%
(Romania). One country reported a percentage of
below 1%, five countries reported 15%, three countries reported 510%, 14 countries reported 1025%,
Table 3.12. Staphylococcus aureus. Number and
percentage (%) of invasive isolates resistant to
meticillin (MRSA) and rifampicin including 95%
confidence intervals, by country, EU/EEA countries, 2012
Country
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
Sweden
United Kingdom
Meticillin
Number of
isolates tested
2164
2077
227
412
165
1611
1431
104
1409
5228
2558
876
1143
58
1038
1631
211
323
131
102
1943
1430
781
1455
227
474
445
1899
3262
2680
% MRSA (95%CI)
7.7 (7-9)
16.1 (15-18)
19.8 (15-26)
22.0 (18-26)
35.2 (28-43)
13.0 (11-15)
1.3 (1-2)
7.7 (3-15)
2.1 (1-3)
19.2 (18-20)
15.4 (14-17)
41.0 (38-44)
24.8 (22-27)
1.7 (0-5)
22.6 (20-25)
35.2 (33-38)
9.0 (5-13)
10.2 (7-14)
15.3 (10-23)
47.1 (37-57)
1.3 (1-2)
1.3 (1-2)
29.2 (26-32)
53.8 (51-56)
53.9 (47-61)
21.7 (18-26)
10.3 (8-14)
24.2 (22-26)
0.7 (0-1)
14.1 (12-15)
17.8

trends were observed for four countries (Norway,
Poland, Portugal and Romania). For Poland, the trend
did not remain significant when considering only data
from laboratories reporting consistently throughout
all four years. Statistically significant decreasing
trends were observed for seven countries (Belgium,
Croatia, France, Germany, Hungary, Ireland and the
United Kingdom). The EU/EEA population-weighted
mean percentage also decreased significantly during
the same period, from 23.2% in 2009 to 17.8% in 2012
(Figure 3.44).
Rifampicin
relevant AST information for rifampicin. The percentage of rifampicin resistance was 5.7% among the
MRSA isolates and 0.6% among the meticillin-susceptible S. aureus (MSSA) isolates.
Fluoroquinolones
For 2012, 29 countries reported AST data for at least
one fluoroquinolone in 23264 isolates. The percentage of fluoroquinolone resistance was 81% among the
MRSA isolates and 6% among the MSSA isolates.
Linezolid
For 2012, 29 countries reported linezolid susceptibility data for 22653 S. aureus isolates, of which 0.2%
were resistant to linezolid.

The decrease in the population-weighted EU/EEA MRSA
mean percentage over the past four years, reflecting
the decreasing MRSA trends for seven individual countries, provides reason for optimism. This decrease is
consistent with what has been reported from a number
of European national surveillance programmes and scientific studies in recent years16,17,18. In several studies,
the decrease has been attributed to improved infection control routines19,20. In addition, the decay of some
16 Johnson AP, Davies J, Guy R, Abernethy J, Sheridan E, Pearson
A, Duckworth G. Mandatory surveillance of meticillin-resistant
Staphylococcus aureus (MRSA) bacteraemia in England: the first 10
years. J Antimicrob Chemother. 2012 Apr;67(4):802-9.
17 Anonymous. Recent trends in antimicrobial resistance among
Streptococcus pneumoniae and Staphylococcus aureus isolates: the
French experience. Euro Surveill. 2008 Nov 13;13(46).
18 de Kraker ME, Davey PG, Grundmann H; BURDEN study group.
Mortality and hospital stay associated with resistant Staphylococcus
aureus and Escherichia coli bacteraemia: estimating the burden of
antibiotic resistance in Europe. PLoS Med. 2011 Oct;8(10):e1001104.
19 Rampling A, Wiseman S, Davis L, Hyett AP, Walbridge AN, Payne
GC, et al. Evidence that hospital hygiene is important in the
control of meticillin-resistant Staphylococcus aureus. J Hosp Infect
2001;49(2):109-16.
20 Vos MC, Behrendt MD, Melles DC, Mollema FP, de Groot W, Parlevliet
G, et al. 5 years of experience implementing a methicillin-resistant
Staphylococcus aureus search and destroy policy at the largest
university medical center in the Netherlands. Infect Control Hosp
Epidemiol. 2009;30(10):977-84.
61
dominant MRSA clones might also have influenced the

epidemiology of MRSA in Europe21.
However, the EU/EEA MRSA population-weighted mean
remains at 17.8% and seven out of the 30 reporting
countries report MRSA percentages of above 25%, highlighting that MRSA remains a public health priority.
To continue to reduce the spread of MRSA in Europe,
SURVEILLANCE REPORT
comprehensive MRSA strategies targeting all healthcare

sectors (acute, long-term care facilities and ambulatory
care) remain essential.
The large differences between MRSA and MSSA in resistance percentage for rifampicin and fluoroquinolones are
most likely due to selective testing of MRSA isolates for
additional antimicrobial agents.
21 Thompson DS, Workman R, Strutt M. Decline in the rates of

methiicillin-resistant Staphlococcus aureus acquisition and
bacteraemia in a general intensive care unit between 1996 and 2008.
J Hosp Infect 2009;71(4):314-9.
Figure 3.45. Enterococcus faecalis. Percentage (%) of invasive isolates with high-level resistance to aminoglycosides, by
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
62
SURVEILLANCE REPORT
3.7 Enterococci
Enterococci belong to the normal bacterial flora of the
gastrointestinal tract of humans, other mammals, birds
and reptiles. Enterococci are regarded as harmless
commensals, and are even believed to have positive
effects on a number of gastrointestinal and systemic
conditions. However, enterococci can cause invasive
diseases. Recently, the recognition of high-risk clones
suggests that some particular strains can act as true
pathogens, and not only as opportunistic commensals.
Enterococci can cause a variety of infections, including
endocarditis, bloodstream infections, and urinary tract
infections, and are associated with peritonitis and intraabdominal abscesses. In the United States, three to four
nosocomial bloodstream infections per 10000 hospital
discharges are caused by enterococci, and contribute to
patient mortality as well as additional hospital stay.
The vast majority of clinical enterococcal infections in
humans are caused by Enterococcus faecalis and E. faecium. Epidemiological data collected over the last two
decades have documented the emergence of enterococci as important nosocomial pathogens, exemplified
by the expansion of a major hospital-adapted polyclonal
subcluster CC17 in E. faecium, and by CC2 and CC9 in
E. faecalis. The latter clones have even been isolated
from farm animals. The emergence of particular clones
and clonal complexes of E. faecalis and E. faecium was
paralleled by increases in resistance to glycopeptides
and high-level resistance to aminoglycosides. These two

antimicrobial classes provide the few remaining therapeutic options for treatment of human infections caused
by E. faecium when resistance has emerged against
penicillins. Besides the fact that infections caused by
resistant strains are difficult to treat, enterococci are
highly tenacious and thus easily disseminate in the hospital setting.

Enterococci are intrinsically resistant to a broad range
of antimicrobials including cephalosporins, sulphonamides and low concentrations of aminoglycosides.
Patient safety in hospitals is challenged by the ability of
enterococci to acquire additional resistance through the
transfer of plasmids and transposons and recombination
or mutation.
Beta-lactam antimicrobials
By nature, enterococci have low susceptibility to many
beta-lactam antimicrobials as a consequence of their
low-affinity PBPs. Two possible mechanisms of resistance of enterococci to beta-lactams have been reported:
the production of beta-lactamase, which is an extremely
rare finding, and the overproduction and modification of
PBPs, particularly PBP5, that causes high-level penicillin
resistance in E. faecium. Resistance to aminopenicillin is
currently rare in E. faecalis. Therefore, the first choice for
treatment of infections caused by this microorganism is
still an aminopenicillin such as ampicillin. In E. faecium,
Figure 3.46. Enterococcus faecium. Percentage (%) of invasive isolates resistant to vancomycin, by country, EU/EEA
countries, 2012
< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
50%
Not included
Liechtenstein
Luxembourg
Malta
63
SURVEILLANCE REPORT
Figure 3.47. Enterococcus faecalis. Trends of invasive isolates with high-level resistance to aminoglycosides, by
CY (<)
2009
SE
2010
FR
2011
2012
LU
BE
DK
EL (<)
UK
LV
AT
EU/EEA
Country code
NO
NL
IE
SI
DE (<)
ES (<*)
BG
HR
PL
CZ
PT
LT
IT
HU
0
10
20
30
40
50
60
70
% aminoglycoside high-level resistance

64
80
SURVEILLANCE REPORT
ampicillin-resistance has increased significantly in

recent years, due not least to the wide dissemination of
ampicillin-resistant strains belonging to the polyclonal
subcluster CC17.
Aminoglycosides
In addition to the intrinsic mechanism of low-level resistance to aminoglycosides, which causes a low uptake of
the drug, enterococci have acquired genes conferring
high-level resistance to aminoglycosides. High-level
resistance to streptomycin can be mediated by single
mutations within a protein of the 30S ribosomal subunit, the target of aminoglycoside activity. In addition,
different aminoglycoside-modifying enzymes have been
identified, targeting eight different aminoglycosides. The
bi-functional APH(2)/AAC(6) enzyme confers high-level
resistance to all aminoglycosides except streptomycin
and is now widespread across Europe. With high-level
resistance, any synergistic effect between beta-lactams
and glycopeptides is lost.
Glycopeptides
Vancomycin resistance in enterococci was first reported
in France and England, but showed the most dramatic
increase in the United States and was attributed to the
widespread use of vancomycin in US hospitals. While
vancomycin consumption was lower in Europe, a closely
related glycopeptide, avoparcin, had been widely used

as a growth promoter in animal husbandry since the late
1970s until it was banned in the EU by 1998. Glycopeptide
resistance is due to the synthesis of modified cell wall
precursors that show a decreased affinity for glycopeptides. Six phenotypes have been identified of which two
have clinical relevance: VanA, with high-level resistance
to vancomycin and a variable level of resistance to teicoplanin; and VanB, with a variable level of resistance in
most cases to vancomycin only. The VanA and VanB phenotypes, mostly found among E. faecalis and E. faecium,
may be transferred by plasmids and through conjugative
transposition.

High-level aminoglycoside resistance in E. faecalis seems stable in Europe, but is generally very
high with the majority of countries reporting percentages of above 25% over the recent years.
The percentage of vancomycin resistance in
E. faecium shows large inter-country variations,
with the majority of countries reporting resistance
percentages of below 5% during recent years and
only a few countries reporting estimates above
10%.
Table 3.13. Total number of invasive isolates and percentages (%) of high-level aminoglycoside-resistant E. faecalis
and vancomycin-resistant E. faecium, including 95% confidence intervals, by country, EU/EEA countries, 2012
Country
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Slovakia
Slovenia
Spain
Sweden
United Kingdom
High-level aminoglycoside resistant E. faecalis

Number of isolates
% R (95% CI)
425
29.2 (25-34)
396
24.5 (20-29)
78
38.5 (28-50)
160
38.8 (31-47)
77
10.4 (5-19)
581
41.7 (38-46)
112
27.7 (20-37)
19
42.1 (20-67)
0
1528
16.7 (15-19)
680
35.6 (32-39)
667
28.3 (25-32)
452
56.2 (51-61)
20
11.8 (5-28)
279
32.6 (27-38)
300
51.0 (45-57)
55
29.1 (18-43)
59
50.8 (37-64)
45
22.2 (11-37)
0
287
30.7 (25-36)
123
30.1 (22-39)
105
39.0 (30-49)
347
42.9 (38-48)
179
50.3 (43-58)
129
34.9 (27-44)
878
38.3 (35-42)
792
14.8 (12-17)
377
29.4 (22-38)
26.5
Vancomycin-resistant E. faecium
Number of isolates
% R (95% CI)
376
3.2 (2-6)
212
1.4 (0-4)
42
0.0 (0-8)
61
0.0 (0-7)
29
10.3 (2-27)
262
11.5 (8-16)
593
2.0 (1-4)
40
0.0 (0-9)
274
0.7 (0-3)
614
0.8 (0-2)
647
16.2 (13-19)
418
17.2 (14-21)
142
3.5 (1-8)
14
0.0 (0-20)
386
44.0 (39-49)
435
6.0 (4-9)
18
5.6 (0-27)
36
5.6 (1-19)
20
0.0 (0-17)
6
*
484
0.0 (0-1)
168
0.6 (0-3)
157
8.3 (4-14)
257
23.3 (18-29)
82
4.9 (0-10)
95
0.0 (0-4)
537
1.5 (1-3)
404
0.0 (0-1)
362
13.3 (10-17)
8.1
* Fewer than 10 isolates, percentage not calculated.
65
SURVEILLANCE REPORT
Figure 3.48. Enterococcus faecium. Trends of invasive isolates with resistance to vancomycin, by country, EU/EEA
countries, 20092012
BG
2009
2010
HR (<)
2011
NL
2012
SE
SI (<)
NO
FI
FR
BE
Country code
ES
DK
AT
HU
IT
EU/EEA
PL
CZ (>)
UK
DE (>)
EL (<)
PT
IE
0
10
20
30
40
% vancomycin resistance
66
50
SURVEILLANCE REPORT
High-level aminoglycoside resistance
For 2012, 27 countries reported 9150 isolates with relevant AST information for high-level aminoglycoside
resistance. The number of isolates reported per country ranged from 19 to 1528 (Table 3.13).
for high-level aminoglycoside resistance was 26.5%.
The percentages of resistant isolates in the reporting countries ranged from 10.4 (Cyprus) to 56.2%
(Hungary). Six countries reported resistance percentages of 1025%, 17 reported 2550% and four
reported over 50%. (Figure 3.45 and Table 3.13).
Twenty-four countries have reported more than 20 isolates per year since 2009 and were thus included in the
trend analysis for the period 20092012.
Four countries (Cyprus, Germany, Greece and Spain)
have had statistically significant decreasing trends
of high-level aminoglycoside resistance for the past
four years. No country showed a significant increasing
trend for the same period (Figure 3.47).
Vancomycin
For 2012, 29 countries reported 7171 isolates with relevant AST information for vancomycin. The number of
isolates with relevant AST information reported per
country ranged from 6 to 647. Only one country (Malta)
reported fewer than 10 isolates and is therefore not
included in Figure 3.46 or the resistance calculations
in Table 3.13.
for vancomycin resistance was 8.1%. The percentages of vancomycin-resistant isolates ranged from
zero (Bulgaria, Croatia, Estonia, Iceland, Luxembourg,
Malta, the Netherlands, Slovenia and Sweden) to
44.0% (Ireland). Eleven countries reported resistance percentages of below 1%, six countries reported
15%, four countries reported 510%, six countries

reported 1025%, and one country reported above
25% (Figure 3.46 and Table 3.13).
Twenty-one countries have reported more than 20 isolates per year since 2009 and were thus included in the
trend analysis for the period 20092012. Statistically
significant increasing trends were observed for the
Czech Republic and Germany. Statistically significant decreasing trends of vancomycin resistance were
observed for Croatia, Greece and Slovenia (Figure
3.48).

High levels of antimicrobial-resistant enterococci remain
a major infection control challenge and an important
cause of healthcare-associated infections in Europe.
In the recent point prevalence survey of healthcareassociated infections and antimicrobial use in European
acute care hospitals 20112012, Enterococcus spp. were
one of the most commonly isolated microorganisms in
healthcare-associated infections and resistance to vancomycin or high-level resistance to aminoglycoside was
not unusual22.
The previously reported23 large decrease in the percentage of high-level aminoglycoside-resistant E. faecalis
in Cyprus and Greece continued in 2012. No country
reported an increasing trend for the period 20092012,
and the EU/EEA population-adjusted mean decreased
for the first time during the past four years. Despite
this positive development, aminoglycoside resistance in
E. faecalis remained very high at levels above 25% for
most European countries.
22 European Centre for Disease Prevention and Control. Point

prevalence survey of health-care associated infections and
antimicrobial use in European acute care hospitals. Stockholm:
ECDC; 2013.
23 European Centre for Disease Prevention and Control. Antimicrobial
Resistance Surveillance in Europe 2011. Annual report of the
European Antimicrobial Resistance Surveillance network (EARS-Net).
67
SURVEILLANCE REPORT
Annexes
69
SURVEILLANCE REPORT
Annex 1 External quality assessment 2012

Introduction
MICs of strains were each tested in two of three laboratories; Addenbrookes Hospital, Cambridge (UK),
University Hospital of Wales, Cardiff (UK) and City
Hospital, Birmingham (UK). Reference laboratories confirmed MICs and results were interpreted according to
the most frequently used breakpoint criteria (EUCAST
and CLSI), as indicated in the summary for each species
outlined below.
Since 2000, EARSS/EARS-Net have organised external

quality assessment (EQA) of antimicrobial susceptibility
testing in collaboration with UK NEQAS (United Kingdom
National External Quality Assessment Service). UK
NEQAS is based at the Health Protection Agency in
London, and is a non-profit organisation with more than
35 years of experience in external quality assessment in
different countries (www.ukneqasmicro.org.uk).
Results
The purpose of the EARS-Net EQA is:
Six strains were distributed to 883 laboratories participating in EARS-Net. Laboratories were asked to report
the identification of each organism and clinical susceptibility characterisation susceptible, intermediate
and resistant (S, I, R) according to guideline used.
The return rate was equivalent to previous years; 807
laboratories (91%) returned reports. Figure A1.1 shows
the proportion of participating laboratories returning
results per country.
to assess the ability of participating laboratories to

identify antimicrobial resistance of clinical and public
health importance;
to determine the accuracy of susceptibility test results
reported by individual laboratories;
to estimate the overall comparability of routinely collected test results between laboratories and countries
across Europe.
Participants results were analysed and considered

concordant if the reported categorisation agreed with
the interpretation of the reference laboratories (Tables
A1.1A1.6).
The strains used for the 2012 EQA were compatible with species under surveillance at ECDC, namely
Streptococcus pneumoniae, Staphylococcus aureus,
Escherichia coli, Klebsiella pneumoniae, Pseudomonas
aeruginosa and Enterococcus faecium. The reference
For the determination of AST results, laboratories used

automated methods (44%), disk diffusion tests (34%), or
Country
Figure A1.1. Number of participating laboratories returning EQA reports 2012, per country
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovenia
Spain
Sweden
UK
Results
No results
20
40
60
80
100
Number of laboratories
71
SURVEILLANCE REPORT
shows the adherence to (inter)national guidelines by

number of laboratories per country.
a combination of methods (13%). For species identification, 56% used automated and 44% used conventional
methods. Increased use of conventional methods was
associated with identification of S. pneumoniae and
E.faecalis.
Specimen 1373 Enterococcus faecalis

This organism was an Enterococcus faecalis with
vanA-mediated glycopeptide resistance (resistant to
vancomycin and teicoplanin). There were no significant
problems detecting vancomycin resistance and only a
small minority of participants failed to report reduced
susceptibility to teicoplanin (2.9% susceptible, 4.3%
intermediate, and 92.8% resistant) (Table A1.1).
Some 39% of laboratories applied CLSI guidelines; this

is a significant reduction from the previous year when
the proportion was 47%. Some countries used national
guidelines, for example, France (SFM), UK (BSAC), and
Sweden (SRGA). EUCAST guidelines were used by 395
(49%) laboratories, this was an increase of 114 laboratories compared to last year (n=281). However, the UK,
Sweden, the Netherlands, Germany, France and Norway
have been implementing EUCAST breakpoints in their
national MIC breakpoint recommendations as harmonised breakpoints have been agreed, and have adjusted
the interpretation of their disk diffusion method accordingly. Therefore, a combined total of some 61% of
laboratories used EUCAST breakpoints. Figure A1.2
Gentamicin monotherapy is ineffective against enterococci. There is, however, synergism between gentamicin
and beta-lactam agents against enterococci without
mechanisms conferring high-level gentamicin resistance
(usually production of the bi-functional enzyme APH(2)/
AAC(6)). This organism was not high-level gentamicinresistant but 23.7% of participants incorrectly reported
it to be so, very similar to error rates for an Enterococcus
Country
Figure A1.2. Guidelines reported to be used by laboratories: number of laboratories per country, 2012
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovenia
Spain
Sweden
Turkey
United Kingdom
EUCAST
NWGA
BSAC
SRGA
DIN
CLSI
SFM
20
40
60
80
100
BSAC: British Society for Antimicrobial Chemotherapy; DIN: Deutsche Industrie Norm; EUCAST: European Committee on Antimicrobial Susceptibility Testing; CLSI:
Clinical and Laboratory Standards Institute; NWGA: Norwegian Working Group on Antimicrobials; SFM: Societe Francaise de Microbiologie; SRGA: Swedish Reference
Group for Antimicrobials.
Table A1.1. Enterococcus faecalis (1373). Minimum inhibitory concentration (MIC) and intended results reported by the
reference laboratories and the overall concordance of the participating laboratories
Antibiotic agent
Amoxicillin
Ampicillin
High-level gentamicin
Teicoplanin
Vancomycin
72
MIC range (mg/L) ref. lab

from
1
1
8
128
64
to
1
2
16
128
64
EUCAST/CLSI
S
S
S (not HLR)
R
R
Intended interpretation
Overall concordance (%)
97
96
76
93
98
SURVEILLANCE REPORT
faecium without high-level gentamicin resistance in the

2011 EARS-Net EQA exercise.
Specimen 1374 Escherichia coli

This organism was an Escherichia coli with a TEM-10
ESBL and there were no significant problems in identifying that the organism was an ESBL-producer (99.1%
reported ESBL-positive). While the organism was
high-level resistant to ceftazidime (MIC 128 mg/L) it
displayed borderline resistance to cefotaxime and ceftriaxone (MICs 4 mg/L and 816 mg/L, respectively, in
reference tests; resistant to both agents with EUCAST
and CLSI breakpoints).
As is often the case with borderline susceptibility,
reporting of susceptibility categories was variable. For
cefotaxime, 47.7% reported resistant, 25.0% intermediate and 27.3% susceptible, and for ceftriaxone, 48.7%
reported resistant, 19.4% intermediate and 31.9% susceptible. While the majority of participants reported
reduced susceptibility to cefotaxime and ceftriaxone,
substantial minorities reported the isolate susceptible.
Cefotaxime MICs were reported by 481 of 703 participants testing cefotaxime susceptibility, most using
automated or gradient systems. Reported MICs were
more variable than in reference tests, with 248 reporting cefotaxime MICs 1 mg/L (susceptible by EUCAST
and CLSI breakpoints) and 225 reporting MICs >1 mg/L

(intermediate or resistant by EUCAST and CLSI breakpoints). Among participants reporting cefotaxime MICs
in the susceptible range, 48.0% interpreted them as
susceptible, 17.3% intermediate and 34.7% resistant,
indicating that close to half of these laboratories were
reporting as found (in line with current EUCAST and
CLSI recommendations) and about half were probably
editing results of susceptible to intermediate or resistant, presumably because of the presence of an ESBL.
Laboratories reporting cefotaxime MICs >1 mg/L would
be expected to report intermediate or resistant and
96.5% did so. Similar results were seen with ceftriaxone,
for which MICs were reported by 136 of 376 participants
testing ceftriaxone susceptibility. Sixty-five participants reported ceftriaxone MICs 1 mg/L (susceptible
by EUCAST and CLSI breakpoints) and 70 reported MICs
>1 mg/L (intermediate or resistant by EUCAST and CLSI
breakpoints). Among participants reporting ceftriaxone
MICs in the susceptible range, 60.0% interpreted results
as susceptible, 9.2% intermediate and 30.8% resistant.
Among laboratories reporting ceftriaxone MICs >1 mg/L,
92.8% reported either intermediate or resistant.
The organism was susceptible to piperacillintazobactam (MIC 48 mg/L) by both EUCAST and CLSI
breakpoints. Reports of reduced susceptibility to
piperacillintazobactam by some participants (11.6%
Table A1.2. Escherichia coli (1374). Minimum inhibitory concentration (MIC) and intended results reported by the
reference laboratories and the overall concordance of the participating laboratories
Antibiotic agent
Amikacin
Amoxicillin
Ampicillin
Cefotaxime
Ceftazidime
Ceftriaxone
Ciprofloxacin
Gentamicin
Imipenem
Meropenem
Piperacillin-tazobactam
Tobramycin
ESBL
MIC range (mg/L) ref. lab.

from
1
128
128
4
128
8
0.015
0.5
0.25
0.03
4
2
to
1
128
128
4
128
16
0.015
0.5
0.25
0.03
8
2
EUCAST/CLSI
S
R
R
R
R
R
S
S
S
S
S
S
POS
99
98
99
48
99
49
99
100
99
99
80
99
99
Table A1.3. Klebsiella pneumoniae (1375). Minimum inhibitory concentration (MIC) and intended results reported by
the reference laboratories and the overall concordance of the participating laboratories
Antibiotic agent
Amikacin
Amoxicillin
Ampicillin
Cefotaxime
Ceftazidime
Ceftriaxone
Ciprofloxacin
Gentamicin
Imipenem
Meropenem
Tobramycin
ESBL

from
1
128
128
0.03
0.25
0.06
0.06
0.5
0.25
0.03
8
1
to
2
128
128
0.03
0.25
0.06
0.06
0.5
0.5
0.03
8
0.5
EUCAST/CLSI
S
R
R
S
S
S
S
S
S
S
S
S
NEG
99
94
99
99
99
99
99
99
100
100
98
99
99
73
SURVEILLANCE REPORT
resistant, 8.2% intermediate, 80.2% susceptible) may

have been because of editing to a more resistant category because of the presence of the ESBL. Guidelines
from both EUCAST and CLSI recommend reporting betalactamase inhibitor combinations as found in routine
tests, although the current EUCAST expert rule 9.1 does
recommend that when an organism is intermediate or
resistant to any 3rd generation (cefotaxime, ceftriaxone,
ceftazidime) or 4th generation (cefepime) oxyiminocephalosporin, reports of susceptible to beta-lactamase
inhibitor combinations should include a warning of
uncertain therapeutic outcome for infections other than
urinary tract infections (Table A1.2).
interpreted according to CLSI breakpoints. Reference

MICs for piperacillintazobactam ranged from 64 to
128 mg/L (concentration of tazobactam fixed at 4
mg/L), clearly resistant by EUCAST breakpoints (S 16,
R >16 mg/L) but borderline with the much higher CLSI
resistant breakpoint (S 16, R 128 mg/L). Reports from
participants were largely in line with breakpoints used,
in that 95.3% of participants using EUCAST or EUCASTrelated breakpoints reported resistant, while only
66.7% of participants using CLSI breakpoints reported
resistant (Table A1.4).
Specimen 1375 Klebsiella pneumoniae
This organism was a multi-resistant Staphylococcus

aureus with dissociated resistance to clindamycin.
This organism was a Klebsiella pneumoniae susceptible to all reference agents tested except ampicillin and
amoxicillin. K. pneumoniae is inherently resistant to
ampicillin/amoxicillin so reports of susceptible isolates
should always be viewed with caution. Still, 13 (5.7%)
participants falsely reported the organism susceptible to amoxicillin, of which 12 correctly reported the
organism resistant to ampicillin (Table A.1.3). There is
cross-resistance between ampicillin and amoxicillin so
a discrepancy in results for these agents should have
been recognised as very unlikely.
Specimen 1376 Pseudomonas aeruginosa

This organism was a Pseudomonas aeruginosa resistant to all agents tested except piperacillintazobactam
Specimen 1377 Staphylococcus aureus
Discrepancies with clindamycin were fewer than seen

with previous distributions of organisms with dissociated resistance, with 91.1% now reporting resistant,
1.4% intermediate and 7.5% susceptible (Table A1.5).
In staphylococci, most resistance to macrolide, lincosamide, streptogramin type B (MLSB) antibiotics is
mediated by the erm genes and is induced by erythromycin, clarithromycin and azithromycin, but not by
clindamycin (dissociated resistance or MLSB-inducible
resistance). Hence inducible strains are resistant to
erythromycin but not to clindamycin in susceptibility tests. Strains with MLSB-constitutive resistance are
resistant to both agents. There has been debate about
whether staphylococci with inducible resistance (erythromycin-resistant, clindamycin-susceptible) should be
Table A1.4. Pseudomonas aeruginosa (1376). Minimum inhibitory concentration (MIC) and intended results reported by
Antibiotic agent
Amikacin
Ceftazidime
Ciprofloxacin
Gentamicin
Imipenem
Meropenem
Tobramycin

from
64
128
32
64
128
128
64
128
to
64
128
32
64
128
128
128
128
EUCAST/CLSI
R
R
R
R
R
R
R
R
99
100
100
99
99
100
84
100
Table A1.5. Staphylococcus aureus (1377). Minimum inhibitory concentration (MIC) and intended results reported by
Antibiotic agent
Cefoxitin
Ciprofloxacin
Clindamycin
Erythromycin
Fusidic acid
Gentamicin
Meticillin
Oxacillin
Penicillin
Rifampicin
Teicoplanin
Tetracycline
Vancomycin

from
64
16
0.12
128
0.12
128
NT*
128
64
0.008
0.5
128
1
* Not tested, result inferred from oxacillin and cefoxitin results
74
to
64
16
0.12
128
0.12
512
R
128
64
0.008
0.5
128
1
EUCAST/CLSI
R
99
R
97
dissociated resistance
91
R
99
S
99
R
99
99
99
R
99
R
99
S
95
S
99
R
98
S
99
SURVEILLANCE REPORT
reported as resistant because inducible strains segregate clindamycin-resistant mutants, which may be
selected during therapy. The EUCAST expert rules24
indicate that such strains should either be reported
as resistant to clindamycin or reported as susceptible
with a warning of possible clinical failure during treatment with clindamycin due to selection of constitutively
resistant mutants. EUCAST also states that the use of
clindamycin is best avoided in severe infections caused
by isolates with dissociated resistance. CLSI suggests
that such strains should be reported as resistant but
that a comment may be added that clindamycin may
still be effective in some patients. Inducible clindamycin
resistance is detected in disk diffusion tests with a clindamycin disk placed adjacent to an erythromycin disk:
strains with inducible resistance show flattening of the
clindamycin zone adjacent to the erythromycin disk.
methods, with increased use of conventional methods

associated with identification of the S. pneumoniae
and E. faecium/faecalis. National guidelines are commonly followed in some countries e.g. SFM (France), DIN
(Germany) and BSAC (UK). However, the BSAC, SRGA,
CRG, DIN, SFM and NWGA have been implementing
EUCAST breakpoints in their national MIC breakpoint
recommendations as harmonised breakpoints have
been agreed. Increasing uptake of EUCAST harmonised
breakpoints was evident from the guidelines used by
participants over the EQA period. The use of CLSI guidelines was reduced from 66% to 39%, whilst the use of
EUCAST guidelines increased from 15% to 49%, and
when this number was added to users of EUCAST-related
guidelines (12% in 2012) this gave a combined total of
61%.
Participant concordance for identification of the organisms was very good. Variation in interpretation of
susceptibility results was seen with strain/antimicrobial
agent combinations that had borderline MIC values and
clear differences in reporting seen where breakpoints
and interpretation differ between guidelines.
Specimen 1378 Streptococcus pneumoniae

This organism was a Streptococcus pneumoniae susceptible to penicillin. Although there were no significant
problems in reporting susceptibility to penicillin, 5.8%
of participants reported resistance in the oxacillin
screening test for penicillin resistance. An additional
0.7% reported oxacillin intermediate despite the fact
that there is no intermediate category for the oxacillin
screen test (Table A1.6).
The design of the EQA was in keeping with the established AST scheme organised by UK NEQAS, which has
been established for more than forty years and is currently accredited to ISO 14075.
Conclusions
Discussion
The response from the laboratories to the 2012 EARSNet EQA was very good with a high return rate and very
few late responders.
Overall, performance was generally very good and

consistent with that seen in previous EQA. Problems,
where experienced, were related to borderline susceptibility and when remaining discrepancies between
different guidelines resulted in discrepancies in routine susceptibility testing. EQA is a valuable tool in the
quality assurance of antimicrobial susceptibility testing
and indicates the validity of comparing collated data
between laboratories in resistance surveillance studies.
Participants results were analysed and considered concordant if the reported categorisation agreed with the
interpretation of MICs determined in the reference laboratories. For the determination of AST results, on average
43% of laboratories used automated methods and 34%
disk diffusion tests. For species identification, on average 55% used automated and 45% used conventional
Limitations associated with the design of the EQA panels are largely attributable to the restricted number
of isolates distributed in the EARS-Net EQA. It is difficult to cover the full range of strains representative of
the epidemiologically important AMR types currently
24 Leclercq R, Cantn R, Brown DF, Giske CG, Heisig P, MacGowan AP,

et al. EUCAST expert rules in antimicrobial susceptibility testing.
Clin Microbiol Infect. 2013 Feb;19(2):141-60. doi: 10.1111/j.14690691.2011.03703.x. Epub 2011 Nov 25. Review.
Table A1.6. Streptococcus pneumoniae (1378). Minimum inhibitory concentration (MIC) and intended results reported
by the reference laboratories and the overall concordance of the participating laboratories
Antibiotic agent
Cefotaxime
Meningitis
Pneumonia
Ceftriaxone
Meningitis
Pneumonia
Ciprofloxacin
Clindamycin
Erythromycin
Penicillin
Meningitis
Pneumonia
from
to
EUCAST/CLSI
0.004
0.004
S
S
99
100
0.004
0.004
64
16
64
0.125
32
S
S
I/no interpretation
S
R
99
99
96
97
98
0.015
0.03
S
S
97
99
75
circulating in Europe and equally, to re-circulate isolates

that participants found challenging to monitor improvements in resistance detection.
Misunderstanding of language, coupled with differences
in the technical terminology used by different AST guidelines and the commercial instruments, was perceived as
a potential issue for reporting the detection of high-level
gentamicin resistance in enterococci. The differences in
terminology can be confusing and, if the participants
first language is not English, this may explain the higher
76
SURVEILLANCE REPORT
error rates seen for the enterococci isolate without highlevel gentamicin resistance.
ECDC would like to thank UK NEQAS, the reference laboratories, the members of the EARS-Net Coordination
Group and the country EQA coordinators for their efforts
and contribution to the success of this EQA. Special
thanks goes to the all involved staff at the participating laboratories for providing timely and high quality
responses to the assessment.
SURVEILLANCE REPORT
Annex 2 EARS-Net laboratory/hospital

denominator data 2012
Introduction
For correct interpretation of the EARS-Net data on antimicrobial resistance, accurate background information
is important. Therefore, laboratory and hospital denominator data are collected and presented in this Annex.
Methods
Questionnaires (Microsoft Excel files) were sent to
the EARS-Net contact points in April 2013. The contact points distributed the questionnaires to the
participating laboratories and hospitals in their country.
Information was collected on the total number of blood
culture sets processed in the laboratories, and the number of hospital beds for each participating hospital, the
type of hospital, the bed occupancy and the number of
admissions. The national data managers received the
completed questionnaires, compiled them and produced
the final format suitable for uploading to The European
Surveillance System (TESSy). Laboratories were defined
as reporting denominator data if they provided the number of blood culture sets performed for one or more
hospitals. Hospitals were defined as reporting denominator data if they provided the number of beds.
Organisation of healthcare systems and affiliation
between laboratories and hospitals differs considerably
between countries, which might influence data comparability. For countries submitting denominator data for
a small percentage of hospitals and/or laboratories contributing data to EARS-Net, the reported figures might
not be representative for the overall country profile.
The number of hospitals and laboratories reporting AMR
data is defined as the number reporting at least one isolate during the specific year. Please note that the total
number of hospitals and laboratories participating in
EARS-Net might be higher in some countries.
Participation
Nineteen of the 30 countries reporting AMR data also
returned hospital denominator data referring to 2012,
while for five countries, hospital denominator data referring to 2011 were available and included in the analysis.
Seventeen countries could provide laboratory denominator data (number of blood cultures) for 2012 and five
for 2011. Some denominator data for laboratories and
hospitals not reporting AMR data, or reporting zero
cases, have been included in Figure A2.1, but were not
included in other parts of the analysis.
Population coverage
Data on population coverage for AMR data at country level are not reported because of the inherent
limitations of these data. Not all laboratories/hospitals
reporting AST data also provide denominator data, and
this would introduce bias into the calculation of country
Table A2.1. Hospital denominator data for 2011 or 2012 (using the latest available data)
Country
Austria
Bulgaria
Cyprus
Czech Republic*
Denmark*
Finland
France
Germany
Hungary
Iceland*
Ireland
Italy
Latvia
Lithuania
Malta*
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain*
Sweden
United Kingdom
Hospitals reporting
(denominator/AMR
data)
(142/147)
(20/22)
(5/7)
(68/76)
(5/69)
(16/17)
(176/177)
(53/194)
(59/60)
(4/8)
(54/68)
(28/41)
(11/12)
(22/29)
(3/3)
(12/48)
(36/58 )
(19/25)
(7/12)
(26/26)
(15/15)
(41/49 )
(28/42)
(26/89)
Total number of beds
Proportion of ICU
beds (%)
Annual occupancy
rate (%)
Median length of
stay (days)
58276
9679
1330
38911
3254
9528
127423
18700
43896
919
12115
14892
5058
12423
1157
5816
18811
8228
5344
13755
7377
26646
9747
18849
5
7
8
11
67
73
78
70
82
81
79
75
83
87
80
71
74
87
96
68
74
78
69
70
79
95
79
4.5
5.7
5.2
7.2
3.2
7.1
6.7
8.4
7.7
5.1
5.5
7.3
5.3
4.8
5
7
6.2
6.9
5.3
2.8
3
6
7
2
5
3
4
6
3
2
6
8
8
5
4
5
IQR length of stay

(days)
4.0-5.4
5.0-6.3
4.9-5.5
6.1-8.3
2.8-3.6
5.9-8.5
5.9-8.0
7.0-9.7
6.5-14.6
4.3-6.3
4.8-6.3
6.6-8.5
4.8-45.0
4.3-5.7
4.0-6.0
5.0-8.7
6.0-7.2
6.0-7.5
4.9-6.6
2.4-4.8
* Data for 2011.
77
SURVEILLANCE REPORT
Figure A2.1. Number of hospitals (A) and laboratories (B) reporting AMR and/or denominator data in 2011 or 2012
(using latest available data)
A)
Austria
AMR and denominator information
Bulgaria
AMR information only
Cyprus
Czech Republic*
Denominator information only
Denmark*
Finland
France
Germany
Hungary
Country
Iceland*
Ireland
Italy
Latvia
Lithuania
Malta*
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain*
Sweden
United Kingdom
0
50
100
150
200
250
Number of hospitals
B)
Austria
AMR and denominator information
Bulgaria
AMR information only
Cyprus
Czech Republic*
Denominator information only
Denmark*
Finland
France
Germany
Hungary
Country
Iceland*
Ireland
Italy
Latvia
Lithuania
Malta*
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain*
Sweden
United Kingdom
0
50
100
* Denominator data from 2011.
78
150
200
SURVEILLANCE REPORT
population coverage since only laboratories/hospitals

reporting denominator data can be included. Secondly,
laboratories and hospitals cluster in big cities and, for
this reason, some of the catchment areas overlap. This
could lead to double counts, which would artificially
increase the estimated coverage.
Hospital denominator
information
The total number of hospital beds for hospitals reporting
both AMR and denominator data in different countries
ranged from 919 in Iceland to 127423 in France, reflecting the size of the country as well as the rate of
participation in EARS-Net and the rate of response to
the questionnaires.
The percentage of ICU beds over total hospital beds
shows wide variation by country, ranging from 2% in
Hungary, to 11% in the Czech Republic. The overall
median length of stay in hospital was 5.6 days with the
lowest median in United Kingdom (2.8 days) and the
highest in Hungary (8.4 days). The annual occupancy
rate was 75 % or higher in 14 out of the 23 countries providing data for this (Table A2.1).
Hospital characteristics
Both the size of a hospital and the level of specialisation
may influence the occurrence of antimicrobial resistance
in the hospital. As can be seen from Table A2.2 and Figure

A2.2, the distribution of size and specialisation level of
hospitals varied considerably between the reporting
countries. This does not necessarily reflect different
distributions of the origin of EARS-Net blood cultures
per country, as not all hospitals contribute evenly to the
EARS-Net database. On the other hand, this diversity
can indicate differences in case-mix, which may confound comparison of AMR results between countries.
The type of hospital and the size of hospital are not
always linked and it is not rare, especially in smaller
countries, that university hospitals have fewer than 500
beds.
Laboratory denominator
information
In 2012/2011 (latest available data), the median blood
culture sets per 1000 patient days sets processed in
the EARS-Net laboratories responding to the questionnaire was 31.5. The highest rate was reported by
Finland (83 cultures per 1000 patient days) and the lowest by Lithuania (7 cultures per 1000 patient days). For
the majority of the reporting countries, there are only
minor changes in the number of blood culture sets taken
per 1000 patient days (Table A2.3) when comparing
2012/2011 (latest available data) data with 2010/2011
(latest available data).
Figure A2.2: Percentage of small, medium and large hospitals per country, based on number of beds, for all hospitals
reporting both antimicrobial resistance data and denominator data in 2011 or 2012 (using latest available data)
Austria (142/147)
Large hospitals
(> 500 beds)
Bulgaria (20/22)
Cyprus (5/7)
Medium-sized hospitals
(201500 beds)
Czech Republic* (68/76)

Denmark* (5/69)
Small hospitals
( 200 beds)
Finland (16/17)
France (176/177)
Germany (53/194)
Hungary (59/60)
Iceland* (4/8)
Country
Ireland (54/68)
Italy (27/41)
Latvia (11/12)
Lithuania (22/29)
Malta* (3/3)
Norway (12/48)
Poland (36/58)
Portugal (19/25)
Romania (7/12)
Slovakia (26/26)
Slovenia (15/15)
Spain* (41/49)
Sweden (28/42)
United Kingdom (26/89)
0
20
40
60
80
100
Percentage hospital type

* Denominator data from 2011.
79
SURVEILLANCE REPORT
Table A2.2. Hospital characteristics for 2011 or 2012 (using the latest available data)
Country
Austria
Bulgaria
Cyprus
Czech Republic*
Denmark*
Finland
France
Germany
Hungary
Iceland*
Ireland
Italy
Latvia
Lithuania
Malta*
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain*
Sweden
United Kingdom
Hospitals reporting
(denominator/AMR data)
(142/147)
(20/22)
(5/7)
(68/76)
(5/69)
(16/17)
(176/177)
(53/194)
(59/60)
(4/8)
(54/68)
(28/41)
(11/12)
(22/29)
(3/3)
(12/48)
(36/58 )
(19/25)
(7/12)
(26/26)
(15/15)
(41/49)
(28/42)
(26/89)
Tertiary level
8
65
20
34
40
44
28
25
46
50
17
48
36
41
33
42
33
63
71
54
13
59
21
54
Percentage of hospitals by level of care

Secondary level
Primary level
26
41
30
5
20
40
34
29
40
0
56
0
71
0
40
26
27
15
0
50
54
11
41
11
27
9
32
23
33
0
0
58
61
0
16
11
29
0
19
8
67
0
37
5
25
54
35
12
Other
25
0
20
3
0
0
0
9
12
0
19
0
27
5
33
0
6
5
0
19
20
0
0
0
Unknown
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
* Data for 2011.

Primary level or district hospital = has few specialties, limited laboratory services; bed capacity ranges from 30 to 200 beds. Secondary level, or provincial hospital
= highly differentiated by function with five to 10 clinical specialties; bed capacity ranging from 200 to 800 beds. Tertiary level or central/regional hospital = highly
specialised staff and technical equipment; clinical services are highly differentiated by function; may have teaching activities; bed capacity ranges from 300 to 1500
beds. Other = hospitals for a specific patient population, like a military hospital, or hospitals with any single specialty, like a burns unit. Unknown = not available.
Table A2.3. Laboratory denominator information for 2011 or 2012 (using the latest available data)
Country
Austria
Bulgaria
Cyprus
Czech Republic*
Denmark*
Finland
Germany
Hungary
Iceland*
Ireland
Latvia
Lithuania
Malta*
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain*
Sweden
United Kingdom
* Data for 2011.
80
Laboratories reporting
(denominator/AMR data)
(37/40)
(20/20)
(5/5)
(44/46)
(4/13)
(16/17)
(11/21)
(24/30)
(2/2)
(39/41)
(11/11)
(10/10)
(1/1)
(9/18)
(36/41)
(15/19)
(7/8)
(14/14)
(10/10)
(41/41)
(8/18)
(19/60)
Number of hospitals
Total number of blood culture sets
117
20
5
68
4
16
53
47
4
54
11
22
3
12
36
17
9
26
15
41
28
21
193810
19196
14114
144615
79269
203130
90328
87931
8906
186354
10587
20608
8796
116550
121633
114116
26523
56267
59173
305229
219380
187245
Number of blood culture sets per

1000 patient days
16
7.5
37.5
14.5
81
83
16.6
8.9
32.2
48.5
8.1
7.2
24
57.3
25.4
54
27.5
16.1
31.5
.
64.9
45.4
SURVEILLANCE REPORT
Discussion and conclusions

In summary, the situation for most countries as assessed
from denominator data reported to EARS-Net in 2012
appears stable and similar to 2011. This indicates that
based on EARS-Net data the comparison of resistance
percentages over time remains valid.
The BSIs ascertainment is strongly linked to the blood
culture rate. Therefore, the wide range in blood culture
rates observed in the countries providing denominator data has implications for inter-country comparisons
of both the incidence rate of infections, which could
be underestimated in some countries, and of the percentage of resistance. In particular, the percentage of
resistance could be overestimated if blood cultures are

not systematically performed before starting empiric
therapy and if blood cultures are more likely to be performed in patients not responding to initial empiric
treatment.
For future improvement of the denominator data collection and analysis, a further increase in the number
of countries reporting denominator data, as well as
an increased number of hospital and laboratories
participating within countries, would be desirable.
Furthermore, an improved estimation of the coverage
of the EARS-Net surveillance, e.g. by using estimations
done at the national level based on knowledge of the
country-specific situation, would also be desirable.
81
SURVEILLANCE REPORT
Country summary sheets
83
SURVEILLANCE REPORT
Explanation to the country

summary sheets
General information about EARS-Net
participating laboratories and hospitals
Table 1 gives the number of laboratories and isolates
reported by year and by pathogen under EARSS/EARSNet surveillance for the period 20032011. The total
number of laboratories participating in EARS-Net could
in some countries be higher than the number presented
in Table 1, as only laboratories reporting at least one isolate during each specific year are included.
Antibiotic resistance 20032012

Table 2 provides information on the proportion of invasive bacterial isolates non-susceptible (I+R) or resistant
(R) to the antibiotics or antibiotic classes mentioned in
the EARSS/EARS-Net protocols. When interpreting the
results in Table 2, always check the number of isolates
provided in Table 1.
If the number of isolates in a certain category accounts

for less than 0.5% of the total number of isolates, the %
total is set at <1.
PNSP at laboratory level/MRSA, FREC and

3GCRKP at hospital level
Figures 1, 2, 3 and 4 show the local variation in the percentage of PNSP by laboratory and of MRSA, FREC and
3GCRKP by hospital. These figures are based on data
from 2011 and 2012, only including the laboratories and
hospitals that reported at least five isolates in these two
years. The total number of laboratories or hospitals, the
minimum, maximum, median, first and third quartile of
the proportion of resistance is displayed in a box in the
figures.
Demographic characteristics
Table 3 gives the proportional distribution of the isolates reported by source, gender, age, and hospital
department, and the percentage of resistance within the
different groups, for the period 20112012.
The abbreviations used in this table stand for:
PNSP = penicillin-non-susceptible S. pneumoniae;
MRSA = meticillin-resistant S. aureus;
FREC = fluoroquinolone-resistant E. coli;
VRE = vancomycin-resistant E. faecalis or E. faecium;
3GCRKP = third-generation cephalosporin-resistant
K.pneumoniae; and
CRPA = carbapenem-resistant P. aeruginosa.
85
SURVEILLANCE REPORT
Austria
General information on EARS-Net participating laboratories
Table 1: Annual number of reporting laboratories* and number of reported isolates, 2003-2012
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
20
163
28
257
31
298
32
293
35
322
38
380
38
379
35
375
39
438
38
356
S. aureus
Labs
Isolates
20
871
30
1453
32
1481
33
1640
34
1577
38
1899
38
1794
39
1840
40
1982
40
2173
E. coli
Labs
Isolates
21
985
31
1862
33
2058
33
2483
34
2545
38
2985
38
2625
39
2937
40
3174
40
3766
Enterecocci
Labs
Isolates
19
327
28
604
30
568
33
699
33
688
38
864
36
825
39
944
40
894
39
1049
K. pneumoniae
Labs
Isolates
7
89
30
434
33
445
38
583
37
622
39
722
40
799
40
859
P. aeruginosa
Labs
Isolates
8
77
31
405
33
411
38
510
36
525
39
504
40
544
39
596
*Number of laboratories reporting at least one isolate during the specific year. Please note that the total number of laboratories participating in EARS-Net might be higher.
Note: national data analysis allows for a more accurate validation. Due to differences in the validation algorithms used by EARS-Net and Austria, there are small
discrepancies in the data presented by EARS-Net.
Antibiotic resistance from 2003 to 2012

Table 2: Annual percentage (%) of antimicrobial non-susceptible and resistant isolates, 2003-2012
Microorganism by antimicrobial class
Penicillin R
Penicillin RI
Macrolides RI
Oxacillin/Meticillin R
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
3rd gen. Cephalosporins R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1
9
13
1
5
13
<1
5
15
<1
5
13
2
5
13
<1
5
12
3
5
14
2
4
11
2
3
12
1
5
18
15
14
14
11
41
5
14
2
<1
46
6
17
3
<1
49
6
19
4
<1
53
8
22
7
<1
53
8
26
9
<1
50
7
23
7
<1
49
6
20
8
<1
51
6
21
7
<1
50
7
22
9
<1
51
6
21
9
<1
1
33
<1
<1
23
<1
1
29
<1
2
29
<1
2
30
<1
2
21
<1
1
31
<1
2
32
<1
<1
31
<1
<1
29
<1
85
22
<1
85
22
<1
85
30
1
89
21
<1
82
28
2
91
19
2
88
31
4
92
42
4
91
49
5
91
38
3
3
11
6
<1
5
8
6
<1
5
13
8
<1
6
12
8
<1
4
8
8
<1
6
18
13
<1
7
17
13
<1
5
15
12
<1
13
7
10
6
14
8
9
15
10
15
6
5
12
8
15
8
6
11
8
12
6
6
9
8
13
9
8
14
11
16
14
11
14
13
19
18
14
15
11
14
Note: national data analysis allows for a more accurate validation. Due to differences in the validation algorithms used by EARS-Net and Austria, there are small
86
SURVEILLANCE REPORT
Table 3: Selected details on invasive isolates reported for 2011 and 2012
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Sex
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
97
3
4
5
100
-
8
-
100
<1
21
33
100
-
0
-
100
-
4
-
100
<1
12
33
99
1
14
0
55
45
-
3
5
-
58
42
1
8
7
0
42
57
1
25
18
25
65
34
1
0
1
0
57
43
1
4
4
20
56
43
1
13
12
18
60
39
<1
15
13
25
4
2
36
58
3
6
4
4
1
1
33
64
5
4
6
8
1
<1
24
74
6
17
21
22
2
<1
28
70
0
0
0
1
1
<1
34
65
0
33
5
3
1
<1
30
68
29
38
13
12
1
1
31
68
9
43
18
12
16
57
2
21
4
4
4
0
3
7
10
53
8
23
5
12
7
11
6
5
7
58
7
24
4
23
21
18
24
24
14
45
12
24
5
1
0
1
0
0
24
42
11
20
3
3
3
2
6
12
13
48
10
25
5
19
11
11
13
11
15
43
9
28
5
21
12
12
14
14
87
SURVEILLANCE REPORT
Austria
Figure 1: S. pneumoniae: percentage (%) of invasive
isolates with penicillin non-susceptibility by laboratory
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
AT023 (0/9)
AT037 (0/26)
AT041 (0/5)
AT032 (0/7)
Figure 2: S. aureus: percentage (%) of invasive isolates

with resistance to meticillin (MRSA) by hospital
(2011-2012)
36
0
0
0
7.5
33.3
AT011 (0/7)
AT019 (0/25)
AT038 (0/8)
AT030 (0/25)
AT009 (0/12)
AT015 (0/17)
AT031 (0/16)
AT014 (0/6)
AT018 (0/27)
AT001 (0/26)
AT024 (0/11)
AT036 (0/6)
Hospital codes
Laboratory codes
AT002 (0/46)
AT022 (0/11)
AT034 (0/10)
AT005 (1/59)
AT006 (1/42)
AT007 (1/27)
AT026 (1/25)
AT012 (1/25)
AT021 (1/20)
AT016 (2/29)
AT028 (2/27)
AT010 (1/13)
AT020 (1/11)
AT033 (1/11)
AT027 (3/31)
AT025 (3/29)
AT003 (1/9)
AT017 (1/8)
AT042 (1/7)
AT043 (4/12)
25
50
75
% penicillin non-susceptible
88
100
AT033F (0/30)
AT015W (0/9)
AT026Z (0/9)
AT003M (0/21)
AT010R (0/9)
AT009K (0/11)
AT023F (0/9)
AT030F (0/34)
AT016G (0/13)
AT010F (0/61)
AT022Z (0/9)
AT042B (0/52)
AT043S (0/8)
AT007E (0/13)
AT30UE (0/5)
AT010H (0/15)
AT030V (0/10)
AT030G (0/24)
AT022R (0/11)
AT005M (0/7)
AT010L (0/18)
AT032R (0/6)
AT030W (0/16)
AT006O (0/7)
AT007W (0/21)
AT010B (0/26)
AT030H (0/6)
AT006M (0/7)
AT009S (0/11)
AT022B (0/28)
AT026S (0/67)
AT036D (0/6)
AT040A (0/18)
AT022K (0/21)
AT030Q (0/6)
AT030L (0/5)
AT012N (0/6)
AT007V (0/7)
AT009R (0/17)
AT015S (0/23)
AT014R (1/84)
AT001E (1/65)
AT016W (2/106)
AT001B (1/42)
AT003G (1/34)
AT015A (1/32)
AT023K (1/31)
AT005L (1/30)
AT024V (3/92)
AT037P (3/92)
AT001S (2/56)
AT038M (2/54)
AT022L (1/27)
AT005K (1/26)
AT020N (1/25)
AT005R (1/21)
AT007K (6/117)
AT033D (4/77)
AT005J (1/18)
AT012T (2/34)
AT005Z (2/34)
AT005I (8/130)
AT005H (1/16)
AT007F (1/15)
AT017K (3/43)
AT019P (9/126)
AT043H (1/14)
AT012W (4/56)
AT009W (1/14)
AT032V (2/28)
AT005S (1/14)
AT028R (8/113)
AT023S (5/69)
AT023E (1/13)
AT025K (12/139)
AT043W (2/23)
AT024G (2/23)
AT019T (5/57)
AT006S (10/111)
AT019L (1/11)
AT043J (2/21)
AT002A (17/169)
AT043G (4/38)
AT032J (1/9)
AT021S (3/26)
AT036H (2/17)
AT006N (3/25)
AT035H (6/49)
AT015M (1/8)
AT018S (2/15)
AT021V (11/79)
AT027L (24/170)
AT008M (1/7)
AT036U (1/7)
AT018M (16/109)
AT024B (4/27)
AT006B (2/13)
AT011W (11/68)
AT012H (1/6)
AT008B (1/6)
AT019K (1/6)
AT041E (2/12)
AT029O (3/16)
AT034E (13/65)
AT001W (1/5)
AT032D (2/10)
AT020W (23/113)
AT031W (18/88)
AT038B (11/49)
AT012D (6/19)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
25
50
% MRSA
75
110
0
0
4.4
10.5
31.6
100
SURVEILLANCE REPORT
AT003E (0/5)
AT030Z (0/8)
AT015U (0/5)
AT009W (0/8)
AT009S (1/35)
AT007W (1/31)
AT024G (2/51)
AT030V (2/33)
AT003G (2/30)
AT006N (1/14)
AT010L (3/39)
AT005L (6/75)
AT009K (1/12)
AT021S (2/24)
AT026Z (1/11)
AT023S (6/63)
AT024V (9/92)
AT032H (1/10)
AT006B (7/67)
AT006O (2/19)
AT026S (11/99)
AT010H (5/45)
AT010R (2/18)
AT021V (8/68)
AT032P (1/8)
AT023K (4/31)
AT012W (9/68)
AT016G (5/38)
AT036H (4/29)
AT015S (7/50)
AT023E (2/14)
AT024B (7/49)
AT015M (3/21)
AT008A (1/7)
AT019K (1/7)
AT007E (2/13)
AT006S (28/179)
AT005S (6/38)
AT033F (10/63)
AT043J (6/37)
AT005H (9/55)
AT022A (2/12)
AT036D (1/6)
AT007V (9/54)
AT043S (1/6)
AT030N (1/6)
AT007F (5/30)
AT034E (16/95)
AT010B (14/83)
AT012T (7/41)
AT020N (7/39)
AT032D (2/11)
AT001W (4/22)
AT017K (17/93)
AT001B (8/43)
AT005K (16/84)
AT011W (18/94)
AT030W (7/36)
AT001E (25/128)
AT015A (14/71)
AT008B (1/5)
AT001S (29/144)
AT007K (35/172)
AT033D (27/133)
AT042B (20/97)
AT028R (42/202)
AT029O (4/19)
AT019L (4/19)
AT025K (58/272)
AT005J (6/28)
AT030G (10/46)
AT041E (14/63)
AT005R (8/36)
AT019T (23/103)
AT016W (37/166)
AT020W (30/134)
AT010F (24/106)
AT037P (39/172)
AT032V (7/30)
AT030F (24/103)
AT009R (5/21)
AT038B (21/88)
AT012D (6/25)
AT30UE (6/25)
AT014R (23/96)
AT022B (7/29)
AT012N (2/8)
AT022L (12/48)
AT032R (3/12)
AT038M (20/79)
AT003M (7/27)
AT018M (38/147)
AT031W (38/143)
AT043H (8/30)
AT003L (2/7)
AT018S (6/21)
AT035H (34/119)
AT005Z (17/59)
AT019P (48/161)
AT043G (14/47)
AT022S (3/10)
AT040A (6/20)
AT005C (3/10)
AT002A (44/142)
AT027L (92/283)
AT005I (74/224)
AT006Z (2/6)
AT023F (2/6)
AT011P (4/12)
AT015W (9/26)
AT043W (18/49)
AT032J (3/8)
AT022K (12/32)
AT012H (9/23)
AT008H (2/5)
AT041S (2/5)
AT030H (5/12)
AT006M (10/24)
AT022R (6/13)
AT030D (3/6)
AT032T (3/6)
AT005N (4/7)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
Figure 4: K. pneumoniae: percentage (%) of invasive

isolates with resistance to third-generation
cephalosporins by hospital (2011-2012)
122
0
14.3
20.1
25.9
57.1
Hospital codes
Hospital codes
Figure 3: E. coli: percentage (%) of invasive isolates

with resistance to fluoroquinolones by hospital
(2011-2012)
25
50
75
100
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
AT023K (0/14)
AT043J (0/10)
AT006N (0/8)
AT005S (0/5)
AT012W (0/6)
AT036H (0/7)
AT032R (0/8)
AT032V (0/11)
AT022L (0/14)
AT009R (0/7)
AT016G (0/8)
AT022K (0/5)
AT043G (0/7)
AT029O (0/7)
AT021S (0/6)
AT030W (0/5)
AT006B (0/10)
AT015A (0/11)
AT022A (0/5)
AT007V (0/11)
AT005Z (0/10)
AT031W (1/37)
AT024V (1/25)
AT042B (1/24)
AT017K (1/23)
AT006S (3/70)
AT027L (4/78)
AT033F (1/19)
AT010B (1/17)
AT016W (3/47)
AT025K (5/77)
AT026S (1/15)
AT038M (1/14)
AT021V (1/14)
AT020W (3/41)
AT001S (3/40)
AT003G (1/13)
AT007K (3/38)
AT018M (2/25)
AT041E (1/12)
AT022B (1/12)
AT043W (1/11)
AT005H (1/11)
AT037P (4/41)
AT024G (1/10)
AT001B (1/10)
AT028R (7/66)
AT010F (2/16)
AT005K (2/15)
AT023E (1/7)
AT023S (3/20)
AT038B (2/13)
AT005L (2/13)
AT020N (2/13)
AT034E (2/12)
AT033D (9/54)
AT005R (1/6)
AT001E (6/33)
AT002A (12/64)
AT005I (16/77)
AT014R (4/19)
AT030F (4/18)
AT012T (3/13)
AT035H (8/34)
AT019T (5/19)
AT009K (2/7)
AT009W (3/10)
AT011W (10/33)
AT030G (2/5)
AT019P (30/63)
AT005C (3/6)
25
50
75
71
0
0
7.5
15.4
50
100
89
SURVEILLANCE REPORT
Belgium
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
107
1488
95
1443
97
1539
98
1427
105
1511
101
1647
101
1885
97
1797
91
1829
96
1739
S. aureus
Labs
Isolates
47
1133
49
1227
41
1048
33
858
34
855
38
906
34
949
40
1088
50
1771
44
1582
E. coli
Labs
Isolates
24
1326
25
1601
25
1592
21
1632
17
1460
16
1430
18
1610
23
1966
43
4039
41
4138
Enterecocci
Labs
Isolates
16
146
18
228
19
223
22
267
20
245
19
236
14
227
22
323
46
754
41
752
K. pneumoniae
Labs
Isolates
8
142
14
145
44
676
41
549
P. aeruginosa
Labs
Isolates
8
136
15
130
43
460
40
392

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
90
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
12
34
<1
9
33
3
12
31
4
10
31
3
9
25
<1
8
24
<1
<1
23
<1
<1
25
<1
<1
26
<1
2
25
30
33
31
22
23
21
21
21
17
16
50
5
12
3
-
50
5
15
3
-
53
4
17
4
-
54
6
19
3
-
57
5
19
4
-
55
4
17
4
-
56
7
20
6
-
57
6
22
5
<1
59
9
22
6
<1
56
6
22
7
<1
1
17
1
2
22
<1
<1
26
<1
<1
30
<1
<1
26
1
3
30
<1
1
23
1
2
18
<1
2
18
<1
2
25
<1
78
<1
<1
63
11
5
61
22
14
67
19
4
68
23
<1
76
17
5
90
32
4
89
30
3
83
33
7
78
39
1
10
13
15
1
2
13
13
<1
8
15
14
<1
11
17
16
<1
7
6
9
12
16
12
7
5
11
12
15
9
11
13
21
10
8
10
11
18
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
96
4
0
8
100
-
21
-
100
0
21
0
100
-
1
-
100
-
3
-
100
0
14
0
100
0
7
0
55
44
1
0
0
0
62
37
1
22
19
7
46
53
<1
24
18
40
64
35
1
1
0
0
56
42
1
5
2
0
57
42
0
13
15
0
68
32
-
4
13
-
17
5
37
41
-
1
1
0
0
-
4
2
34
59
-
16
9
17
24
-
2
1
30
67
-
11
26
17
23
-
3
0
28
68
1
0
0
0
1
0
1
33
64
1
0
2
4
0
5
29
65
-
13
15
13
-
3
2
25
71
-
0
0
9
6
-
7
15
1
15
63
1
0
0
0
0
1
2
1
5
91
4
16
27
16
21
1
1
<1
1
97
37
27
29
67
20
7
10
3
5
75
0
3
0
0
0
7
10
1
7
76
0
0
0
0
5
100
14
100
91
SURVEILLANCE REPORT
Belgium
BE081 (0/9)
BE007 (0/20)
BE125 (0/17)
BE073 (0/5)
BE003 (0/26)
BE049 (0/38)
BE022 (0/44)
BE037 (0/32)
BE024 (0/62)
BE152 (0/17)
BE116 (0/32)
BE102 (0/21)
BE105 (0/33)
BE032 (0/41)
BE057 (0/17)
BE098 (0/8)
BE044 (0/45)
BE030 (0/45)
BE114 (0/17)
BE014 (0/28)
BE170 (0/17)
BE164 (0/20)
BE071 (0/15)
BE087 (0/28)
BE107 (0/25)
BE023 (0/31)
BE158 (0/6)
BE027 (0/15)
BE113 (0/70)
BE166 (0/25)
BE026 (0/20)
BE091 (0/82)
BE004 (0/51)
BE061 (0/59)
BE100 (0/15)
BE109 (0/12)
BE104 (0/47)
BE129 (0/23)
BE031 (0/20)
BE103 (0/30)
BE146 (0/41)
BE018 (0/16)
BE108 (0/161)
BE029 (0/16)
BE090 (0/15)
BE001 (0/44)
BE002 (0/40)
BE093 (0/18)
BE161 (0/31)
BE011 (0/29)
BE160 (0/13)
BE154 (0/21)
BE072 (0/30)
BE141 (0/16)
BE083 (0/17)
BE047 (0/15)
BE097 (0/79)
BE008 (0/97)
BE101 (0/23)
BE043 (0/72)
BE035 (0/32)
BE051 (0/35)
BE118 (0/25)
BE048 (0/20)
BE112 (0/39)
BE137 (0/33)
BE131 (0/5)
BE077 (1/89)
BE092 (1/89)
BE056 (1/79)
BE046 (1/63)
BE045 (1/53)
BE111 (1/54)
BE021 (1/49)
BE143 (1/51)
BE115 (1/48)
BE095 (1/41)
BE070 (2/83)
BE016 (2/84)
BE074 (1/42)
BE006 (1/39)
BE063 (1/39)
BE110 (1/37)
BE139 (2/64)
BE019 (1/29)
BE054 (2/54)
BE012 (1/24)
BE084 (2/43)
BE075 (5/80)
BE060 (4/53)
BE069 (2/21)
BE033 (3/28)
BE017 (5/33)
BE138 (4/14)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
94
0
0
0
1.6
28.6
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
BE0031 (0/46)
BE1141 (1/29)
BE0481 (1/20)
BE0771 (6/102)
BE0571 (4/54)
BE0751 (6/70)
55
0
10.5
16.2
21.4
50
BE1121 (8/90)
BE0371 (4/42)
BE0191 (2/20)
BE0611 (7/69)
BE0921 (11/108)
BE0121 (4/39)
BE0221 (5/48)
BE0071 (2/19)
BE0011 (13/121)
BE0911 (5/46)
BE0241 (9/77)
BE0601 (17/142)
BE1151 (5/40)
BE0081 (23/184)
BE0631 (18/142)
BE1581 (5/37)
BE0451 (26/187)
BE0971 (10/65)
BE1111 (9/58)
BE0541 (18/113)
BE0841 (9/56)
BE1391 (11/68)
BE1381 (5/30)
BE1641 (5/30)
BE0161 (21/121)
BE0021 (20/112)
BE1091 (10/56)
BE0741 (7/38)
BE1361 (5/27)
BE0701 (39/210)
BE0561 (40/210)
BE0321 (22/116)
BE0441 (14/70)
BE1251 (8/39)
BE0511 (11/52)
BE0721 (6/28)
BE0331 (17/75)
BE1431 (15/62)
BE1571 (3/12)
BE1701 (20/72)
BE0842 (13/42)
BE1291 (36/115)
BE1411 (22/70)
BE1311 (2/6)
BE1021 (11/31)
BE1601 (7/17)
BE0171 (18/42)
BE0401 (7/16)
BE1161 (13/26)
25
50
75
92

(2011-2012)
Hospital codes
Laboratory codes

(2011-2012)
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
BE1582 (1/9)
BE1391 (33/265)
BE0321 (30/231)
BE0011 (32/242)
BE0541 (36/243)

49
11.1
18.4
21.6
25.6
33.8
BE1251 (0/9)
BE0011 (0/45)
BE1641 (0/20)
BE0611 (0/19)
BE0511 (26/175)
BE1601 (0/11)
BE0221 (45/263)
BE0842 (0/17)
BE0331 (27/156)
BE0221 (0/26)
BE1161 (39/223)
BE1311 (0/12)
BE0751 (50/284)
BE1161 (1/36)
BE0021 (66/362)
BE0721 (1/31)
BE1121 (62/338)
BE0561 (4/109)
BE1381 (33/179)
48
0
3.8
10.7
20
47.1
BE1111 (1/26)
BE0451 (91/493)
BE0241 (1/20)
BE1291 (77/396)
BE1121 (1/17)
BE1311 (12/62)
BE0371 (1/16)
BE0012 (2/10)
BE0911 (3/42)
BE0601 (44/216)
BE1391 (3/33)
BE0611 (21/100)
BE0441 (3/33)
BE1111 (38/181)
BE0031 (2/21)
BE1431 (54/256)
BE0541 (5/50)
BE1571 (8/38)
BE0171 (3/30)
BE0301 (4/19)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
BE0751 (0/51)
BE0161 (35/165)
BE0921 (36/167)
BE0371 (26/120)
BE0842 (25/113)
BE0021 (5/48)
BE1411 (3/28)
BE0161 (3/28)
BE1701 (2/18)
BE0451 (10/87)
BE0971 (40/179)
BE0321 (5/40)
BE0031 (30/133)
BE1581 (5/39)
BE0071 (22/96)
BE0971 (5/37)
BE0841 (67/286)
BE0601 (7/51)
BE0121 (24/102)
BE0841 (6/39)
BE1361 (31/130)
BE0081 (12/73)
BE1601 (19/79)
BE1381 (6/36)
BE0701 (56/231)
BE0511 (8/44)
BE0081 (107/431)
BE1411 (74/289)
BE0701 (14/73)
BE0631 (134/501)
BE0631 (14/67)
BE0771 (59/218)
BE1091 (8/38)
BE1091 (47/170)
BE1291 (15/64)
BE0911 (45/163)
BE0331 (7/28)
BE1251 (24/87)
BE1021 (2/7)
BE0441 (60/216)
BE0921 (11/34)
BE0171 (15/54)
BE1361 (3/9)
BE0721 (65/233)
BE0771 (27/78)
BE1581 (55/177)
BE1571 (2/5)
BE1141 (23/73)
BE0121 (9/20)
BE1701 (24/71)
BE1151 (12/26)
BE1141 (8/17)
BE1641 (27/80)
25
50
75
100
25
50
75
100
93
SURVEILLANCE REPORT
Bulgaria
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
13
22
13
32
16
43
11
29
10
32
13
29
10
27
13
22
16
33
12
21
S. aureus
Labs
Isolates
20
157
22
170
26
160
23
159
14
121
21
160
20
221
20
200
19
214
19
227
E. coli
Labs
Isolates
20
158
20
167
23
203
20
196
15
127
22
147
17
194
21
153
19
179
19
223
Enterecocci
Labs
Isolates
16
49
16
75
21
95
19
98
13
65
18
70
16
92
16
108
16
117
20
129
K. pneumoniae
Labs
Isolates
15
34
15
55
9
29
11
49
12
95
15
127
15
121
14
127
P. aeruginosa
Labs
Isolates
9
34
13
31
6
14
10
23
11
36
11
42
12
48
11
52

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
94
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
9
14
11
22
22
17
30
33
8
7
7
15
9
16
17
21
21
4
22
37
27
18
18
25
21
21
13
29
29
20
31
23
29
28
13
25
16
19
22
20
54
22
19
18
<1
64
20
24
22
<1
69
24
29
28
<1
64
28
26
29
<1
70
20
35
23
<1
65
31
32
29
<1
66
18
28
19
<1
72
16
33
25
<1
61
17
30
23
<1
71
26
34
38
3
7
36
<1
15
33
2
8
24
<1
31
53
2
13
29
<1
8
44
<1
16
36
<1
5
41
<1
6
31
<1
12
38
<1
60
60
<1
59
62
<1
96
56
<1
97
79
<1
100
75
<1
93
84
<1
96
65
<1
100
71
<1
84
79
<1
95
71
<1
53
26
50
<1
60
24
60
<1
59
41
55
<1
59
52
73
<1
65
48
69
<1
69
52
76
<1
72
51
81
<1
54
47
75
2
50
45
38
53
47
33
13
14
42
17
14
21
7
29
14
48
55
17
48
36
33
23
24
31
33
15
19
31
21
21
23
31
29
38
30
26
35
31
33
33
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
63
37
29
15
100
-
21
-
99
1
32
25
100
-
0
-
100
-
0
-
99
1
78
67
98
2
31
0
52
48
-
29
19
-
60
40
<1
23
18
50
54
46
0
36
28
0
61
39
-
0
0
-
65
35
-
0
0
-
71
29
-
80
73
-
63
37
-
40
14
-
9
13
52
20
6
80
14
21
18
0
2
4
47
35
12
60
33
23
15
18
3
2
38
46
11
21
22
32
33
36
1
3
40
48
9
0
0
0
0
0
5
1
48
35
11
0
0
0
0
0
9
3
35
29
23
91
75
76
72
83
4
3
40
39
13
0
0
43
18
46
22
22
56
-
17
17
30
-
20
36
12
32
0
40
8
31
20
0
18
44
11
26
0
48
26
30
34
0
24
34
11
30
1
0
0
0
0
0
31
23
17
27
1
0
0
0
0
0
22
21
13
43
1
84
57
84
83
67
36
21
8
34
-
53
10
0
26
-
95
SURVEILLANCE REPORT
Bulgaria
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum

(2011-2012)
4
0
6.3
14.6
27.1
37.5
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
BG004A (0/7)
BG011A (0/14)
BG016 (0/5)
20
0
9.5
13.8
22.5
75
BG013A (1/28)
BG001A (2/27)
BG002A (1/11)
BG014A (1/10)
BG003A (2/19)
BG017 (1/8)
BG017A (6/56)
Hospital codes
Laboratory codes
BG007A (5/43)
BG026A (2/15)
BG029A (1/7)
BG022A (3/21)
BG007 (1/6)
BG009A (1/6)
BG018A (3/18)
BG021A (7/34)
BG005A (11/45)
BG032A (4/16)
BG003 (3/8)
BG027A (2/6)
BG006A (32/46)
BG008A (9/12)
25
50
75
96
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
BG022A (1/12)
BG013A (2/19)

18
8.3
14.3
25
38.5
51.5
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
BG013A (3/9)
11
33.3
63.6
83.3
86.7
100
BG018A (9/15)
BG032A (2/17)
BG026A (2/16)
BG032A (7/11)
BG014A (1/7)
BG004A (1/6)
BG007A (11/17)
BG027A (2/10)
BG017A (42/54)
Hospital codes
Hospital codes
BG029A (2/9)
BG001A (5/20)
BG018A (8/32)
BG007A (15/48)
BG026A (5/6)
BG021A (51/61)
BG021A (12/35)
BG011A (12/14)
BG003A (10/27)
BG011A (5/13)
BG001A (13/15)
BG005A (13/33)
BG017A (24/50)
BG006A (23/26)
BG009A (4/8)
BG008A (7/7)
BG006A (17/33)
25
50
75
100
25
50
75
100
97
SURVEILLANCE REPORT
Croatia
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
14
100
11
103
16
127
11
98
S. aureus
Labs
Isolates
14
463
15
363
14
451
17
412
E. coli
Labs
Isolates
16
911
16
897
16
1007
17
921
Enterecocci
Labs
Isolates
20
223
12
176
15
244
14
219
K. pneumoniae
Labs
Isolates
16
318
16
286
14
314
15
344
P. aeruginosa
Labs
Isolates
15
212
15
217
15
265
14
204

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
98
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
3
15
23
7
21
29
1
18
24
1
23
28
35
27
27
22
54
6
17
7
<1
55
6
17
8
<1
55
7
20
7
<1
51
7
17
6
<1
10
41
<1
5
37
<1
1
33
1
5
39
<1
89
67
7
82
60
12
98
66
2
98
61
0
45
47
50
<1
49
48
56
2
43
43
50
<1
45
43
44
<1
27
12
22
34
29
16
12
26
26
27
17
30
34
34
18
13
22
26
24
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
92
8
21
12
98
-
25
33
99
2
19
-
96
3
1
0
100
0
100
0
97
1
41
89
96
3
22
50
54
44
<1
21
19
0
58
37
5
22
27
30
40
56
4
25
14
19
61
32
6
<1
2
0
54
42
4
0
0
55
41
33
49
34
36
65
29
6
22
21
39
26
7
34
32
0
25
19
20
18
0
3
4
37
56
1
3
3
24
28
33
3
1
34
61
16
5
20
21
18
1
9
3
35
52
1
0
0
2
1
0
5
0
39
54
1
0
0
0
1
0
12
3
36
48
1
48
61
45
51
17
4
2
42
50
1
35
27
32
14
0
11
17
3
67
21
13
33
23
10
39
12
38
76
18
45
18
6
40
6
48
19
20
68
15
1
31
11
40
0
1
3
1
0
<1
0
99
0
100
0
0
17
35
11
36
61
30
68
38
22
28
17
33
28
14
25
6
99
SURVEILLANCE REPORT
Croatia
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
HR004 (0/7)

(2011-2012)
9
0
16.6
20.5
25
50
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
HR016 (0/15)
HR030 (0/5)
HR020 (0/7)
15
0
4.2
20
28.3
36.2
HR014 (1/24)
HR009 (5/54)
HR028 (1/6)
HR004 (11/69)
HR017 (1/6)
HR009 (1/6)
Hospital codes
Laboratory codes
HR024 (1/6)
HR002 (24/117)
HR010 (10/50_
HR020 (7/32)
HR007 (6/29)
HR011 (11/47)
HR002 (35/148)
HR001 (5/20)
HR008 (20/71)
HR014 (2/8)
HR001 (36/127)
HR005 (19/53)
HR010 (4/8)
HR007 (54/149)
25
50
75
100
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
HR016 (5/55)
HR009 (9/98)

16
9.1
15.4
18.2
21.9
29.9
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
HR014 (5/27)
12
36.8
41
42.1
55.6
63.6
HR016 3/9)
HR030 (3/32)
HR010 (14/38)
HR024 (1/8)
HR029 (2/13)
HR004 (20/54)
HR002 (77/462)
HR008 (7/18)
Hospital codes
Hospital codes
HR010 (27/162)
HR011 (22/130)
HR014 (17/97)
HR002 (57/137)
HR001 (65/153)
HR007 (46/244)
HR007 (42/98)
HR005 (18/95)
HR011 (21/47)
HR008 (22/109)
HR004 (33/151)
HR030 (5/9)
HR020 (7/30)
HR005 (21/35)
HR017 (4/17)
HR009 (14/22)
HR001 (67/224)
25
50
75
100
25
50
75
100
101
SURVEILLANCE REPORT
Cyprus
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
1
3
1
7
4
16
5
13
4
15
4
14
4
11
4
12
2
12
3
8
S. aureus
Labs
Isolates
1
28
3
39
5
54
5
62
4
85
5
92
5
89
5
99
4
113
5
165
E. coli
Labs
Isolates
1
19
4
46
5
75
5
90
5
109
4
119
5
136
5
139
5
138
5
176
Enterecocci
Labs
Isolates
1
28
3
38
3
40
4
48
3
63
5
85
5
80
5
91
4
71
5
106
K. pneumoniae
Labs
Isolates
4
9
4
26
4
39
5
62
5
53
4
67
4
83
5
65
P. aeruginosa
Labs
Isolates
4
8
4
37
3
52
5
43
5
62
5
48
4
51
5
52

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
102
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
<1
33
<1
14
<1
<1
19
13
31
38
31
7
33
27
21
43
29
18
36
36
33
42
55
25
25
25
25
25
14
64
49
56
34
48
46
33
32
42
35
63
11
32
11
<1
61
11
22
9
<1
72
13
29
16
<1
62
10
35
16
<1
72
11
39
18
2
58
10
45
19
<1
66
10
43
14
<1
62
16
43
20
<1
78
24
47
36
<1
70
21
42
32
<1
<1
43
<1
3
77
3
3
71
<1
5
44
<1
2
61
<1
16
65
1
32
66
<1
6
24
<1
2
19
4
1
10
<1
100
<1
100
33
33
80
<1
40
43
14
14
92
33
25
60
10
20
80
13
13
78
<1
<1
82
6
<1
76
<1
10
11
22
33
<1
12
12
27
<1
13
23
31
3
21
23
35
10
19
43
42
17
19
39
34
16
28
36
41
16
18
22
23
9
13
38
13
13
13
27
24
11
11
27
31
15
19
25
23
23
9
19
21
38
18
18
8
5
13
19
17
29
10
17
20
24
43
16
14
10
15
19
15
15
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
90
10
17
100
100
-
38
-
100
<1
44
100
100
-
2
-
100
-
7
-
99
1
33
50
98
2
31
50
55
40
5
18
25
100
62
33
5
37
38
50
47
51
2
58
32
40
53
44
4
0
0
40
50
46
4
9
5
0
52
44
4
39
29
0
64
32
4
32
24
75
10
5
20
30
35
50
0
0
50
14
4
1
29
42
23
33
33
38
38
37
4
1
22
47
27
33
50
44
47
41
5
28
45
22
0
0
0
7
11
26
48
15
0
8
5
14
3
1
35
34
26
20
0
37
37
26
4
1
31
45
19
0
0
38
24
45
5
65
15
15
0
23
0
67
21
56
11
5
8
51
29
65
29
33
10
69
5
10
6
56
46
69
23
26
41
41
8
4
6
2
0
0
0
13
22
48
2
13
15
0
9
0
17
0
32
44
13
10
1
51
23
47
7
0
42
32
8
13
6
33
21
63
23
50
103
SURVEILLANCE REPORT
Cyprus
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum

(2011-2012)
2
20
20
25.4
30.8
30.8
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
CY004A (3/14)
5
21.4
31.3
33.9
41.3
46.7
CY002 (1/5)
Hospital codes
Laboratory codes
CY003A (10/32)
CY002A (19/56)
CY001A (66/160)
CY001 (4/13)
CY005A (7/15)
25
50
75
104
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
CY005A (2/10)

5
20
32
37.6
42.9
51.8
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
4
12.5
16.3
24
33.6
39.3
CY005A (1/8)
CY003A (8/25)
Hospital codes
Hospital codes
CY003A (2/10)
CY002A (38/101)
CY002A (12/43)
CY004A (3/7)
CY001A (33/84)
CY001A (88/170)
25
50
75
100
25
50
75
100
105
SURVEILLANCE REPORT
Czech Republic
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
32
204
37
162
39
195
39
172
41
205
40
244
41
297
41
288
42
316
39
274
S. aureus
Labs
Isolates
45
1387
45
1444
47
1553
47
1527
47
1653
47
1715
46
1695
44
1593
46
1555
47
1611
E. coli
Labs
Isolates
43
1766
44
1966
47
2234
47
2176
48
2407
46
2738
45
2759
43
2484
45
2696
44
2812
Enterecocci
Labs
Isolates
44
630
41
660
45
758
45
697
47
816
44
883
44
835
41
759
44
767
42
843
K. pneumoniae
Labs
Isolates
37
478
45
1130
48
1230
45
1493
45
1415
44
1264
44
1287
46
1399
P. aeruginosa
Labs
Isolates
36
257
43
490
41
517
42
568
45
575
41
511
42
448
44
489

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
106
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
2
2
2
6
4
<1
4
2
<1
2
3
<1
4
5
<1
3
3
<1
4
5
<1
5
6
<1
4
3
<1
3
8
13
12
13
14
15
13
15
13
45
5
13
1
-
47
5
16
2
-
50
6
20
2
<1
56
8
23
5
<1
56
7
24
7
<1
60
9
26
10
<1
61
9
23
10
<1
59
8
23
10
<1
61
9
23
11
<1
57
8
21
11
<1
4
44
<1
<1
43
<1
<1
45
<1
2
43
<1
3
49
1
2
49
<1
<1
47
<1
8
48
<1
4
46
<1
2
42
<1
80
48
3
81
43
3
92
69
14
90
74
4
91
79
6
94
75
8
98
65
6
98
54
5
97
61
8
98
69
11
36
38
32
<1
38
47
35
<1
43
48
46
<1
42
52
48
<1
47
54
52
<1
47
55
48
<1
45
53
48
<1
54
50
51
<1
21
40
31
27
45
29
30
33
29
47
30
33
36
32
43
27
44
29
43
46
28
29
29
33
41
28
28
16
33
41
22
20
13
24
34
26
20
15
24
31
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
84
16
3
3
100
-
14
-
100
0
22
0
100
-
1
-
100
-
10
-
99
1
50
57
99
1
14
0
64
36
3
4
62
38
13
15
44
56
27
19
64
36
1
0
59
41
8
12
60
40
51
47
64
36
14
14
5
6
48
41
4
0
2
5
4
2
42
52
1
1
12
17
2
1
29
67
11
18
20
23
4
1
38
57
2
7
1
1
0
2
49
49
0
11
15
5
2
1
39
58
34
63
54
47
2
2
39
57
12
5
18
12
27
32
32
9
3
4
4
2
27
42
7
23
1
17
14
13
10
17
20
49
5
27
0
27
20
25
23
0
45
27
6
23
0
1
1
0
2
0
43
19
6
32
0
4
7
11
18
0
41
30
6
22
0
58
39
39
52
86
47
23
5
25
1
17
9
15
13
0
107
SURVEILLANCE REPORT
Czech Republic
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
CZ027 (0/24)
CZ020 (0/5)
CZ013 (0/14)

(2011-2012)
34
0
0
0
7.1
16.7
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
CZ031J (0/15)
CZ015B (0/6)
CZ012C (0/6)
CZ052A (0/16)
CZ036A (0/33)
CZ031P (0/5)
CZ039A (0/6)
CZ004 (0/12)
67
0
7.6
12.5
20
41.7
CZ021A (3/72)
CZ023 (0/10)
CZ047A (1/23)
CZ037 (0/7)
CZ029A (2/40)
CZ011A (2/47)
CZ017A (4/72)
CZ032A (5/81)
CZ015 (0/22)
CZ044A (3/43)
CZ023B (1/14)
CZ021 (0/11)
CZ034B (1/14)
CZ003 (0/10)
CZ026A (6/79)
CZ041 (0/9)
CZ028A (3/35)
CZ016 (0/46)
CZ020A (8/89)
CZ049 (0/21)
CZ030A (6/66)
CZ032 (0/15)
CZ022A (3/30)
CZ047B (1/12)
CZ037A (3/35)
CZ038A (2/22)
CZ043B (1/11)
CZ034A (6/59)
CZ030 (0/11)
CZ016A (10/95)
CZ009A (15/139)
CZ018 (0/26)
CZ040A (2/18)
CZ019 (0/8)
CZ024A (17/140)
Hospital codes
Laboratory codes
CZ013A (7/63)
CZ026 (0/7)
CZ011 (0/10)
CZ006 (1/55)
CZ012B (1/8)
CZ041A (4/32)
CZ018A (22/174)
CZ035A (7/54)
CZ004A (7/54)
CZ019A (7/52)
CZ017 (1/28)
CZ006A (31/226)
CZ039B (2/14)
CZ044 (1/24)
CZ031A (8/53)
CZ009B (2/13)
CZ024 (1/20)
CZ007A (12/78)
CZ042 (1/17)
CZ003A (12/73)
CZ002A (11/70)
CZ015A (23/135)
CZ007 (1/15)
CZ012A (3/17)
CZ027A (23/126)
CZ033 (2/29)
CZ033A (15/81)
CZ005A (22/112)
CZ047 (1/14)
CZ034C (3/15)
CZ037C (1/5)
CZ009 (2/27)
CZ051A (4/19)
CZ017B (10/47)
CZ025 (1/9)
CZ008A (5/23)
CZ050A (5/22)
CZ002 (1/9)
CZ007B (2/8)
CZ025A (10/38)
CZ036 (1/9)
CZ014A (12/43)
CZ044C (2/7)
CZ031 (2/16)
CZ037D (5/17)
CZ049A (13/43)
CZ014 (1/7)
CZ042A (9/28)
CZ007D (3/9)
CZ029 (2/13)
CZ023A (12/35)
CZ031C (4/10)
CZ005 (1/6)
CZ031F (5/12)
25
50
75
108
CZ053B (1/8)
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
CZ047B (2/24)
CZ009B (1/11)
CZ030A (18/186)
CZ049B (1/10)
CZ014A (12/116)
CZ020A (10/96)
CZ040A (1/9)

69
8.3
15
20.2
29.1
80
CZ019A (4/24)
CZ031P (2/11)
CZ044A (4/21)
CZ030A (10/40)
62
0
40
50
61.8
90
CZ020A (20/65)
CZ032A (19/171)
CZ012A (2/17)
CZ029A (9/28)
CZ029A (9/73)
CZ015A (23/70)
CZ051A (4/32)
CZ044C (2/6)
CZ019A (13/96)
CZ018A (46/132)
CZ038A (9/66)
CZ051A (4/11)
CZ023B (1/7)
CZ003A (27/72)
CZ031F (3/21)
CZ014A (17/45)
CZ026A (16/108)
CZ012B (2/5)
CZ004A (8/54)
CZ034B (2/5)
CZ023A (9/60)
CZ039A (6/40)
CZ007D (2/5)
CZ015A (37/240)
CZ007A (11/27)
CZ003A (22/142)
CZ028A (12/29)
CZ037C (3/18)
CZ006A (76/176)
CZ037D (6/35)
CZ004A (18/40)
CZ050A (6/35)
CZ031A (35/77)
CZ041A (15/87)
CZ016A (32/70)
CZ011A (14/80)
CZ022A (11/24)
CZ047A (7/39)
CZ049A (12/26)
CZ017B (13/71)
CZ027A (64/137)
CZ013A (18/96)
CZ007D (6/31)
CZ008A (17/36)
CZ022A (12/61)
CZ005A (51/104)
CZ035A (12/60)
CZ037A (7/14)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
CZ037D (0/7)
CZ032A (3/30)
CZ007A (27/135)
CZ050B (1/5)
CZ031A (17/84)
CZ006A (100/495)
CZ017A (25/124)
CZ016A (44/217)
CZ012A (3/6)
CZ043B (3/6)
CZ039A (3/6)
CZ031F (6/12)
CZ021A (21/42)
CZ033A (59/110)
CZ031P (6/29)
CZ033A (13/62)
CZ007B (7/13)
CZ042A (16/73)
CZ017A (43/79)
CZ036A (16/73)
CZ024A (75/137)
CZ009A (40/178)
CZ036A (20/36)
CZ044A (14/62)
CZ034A (13/23)
CZ052A (4/17)
CZ013A (17/30)
CZ039B (8/33)
CZ034C (4/7)
CZ037A (15/62)
CZ031C (11/19)
CZ024A (63/247)
CZ012B (5/19)
CZ031J (11/19)
CZ053C (2/7)
CZ035A (40/69)
CZ049A (28/97)
CZ009A (109/177)
CZ028A (16/55)
CZ041A (21/34)
CZ021A (36/123)
CZ026A (36/58)
CZ034A (5/17)
CZ011A (32/51)
CZ018A (75/242)
CZ047A (12/19)
CZ031J (14/42)
CZ002A (39/61)
CZ053D (5/14)
CZ027A (73/203)
CZ025A (29/45)
CZ005A (60/165)
CZ038A (15/23)
CZ008A (27/70)
CZ053B (8/12)
CZ002A (68/174)
CZ017B (47/69)
CZ053B (2/5)
CZ049B (11/16)
CZ031Y (2/5)
CZ050A (16/23)
CZ031C (8/19)
CZ023B (10/14)
CZ025A (40/93)
CZ009B (11/15)
CZ007B (10/22)
CZ042A (28/38)
CZ031K (5/9)
CZ023A (25/32)
CZ012C (7/10)
CZ012C (9/10)
CZ007E (4/5)
25
50
75
100
25
50
75
100
109
SURVEILLANCE REPORT
Denmark
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
5
606
15
1188
14
1081
15
872
15
1030
15
934
15
996
15
954
13
896
13
867
S. aureus
Labs
Isolates
5
671
15
1436
15
1350
15
1279
14
1315
15
1295
15
1395
15
1362
13
1452
13
1431
E. coli
Labs
Isolates
5
1283
11
2723
12
3021
14
3283
14
3532
14
3418
12
3642
12
3925
Enterecocci
Labs
Isolates
11
711
13
927
14
1005
14
1100
14
1112
12
1197
12
1248
K. pneumoniae
Labs
Isolates
11
607
13
784
14
793
14
822
14
799
12
910
12
948
P. aeruginosa
Labs
Isolates
13
417
14
420
14
429
14
376
12
407
12
390

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
110
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
3
5
<1
3
5
<1
4
6
<1
4
6
<1
3
6
<1
3
7
<1
4
4
<1
4
4
<1
5
5
<1
5
6
<1
<1
40
2
5
1
<1
42
3
7
2
<1
43
4
9
3
<1
43
4
10
4
<1
43
4
13
6
<1
46
6
14
8
<1
48
6
14
8
<1
45
7
14
8
<1
<1
<1
2
<1
2
37
<1
1
33
<1
<1
36
<1
<1
31
<1
1
28
<1
87
<1
88
<1
88
61
<1
88
52
2
93
74
2
93
73
1
94
62
2
2
6
4
<1
6
13
10
<1
7
16
9
<1
7
16
11
<1
6
11
11
<1
6
12
11
<1
6
9
10
<1
3
2
2
1
6
2
3
1
1
3
2
4
3
<1
5
4
3
3
1
6
5
5
5
2
7
5
5
4
4
4
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
94
CSF
6
Gender
Male
51
Female
49
Unknown
Age (years)
04
4
519
3
2064
37
65 and over
56
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
100
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
5
3
100
-
1
-
100
<1
14
3
100
-
0
-
100
-
2
-
100
<1
11
33
99
1
5
14
5
5
-
63
37
-
1
1
-
48
50
2
16
12
15
68
28
3
0
0
0
62
36
2
2
2
4
60
38
2
12
9
4
67
30
3
6
3
0
8
2
3
6
3
2
36
58
1
1
2
1
1
1
27
70
9
15
17
13
3
1
26
70
0
0
0
0
1
0
39
59
0
0
2
1
1
2
31
66
29
21
12
10
1
1
28
70
0
9
7
4
100
4
40
14
37
5
15
13
15
15
18
8
42
17
26
6
0
0
0
0
0
28
22
26
19
5
2
1
1
2
2
6
41
17
32
4
15
9
13
11
8
6
40
15
33
6
7
6
7
2
2
111
SURVEILLANCE REPORT
Denmark
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
DK015 (2/96)

(2011-2012)
13
2.1
4.4
4.7
5.9
9.1
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
DK016X (0/9)
DK014X (0/14)
DK014B (0/238)
DK008A (0/8)
DK014C (0/24)
DK012 (4/109)
45
0
0
0
1.2
7.7
DK002F (0/17)
DK002E (0/7)
DK003B (0/5)
DK015C (0/17)
DK016 (7/186)
DK004B (0/8)
DK016D (0/8)
DK009X (0/12)
DK010 (2/45)
DK007X (0/5)
DK013B (0/77)
DK015X (0/36)
DK005B (0/17)
DK002 (12/270)
DK014D (0/45)
DK004X (0/21)
DK012D (0/22)
DK013A (0/32)
Hospital codes
Laboratory codes
DK011 (3/65)
DK006 (13/276)
DK009A (0/22)
DK005A (0/28)
DK014N (0/36)
DK012E (0/18)
DK014A (0/7)
DK016B (0/27)
DK009 (8/150)
DK012B (0/20)
DK007B (0/69)
DK016C (0/8)
DK013 (2/35)
DK004A (0/122)
DK016A (2/247)
DK006B (2/196)
DK012F (1/89)
DK003 (9/152)
DK009B (3/253)
DK003C (3/237)
DK002X (1/74)
DK014 (14/231)
DK015A (1/60)
DK011A (2/100)
DK002B (6/285)
DK002A (1/36)
DK004 (7/104)
DK001A (6/198)
DK006A (1/32)
DK003A (1/28)
DK001 (4/44)
DK006X (1/25)
DK007A (1/13)
25
50
75
112
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
DK014I (0/8)
DK006C (0/5)
DK015X (1/25)
DK007B (11/182)
DK013B (13/192)

46
0
9.6
13.5
15.2
30.8
DK008A (0/10)
DK003B (0/34)
33
0
0
7.7
12.1
25
DK011D (0/6)
DK016D (3/42)
DK012B (6/83)
DK015G (0/11)
DK012D (16/187)
DK016D (0/9)
DK012E (13/149)
DK016F (0/12)
DK016B (19/202)
DK016C (0/9)
DK014D (22/232)
DK002E (12/125)
DK011A (0/23)
DK006B (18/179)
DK004C (9/88)
DK015C (0/10)
DK014A (5/45)
DK012E (1/30)
DK015C (4/35)
DK002A (3/65)
DK007A (20/171)
DK002E (1/20)
DK009B (58/481)
DK006A (22/180)
DK016A (5/101)
DK016C (8/65)
DK016B (2/39)
Hospital codes
DK015G (6/48)
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
DK015X (0/10)
DK008A (10/75)
DK015A (24/181)
DK012F (24/176)
DK003A (19/139)
DK005A (29/208)
DK004C (1/16)
DK014A (1/13)
DK015A (3/39)
DK009A (4/48)
DK009A (31/223)
DK012B (2/24)
DK003B (24/171)
DK005B (27/191)
DK004B (1/11)
DK014B (13/91)
DK004A (5/53)
DK013A (20/138)
DK004A (43/294)
DK012F (3/31)
DK011A (37/251)
DK002B (9/83)
DK016A (55/375)
DK009B (17/141)
DK004B (7/46)
DK016F (5/32)
DK002F (5/34)
DK002A (49/299)
DK014D (7/46)
DK002B (61/367)
DK003C (111/657)
DK014C (5/30)
DK014C (18/102)
DK001A (28/151)
DK002F (33/165)
DK014B (5/23)
DK014Y (52/246)
DK011D (4/18)
DK014N (4/17)
DK016G (3/13)
DK012D (9/37)
DK014N (13/55)
DK014Y (15/60)
DK001A (80/260)
25
50
75
100
25
50
75
100
113
SURVEILLANCE REPORT
Estonia
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
8
26
6
40
7
53
8
52
8
64
10
66
8
82
10
64
9
54
9
71
S. aureus
Labs
Isolates
9
98
9
104
8
141
9
154
10
206
11
185
11
213
9
152
11
121
10
163
E. coli
Labs
Isolates
9
98
10
167
10
156
9
215
11
219
11
267
11
320
11
317
11
315
11
306
Enterecocci
Labs
Isolates
6
27
5
63
7
66
8
85
8
66
11
86
8
72
8
66
3
10
8
76
K. pneumoniae
Labs
Isolates
7
38
6
47
9
63
10
72
7
60
9
82
6
91
9
91
P. aeruginosa
Labs
Isolates
5
38
6
43
8
48
8
41
6
43
8
43
6
17
7
33

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
114
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
<1
10
<1
<1
6
<1
2
<1
<1
2
3
<1
<1
2
<1
5
4
<1
1
2
2
2
4
2
2
2
<1
<1
6
<1
42
3
5
1
<1
55
2
6
4
<1
45
4
5
1
<1
52
2
7
<1
<1
50
6
7
1
<1
47
5
7
5
<1
38
4
8
2
<1
37
6
8
6
<1
5
10
12
<1
48
8
14
8
<1
4
22
<1
14
32
<1
14
50
<1
9
35
<1
<1
23
<1
9
27
<1
9
43
<1
14
27
<1
<1
<1
14
42
<1
75
50
<1
79
79
<1
83
74
<1
84
78
<1
94
89
<1
85
75
3
90
79
<1
90
67
<1
25
<1
89
63
<1
8
<1
8
<1
9
5
9
<1
2
2
3
<1
15
7
12
<1
15
19
17
<1
26
25
17
<1
12
22
40
<1
13
17
18
1
27
18
38
26
14
12
7
29
7
10
9
7
18
6
9
18
13
30
17
18
13
7
17
9
19
25
11
21
20
20
<1
<1
8
<1
6
16
17
13
24
16
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
97
3
1
0
100
-
5
-
100
0
12
0
100
-
0
-
100
-
0
-
100
-
25
-
100
-
11
-
61
39
-
2
0
-
57
43
0
3
6
0
37
63
-
15
10
-
62
38
-
0
0
-
45
55
-
0
0
-
56
44
-
16
36
-
50
50
-
18
5
-
6
4
55
36
-
0
25
0
0
-
5
4
48
43
0
8
0
3
6
0
4
1
38
57
-
16
0
11
13
-
12
2
36
50
2
0
0
0
0
0
5
30
66
-
0
0
0
-
8
1
53
39
-
0
0
30
23
-
5
48
48
-
0
10
14
-
30
33
38
-
3
0
0
-
18
40
10
33
-
5
5
0
5
-
15
45
5
35
0
17
8
12
14
50
14
33
7
45
-
0
0
0
0
-
36
27
9
27
-
0
0
0
0
-
24
29
7
40
-
22
33
44
17
-
43
14
5
39
-
11
17
50
6
-
115
SURVEILLANCE REPORT
Estonia
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
EE005 (0/6)

(2011-2012)
7
0
0
0
0
11.1
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
EE008X (0/5)
8
0
0
0.7
7.9
8.8
EE005X (0/11)
EE001 (0/20)
EE003X (0/8)
EE011 (0/12)
Hospital codes
Laboratory codes
EE009X (0/9)
EE006 (0/9)
EE001X (1/72)
EE004 (0/16)
EE006X (2/28)
EE002 (0/25)
EE002X (4/46)
EE009 (1/9)
EE004X (3/34)
25
50
75
116
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
EE011X (1/29)

9
3.4
6.7
11.8
13.8
31
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
EE001X (2/19)
6
10.5
16.7
24.3
38.5
66.7
EE005X (2/45)
EE002X (8/48)
EE008X (1/15)
EE002X (13/137)
Hospital codes
Hospital codes
EE005X (1/6)
EE001X (16/136)
EE004X (8/25)
EE004X (13/102)
EE006X (13/94)
EE006X (5/13)
EE003X (6/21)
EE009X (8/12)
EE009X (9/29)
25
50
75
100
25
50
75
100
117
SURVEILLANCE REPORT
Finland
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
16
517
17
548
17
543
15
501
16
547
15
643
20
688
20
622
17
662
16
607
S. aureus
Labs
Isolates
16
727
17
883
17
790
15
894
16
814
15
923
20
978
20
1094
18
1319
17
1409
E. coli
Labs
Isolates
15
1450
17
1749
17
1924
15
1875
16
1949
15
2111
20
2224
20
2551
17
3021
17
3162
Enterecocci
Labs
Isolates
15
266
17
336
17
340
15
348
16
400
15
381
20
506
20
521
16
479
17
651
K. pneumoniae
Labs
Isolates
14
175
14
228
15
273
12
288
20
375
20
401
17
404
17
536
P. aeruginosa
Labs
Isolates
13
108
14
162
14
183
12
175
18
233
20
281
16
269
17
327

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
118
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2
10
20
<1
8
20
<1
7
20
2
12
24
1
13
25
<1
11
24
2
13
28
1
14
28
<1
13
24
<1
17
22
33
1
5
1
<1
33
2
7
2
<1
35
2
7
2
<1
36
2
8
2
<1
34
3
8
2
<1
35
4
9
2
<1
36
3
9
3
<1
34
4
9
4
<1
37
5
11
5
<1
40
6
12
6
<1
<1
39
<1
<1
39
<1
<1
27
<1
<1
25
<1
2
22
<1
<1
13
<1
<1
<1
<1
<1
<1
<1
<1
<1
79
4
<1
69
12
<1
78
1
<1
80
16
<1
87
19
<1
87
15
<1
87
<1
82
<1
88
<1
85
<1
3
3
2
<1
1
4
<1
<1
<1
<1
1
<1
1
2
2
<1
1
3
1
<1
4
2
4
<1
1
3
2
<1
<1
2
2
<1
8
5
15
10
16
8
3
8
8
17
7
5
9
8
11
8
5
6
6
15
7
5
8
4
11
7
3
10
4
11
16
9
11
5
15
8
5
6
2
8
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
97
3
15
12
100
-
3
-
100
<1
11
13
100
-
0
-
100
-
1
-
100
0
2
0
99
1
8
14
56
44
15
15
62
38
2
3
38
62
15
9
68
32
0
0
59
41
1
1
56
44
3
1
63
37
8
9
7
3
48
41
18
10
15
16
2
3
41
53
6
2
2
3
1
1
26
72
5
13
11
12
5
1
24
70
0
0
0
0
1
1
33
65
0
0
1
1
1
0
27
72
0
0
3
2
1
1
27
71
0
43
12
6
0
9
0
12
79
0
10
0
6
17
1
7
1
11
80
6
1
0
3
3
<1
5
1
11
82
8
7
18
13
11
1
5
3
6
85
0
0
0
0
0
4
7
3
4
83
5
3
0
0
0
1
6
2
9
83
20
4
0
2
2
2
5
2
8
83
17
13
0
0
9
119
SURVEILLANCE REPORT
Finland
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
FI018 (0/25)
FI008 (1/37)

(2011-2012)
16
0
7.6
11.2
22
36.4
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
FI019X (0/64)
FI00LX (0/29)
18
0
0
1.4
4.8
10.1
FI017X (0/36)
FI020 (2/69)
FI003X (0/87)
FI012 (2/42)
FI008X (0/39)
FI00E (11/145)
FI00HX (1/233)
FI003 (5/48)
FI00EX (1/247)
FI012X (1/96)
Hospital codes
Laboratory codes
FI014 (3/28)
FI005 (6/56)
FI00C (11/95)
FI00CX (3/223)
FI005X (2/146)
FI014X (1/64)
FI015 (5/39)
FI002X (13/780)
FI00H (17/112)
FI021X (3/125)
FI011 (7/34)
FI015X (3/63)
FI021 (11/50)
FI011X (4/82)
FI002 (82/369)
FI010X (4/61)
FI00L (5/15)
FI018X (3/37)
FI017 (8/22)
FI020X (32/316)
25
50
75
120
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
FI00LX (4/91)
18
4.4
7.1
9.5
12.5
16
FI019X (0/25)
FI015X (10/156)
FI015X (0/22)
FI010X (11/169)
FI00LX (0/15)
FI017X (8/112)
FI021X (0/34)
FI00EX (31/407)
FI010X (0/20)
FI012X (15/186)
FI018X (0/13)
FI00CX (41/475)
FI011X (0/19)
FI021X (20/219)
FI008X (12/121)
FI00CX (1/77)
FI002X (4/296)
FI020X (68/608)
FI00HX (2/88)
FI014X (21/179)
FI003X (1/41)
FI00HX (78/623)
FI020X (2/77)
FI011X (23/182)
FI00EX (3/82)
FI019X (24/180)
FI012X (1/24)
FI002X (255/1819)
FI014X (1/23)
FI005X (46/288)
FI005X (4/44)
25
50
75
100
18
0
0
0.6
2.6
9.1
FI008X (0/27)
FI003X (31/299)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
FI017X (0/13)
Hospital codes
Hospital codes
FI018X (4/68)

25
50
75
100
121
SURVEILLANCE REPORT
France
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
195
632
97
371
168
663
127
557
225
826
181
1127
255
1413
160
824
S. aureus
Labs
Isolates
21
1710
50
3355
50
3484
50
3824
57
4265
56
4380
54
4727
56
4883
52
4740
55
5242
E. coli
Labs
Isolates
21
2266
50
5678
50
6056
50
6718
57
8093
56
7993
54
8451
56
9028
52
8790
55
9610
Enterecocci
Labs
Isolates
20
468
46
871
47
1023
50
1152
56
1545
54
1555
54
1969
54
1970
46
2163
52
2263
K. pneumoniae
Labs
Isolates
49
838
50
963
56
1187
54
1138
52
1378
56
1542
52
1691
55
1712
P. aeruginosa
Labs
Isolates
48
993
47
1006
56
1305
54
1225
32
1221
36
1191
52
1634
54
1731

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
122
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
5
36
41
4
32
36
4
34
37
7
30
31
6
27
27
<1
28
30
<1
24
26
<1
23
29
29
29
27
27
26
24
23
22
20
19
50
5
9
<1
<1
47
4
8
<1
<1
50
5
11
1
<1
53
6
14
2
<1
54
6
15
2
<1
54
7
16
4
<1
55
8
19
7
<1
55
7
18
7
<1
55
8
18
8
<1
55
8
18
10
<1
3
16
<1
1
17
<1
<1
15
<1
1
16
<1
1
15
<1
<1
18
<1
1
18
<1
<1
18
<1
<1
20
<1
<1
17
<1
30
23
<1
56
21
5
64
24
3
69
30
3
67
30
1
68
30
<1
63
38
<1
78
41
1
81
43
1
80
42
<1
5
7
4
<1
7
9
6
<1
11
14
10
<1
17
21
15
<1
20
24
19
<1
18
22
18
<1
24
28
25
<1
24
24
23
<1
15
9
14
22
27
11
6
12
16
23
11
7
14
18
24
14
8
14
15
22
21
17
17
19
25
20
13
18
19
23
23
16
20
21
27
20
14
18
20
22
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
69
CSF
31
Gender
Male
54
Female
46
Unknown
0
Age (years)
04
19
519
8
2064
38
65 and over
35
Unknown
<1
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
100
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
23
26
100
-
20
-
100
-
18
-
100
-
0
-
100
-
1
-
100
-
24
-
100
-
19
-
24
24
0
63
36
1
19
21
9
49
50
2
20
16
16
66
32
1
0
0
0
65
34
1
1
2
0
61
37
2
25
23
15
64
35
1
19
19
12
23
12
22
28
25
4
3
40
53
1
7
7
13
25
64
2
1
33
63
<1
8
15
19
18
25
4
1
37
58
0
0
0
0
0
0
2
1
44
53
0
26
13
1
0
0
2
1
46
51
<1
22
43
26
22
62
2
2
46
49
<1
15
11
23
15
50
24
13
34
14
37
1
19
23
17
18
24
8
27
9
56
1
23
19
19
16
28
19
30
13
37
1
0
0
0
0
0
28
28
13
30
2
1
0
1
2
0
16
28
13
41
2
42
21
27
17
39
28
23
11
36
2
32
15
17
12
21
123
SURVEILLANCE REPORT
France
FR460 (0/7)
FR175 (0/13)
FR027 (0/5)
FR213 (0/9)
FR188 (0/5)
FR144 (0/6)
FR473 (0/10)
FR054 (0/5)
FR521 (0/9)
FR450 (0/11)
FR125 (0/15)
FR257 (0/6)
FR129 (0/5)
FR162 (1/15)
FR249 (1/14)
FR020 (1/12)
FR004 (1/11)
FR271 (1/11)
FR170 (1/11)
FR050 (1/10)
FR507 (1/9)
FR465 (1/9)
FR098 (1/9)
FR518 (1/8)
FR241 (1/8)
FR153 (1/8)
FR022 (1/8)
FR066 (1/8)
FR146 (1/8)
FR208 (1/7)
FR232 (2/14)
FR100 (1/7)
FR274 (2/14)
FR069 (1/7)
FR434 (1/7)
FR235 (1/7)
FR239 (1/7)
FR043 (3/21)
FR052 (5/34)
FR493 (1/6)
FR062 (1/6)
FR160 (1/6)
FR506 (1/6)
FR514 (1/6)
FR224 (2/12)
FR056 (1/6)
FR009 (4/23)
FR260 (5/28)
FR505 (2/11)
FR167 (4/22)
FR028 (1/5)
FR495 (1/5)
FR462 (1/5)
FR194 (4/20)
FR418 (1/5)
FR015 (1/5)
FR488 (1/5)
FR148 (1/5)
FR107 (1/5)
FR174 (2/10)
FR105 (1/5)
FR126 (2/10)
FR060 (1/5)
FR186 (4/19)
FR496 (4/19)
FR149 (3/14)
FR479 (5/23)
FR219 (2/9)
FR040 (10/45)
FR071 (8/35)
FR263 (18/78)
FR234 (3/13)
FR127 (12/52)
FR476 (8/33)
FR269 (15/61)
FR094 (14/57)
FR251 (3/12)
FR064 (4/16)
FR172 (2/8)
FR198 (3/12)
FR498 (3/12)
FR063 (2/8)
FR467 (7/28)
FR032 (2/8)
FR038 (4/15)
FR164 (7/26)
FR142 (3/11)
FR108 (9/33)
FR999 (3/11)
FR076 (13/46)
FR214 (13/46)
FR079 (2/7)
FR528 (2/7)
FR010 (8/28)
FR131 (4/14)
FR470 (2/7)
FR246 (13/45)
FR116 (7/23)
FR250 (4/13)
FR228 (4/13)
FR266 (6/19)
FR006 (21/66)
FR130 (12/37)
FR306 (2/6)
FR279 (3/9)
FR403 (2/6)
FR112 (2/6)
FR276 (2/6)
FR055 (2/6)
FR414 (2/6)
FR490 (3/9)
FR051 (3/9)
FR109 (20/56)
FR218 (3/8)
FR240 (3/8)
FR277 (5/13)
FR243 (2/5)
FR254 (4/10)
FR135 (2/5)
FR121 (2/5)
FR037 (2/5)
FR036 (5/12)
FR502 (3/7)
FR248 (3/7)
FR132 (3/7)
FR067 (6/14)
FR068 (4/9)
FR230 (4/9)
FR238 (4/9)
FR138 (4/8)
FR220 (3/6)
FR115 (4/7)
FR096 (3/5)
FR077 (3/5)
FR140 (5/8)
FR072 (4/5)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
136
0
14.3
22.2
32.1
80
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
FR095A (1/83)
FR164A (30/378)
FR134A (9/99)
FR202A (4/34)
FR052A (24/190)
FR193A (6/46)
58
1.2
15.8
20.4
24.2
35.3
FR153A (34/262)
FR072A (7/52)
FR084A (9/66)
FR249A (26/183)
FR248A (43/298)
FR400A (9/60)
FR109A (41/264)
FR010A (56/354)
FR055A (6/38)
FR226A (45/279)
FR403A (10/60)
FR208A (2/12)
FR040A (41/241)
FR130A (63/368)
FR076A (51/297)
FR250A (44/251)
FR121A (36/198)
FR276A (18/95)
FR434A (9/47)
FR214A (61/306)
FR206A (3/15)
FR179A (10/50)
FR126A (20/98)
FR263A (151/741)
FR401A (12/58)
FR105A (25/121)
FR165A (65/311)
FR006A (103/482)
FR246A (72/337)
FR213A (30/137)
FR138A (88/396)
FR009A (37/164)
FR046A (8/35)
FR094A (91/396)
FR098A (17/74)
FR238A (78/331)
FR362A (16/66)
FR224A (22/91)
FR120A (18/74)
FR259A (22/86)
FR067A (36/138)
FR260A (33/122)
FR145A (10/37)
FR479A (120/423)
FR015A (6/21)
FR194A (31/107)
FR008A (15/51)
FR237A (36/121)
FR037A (16/52)
FR064A (59/187)
FR186A (14/44)
FR531A (6/17)
25
50
75
124

(2011-2012)
Hospital codes
Laboratory codes

(2011-2012)
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
FR145A (6/86)
FR250A (43/523)
FR276A (27/331)
FR130A (63/627)
FR008A (18/178)
58
7
14.5
17.9
21.6
33.3
FR072A (0/8)
FR202A (0/12)
FR400A (0/18)
FR246A (3/91)
FR434A (14/131)
FR276A (1/25)
FR009A (33/291)
FR006A (9/122)
FR134A (30/263)
FR237A (2/25)
FR531A (5/43)
FR260A (2/23)
FR067A (36/290)
FR052A (5/57)
FR072A (17/136)
FR055A (1/11)
FR249A (40/310)
FR164A (6/61)
FR238A (74/524)
FR250A (4/41)
FR040A (55/380)
FR224A (2/19)
FR153A (54/368)
FR067A (3/28)
FR010A (74/499)
FR120A (4/37)
FR202A (20/135)
FR008A (2/18)
FR037A (18/121)
FR076A (18/149)
FR224A (26/171)
FR145A (2/16)
FR213A (55/357)
FR126A (4/32)
FR260A (42/269)
FR249A (4/30)
FR126A (26/166)
FR259A (4/29)
FR226A (68/431)
FR064A (11/79)
FR400A (27/167)
FR109A (13/82)
FR109A (101/599)
FR194A (6/36)
FR052A (63/364)
FR208A (7/40)
FR094A (120/687)
FR120A (37/202)
FR246A (118/634)
FR164A (126/679)
FR055A (18/96)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
FR434A (0/16)
FR010A (0/42)
Hospital codes
Hospital codes
FR194A (27/257)

58
0
10.5
18.7
29.5
60
FR208A (1/6)
FR105A (15/81)
FR130A (13/70)
FR098A (3/16)
FR094A (24/127)
FR037A (1/5)
FR214A (30/148)
FR179A (31/164)
FR193A (4/19)
FR084A (28/147)
FR084A (7/33)
FR362A (30/157)
FR238A (13/59)
FR214A (106/553)
FR009A (9/38)
FR138A (167/829)
FR362A (6/25)
FR076A (116/567)
FR121A (17/68)
FR263A (197/932)
FR401A (14/53)
FR259A (23/108)
FR479A (32/115)
FR206A (10/47)
FR134A (8/28)
FR193A (17/80)
FR015A (5/17)
FR095A (16/74)
FR138A (52/176)
FR186A (16/73)
FR165A (50/169)
FR121A (65/295)
FR213A (20/64)
FR064A (97/438)
FR248A (60/189)
FR006A (166/741)
FR186A (3/9)
FR098A (45/195)
FR179A (17/47)
FR401A (29/125)
FR095A (7/19)
FR105A (80/333)
FR263A (117/289)
FR403A (19/79)
FR226A (56/130)
FR479A (133/520)
FR403A (21/48)
FR248A (123/476)
FR153A (49/112)
FR237A (54/207)
FR046A (4/9)
FR015A (26/94)
FR040A (36/78)
FR165A (155/542)
FR206A (3/6)
FR046A (11/33)
FR531A (3/5)
25
50
75
100
25
50
75
100
125
SURVEILLANCE REPORT
Germany
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
17
175
16
145
15
119
15
85
11
75
11
209
16
346
16
363
18
359
20
326
S. aureus
Labs
Isolates
20
920
22
1107
17
827
18
799
12
853
14
1090
17
1893
17
1980
19
2388
21
2563
E. coli
Labs
Isolates
19
997
22
1217
17
961
18
850
12
977
14
1615
17
2803
17
3024
19
3650
21
4194
Enterecocci
Labs
Isolates
17
347
22
606
17
569
16
529
12
648
13
451
17
952
16
1009
17
1231
21
1499
K. pneumoniae
Labs
Isolates
.
.
.
.
12
105
14
148
10
173
11
235
15
479
15
478
17
519
20
664
P. aeruginosa
Labs
Isolates
.
.
1
1
12
117
12
162
11
197
11
167
16
287
15
315
17
389
20
438

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
126
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
1
11
<1
1
13
<1
4
17
1
5
12
<1
3
8
<1
5
10
<1
2
8
<1
4
9
<1
2
8
1
5
7
18
20
21
20
16
19
18
21
16
15
47
5
14
<1
<1
55
4
24
2
<1
54
6
23
2
<1
60
10
29
4
<1
55
6
30
8
<1
55
7
23
5
<1
56
8
23
8
<1
54
9
25
8
<1
52
8
24
8
<1
50
7
21
9
<1
7
47
<1
7
42
<1
3
34
<1
3
29
<1
7
67
<1
<1
39
<1
3
40
<1
<1
47
<1
<1
41
<1
<1
36
<1
78
47
3
93
61
11
96
52
10
94
38
8
95
73
15
95
35
6
94
45
6
94
45
8
96
42
11
93
32
16
.
.
.
.
.
.
.
.
10
6
7
2
12
12
14
<1
6
9
6
2
10
15
11
<1
10
15
13
<1
10
15
13
<1
9
14
13
<1
8
14
13
<1
.
.
.
.
.
<1
<1
<1
<1
<1
18
11
25
12
23
17
12
17
18
28
17
17
22
10
28
9
8
11
10
22
13
11
11
8
17
16
8
13
10
18
15
9
10
12
18
16
10
11
11
20
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
94
6
3
13
100
-
16
-
100
<1
22
38
100
-
0
-
100
-
14
-
99
1
13
14
98
2
10
38
39
33
28
4
3
3
48
29
23
16
16
15
33
42
25
26
20
22
52
24
23
0
0
1
47
31
22
16
15
8
46
34
21
14
9
16
52
25
23
10
13
9
5
2
37
55
<1
6
7
2
4
0
1
1
28
69
<1
4
6
14
17
20
1
1
21
76
<1
7
25
25
22
0
2
0
28
70
<1
0
0
0
0
0
1
1
35
64
-
0
22
15
13
-
2
1
26
70
-
4
14
14
13
-
2
1
29
68
-
15
13
15
8
-
20
55
3
20
2
2
3
6
6
0
20
46
11
20
2
19
15
15
14
22
13
53
7
24
3
25
20
22
27
18
25
36
9
27
3
0
0
0
0
0
42
30
11
17
1
16
12
9
15
33
17
45
8
26
3
12
8
18
18
27
23
35
9
30
3
15
8
12
8
11
127
SURVEILLANCE REPORT
Germany
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
DE0401 (0/16)
DE1303 (0/21)

(2011-2012)
19
0
0
0
4.3
11.8
DE1302 (0/7)
DE1203 (0/10)
DE1001 (0/57)
DE0602 (0/5)
DE1304 (0/18)
DE1101 (0/12)
Hospital codes
Laboratory codes
DE0107 (0/25)
DE0308 (0/11)
DE0402 (0/6)
DE0907 (1/69)
DE0911 (4/113)
DE0110 (6/138)
DE0102 (1/23)
DE0908 (3/46)
DE1504 (2/28)
DE0301 (3/27)
DE0111 (2/17)
25
50
75
100
Note. Individual laboratories may serve a large number of hospitals over a
wide geographical area within Germany.
128
DE090708 (0/21)
DE100103 (0/13)
DE010703 (0/8)
DE011044 (0/14)
DE091143 (0/16)
DE150405 (0/8)
DE091106 (0/26)
DE090707 (0/13)
DE100127 (0/6)
DE091110 (0/9)
DE091301 (0/21)
DE091126 (0/24)
DE011068 (0/13)
DE011016 (0/8)
DE090710 (0/16)
DE091133 (0/8)
DE0401C (0/9)
DE011086 (1/42)
DE0102A (5/171)
DE011007 (1/35)
DE010701 (2/58)
DE0401A (6/147)
DE070103 (1/23)
DE091105 (2/39)
DE011062 (2/38)
DE040204 (1/19)
DE011028 (1/18)
DE011027 (1/17)
DE011021 (5/79)
DE091120 (2/32)
DE100110 (1/15)
DE011081 (1/15)
DE011024 (2/30)
DE011066 (2/29)
DE130404 (1/13)
DE010702 (1/13)
DE011087 (1/13)
DE090832 (1/12)
DE100112 (1/12)
DE091135 (3/35)
DE011019 (2/22)
DE011039 (2/21)
DE011063 (2/21)
DE011022 (5/51)
DE011045 (1/10)
DE100106 (1/10)
DE011031 (3/30)
DE090716 (12/112)
DE011010 (6/55)
DE030801 (5/46)
DE090807 (2/18)
DE091116 (1/9)
DE091114 (1/9)
DE100109 (2/18)
DE030107 (1/9)
DE011020 (5/44)
DE011005 (3/26)
DE011029 (2/17)
DE011004 (3/25)
DE011083 (12/97)
DE0401D (2/16)
DE030103 (4/32)
DE091129 (3/24)
DE090715 (2/16)
DE091132 (6/47)
DE040202 (3/23)
DE011003 (3/23)
DE011101 (22/167)
DE011026 (5/37)
DE030108 (4/29)
DE110101 (15/108)
DE090705 (8/57)
DE100102 (1/7)
DE150401 (15/105)
DE100138 (1/7)
DE100131 (1/7)
DE100104 (1/7)
DE100101 (8/54)
DE090719 (3/20)
DE011061 (3/20)
DE120301 (19/127)
DE011041 (2/13)
DE100129 (2/13)
DE011018 (4/26)
DE090713 (3/19)
DE130320 (3/19)
DE091104 (3/19)
DE100128 (4/25)
DE090709 (8/50)
DE070101 (23/144)
DE011042 (5/31)
DE090701 (5/31)
DE011017 (2/12)
DE100108 (1/6)
DE0102B (2/12)
DE091121 (1/6)
DE090906 (1/6)
DE130403 (11/65)
DE090819 (5/29)
DE090718 (9/52)
DE100113 (3/17)
DE011025 (5/28)
DE090714 (5/28)
DE011012 (7/38)
DE030102 (5/27)
DE011038 (14/72)
DE091146 (7/36)
DE090706 (7/35)
DE090704 (1/5)
DE011001 (2/10)
DE060201 (4/20)
DE030101 (7/35)
DE2020 (6/30)
DE091125 (7/35)
DE100136 (9/44)
DE011085 (12/58)
DE090841 (11/53)
DE011084 (2/9)
DE030109 (10/45)
DE100119 (4/18)
DE100107 (2/9)
DE090806 (9/40)
DE091122 (9/40)
DE040201 (7/30)
DE091117 (8/33)
DE011032 (3/12)
DE091107 (2/8)
DE130312 (18/68)
DE091108 (4/15)
DE091101 (11/41)
DE100120 (3/11)
DE011037 (10/36)
DE130307 (13/46)
DE090801 (15/52)
DE150402 (14/48)
DE011014 (9/30)
DE090803 (9/30)
DE090812 (3/10)
DE130201 (42/140)
DE091134 (5/16)
DE091131 (6/19)
DE091302 (4/12)
DE091145 (5/13)
DE090814 (2/5)
DE091119 (2/5)
DE011088 (4/10)
DE090833 (9/22)
DE100111 (5/12)
DE090802 (10/24)
DE090901 (6/14)
DE090804 (8/18)
DE011067 (3/6)
DE011058 (8/16)
DE150407 (7/12)
DE011079 (16/24)
DE130333 (4/5)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
25
50
% MRSA
75
156
0
8.5
14.9
21.5
80
100
SURVEILLANCE REPORT
DE091114 (0/10)
DE011016 (0/11)
DE100127 (0/10)
DE100104 (0/5)
DE091128 (0/5)
DE090812 (0/9)
DE030107 (0/8)
DE011009 (0/9)
DE011041 (0/8)
DE100103 (1/27)
DE011028 (1/24)
DE091121 (1/21)
DE091116 (1/18)
DE090807 (2/34)
DE011088 (1/17)
DE090704 (1/15)
DE130307 (3/42)
DE100110 (2/22)
DE100102 (2/22)
DE011044 (1/10)
DE011029 (3/29)
DE040204 (3/29)
DE011039 (5/45)
DE011079 (1/9)
DE090901 (4/36)
DE100111 (1/9)
DE091122 (11/94)
DE100138 (4/34)
DE090715 (5/42)
DE030103 (7/58)
DE090706 (6/49)
DE090832 (3/24)
DE011081 (2/16)
DE011022 (9/69)
DE091131 (5/38)
DE011001 (2/15)
DE011068 (4/30)
DE011045 (2/15)
DE090819 (5/36)
DE011062 (7/49)
DE090804 (2/14)
DE091129 (6/42)
DE090806 (8/56)
DE011025 (5/35)
DE100115 (1/7)
DE011010 (13/90)
DE091105 (8/54)
DE130320 (6/40)
DE011026 (5/33)
DE150402 (9/57)
DE100108 (3/19)
DE100148 (4/25)
DE090803 (5/31)
DE011087 (4/24)
DE100131 (4/24)
DE060201 (8/48)
DE011027 (3/18)
DE091143 (4/24)
DE100132 (1/6)
DE091138 (1/6)
DE011067 (2/12)
DE011007 (10/59)
DE091117 (10/59)
DE010702 (6/35)
DE010701 (29/170)
DE100106 (5/29)
DE010703 (4/23)
DE011021 (12/68)
DE030801 (15/85)
DE011038 (14/79)
DE091125 (10/56)
DE011031 (10/54)
DE011018 (5/27)
DE100136 (13/70)
DE090718 (15/80)
DE091112 (3/16)
DE040201 (12/63)
DE030102 (7/36)
DE091108 (7/36)
DE090833 (6/31)
DE100109 (8/41)
DE130403 (29/148)
DE091101 (13/66)
DE011024 (18/91)
DE040202 (9/45)
DE090906 (2/10)
DE011012 (9/45)
DE091110 (1/5)
DE011102 (1/5)
DE030101 (13/65)
DE011032 (2/10)
DE090802 (8/40)
DE100107 (2/10)
DE011030 (1/5)
DE090719 (6/30)
DE090705 (15/72)
DE150401 (31/147)
DE130312 (16/76)
DE070103 (8/38)
DE091126 (15/70)
DE100113 (6/28)
DE011066 (13/60)
DE091120 (15/68)
DE011003 (5/22)
DE100101 (30/131)
DE091132 (20/87)
DE070102 (3/13)
DE091134 (3/13)
DE091106 (10/43)
DE011086 (15/64)
DE030109 (15/64)
DE030108 (11/47)
DE090801 (18/77)
DE091133 (10/42)
DE090710 (7/29)
DE100128 (8/33)
DE100120 (9/37)
DE011083 (42/171)
DE091146 (14/57)
DE0401A (64/257)
DE0401C (3/12)
DE100119 (6/24)
DE091145 (9/36)
DE011004 (11/43)
DE011020 (18/70)
DE091104 (9/35)
DE011005 (7/27)
DE130201 (30/116)
DE090713 (6/23)
DE091135 (19/72)
DE090716 (43/163)
DE011063 (9/34)
DE091107 (6/22)
DE091147 (8/29)
DE011037 (13/47)
DE011014 (14/50)
DE120301 (50/175)
DE090840 (2/7)
DE150405 (2/7)
DE011019 (4/14)
DE011085 (20/69)
DE070101 (64/219)
DE090820 (3/10)
DE0102A (103/338)
DE090709 (31/101)
DE100129 (5/16)
DE090708 (11/35)
DE090701 (12/38)
DE090841 (21/64)
DE090707 (5/15)
DE091302 (5/15)
DE011060 (2/6)
DE011050 (2/6)
DE011042 (15/43)
DE110101 (53/150)
DE011061 (12/34)
DE100112 (6/17)
DE011017 (11/29)
DE090714 (11/28)
DE0102B (2/5)
DE011006 (2/5)
DE2020 (11/27)
DE011101 (100/246)
DE011058 (3/7)
DE091136 (3/7)
DE091301 (17/39)
DE091119 (5/10)
DE130404 (6/12)
DE130333 (3/5)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum

169
0
14.3
20
25.9
60
Hospital codes
Hospital codes

(2011-2012)
25
50
75
100
DE090801 (0/12)
DE011021 (0/6)
DE011063 (0/5)
DE100136 (0/13)
DE091131 (0/5)
DE011066 (0/8)
DE091104 (0/5)
DE090706 (0/7)
DE091145 (0/6)
DE030102 (0/6)
DE030109 (0/10)
DE011042 (0/7)
DE090804 (0/5)
DE100128 (0/6)
DE011038 (0/12)
DE090701 (0/5)
DE091129 (0/6)
DE091146 (0/5)
DE091106 (0/6)
DE090719 (0/5)
DE011022 (0/10)
DE090806 (0/13)
DE100102 (0/7)
DE090715 (0/6)
DE011031 (0/9)
DE011087 (0/5)
DE011004 (0/12)
DE090802 (0/7)
DE011083 (1/22)
DE0401A (3/46)
DE030801 (1/13)
DE011010 (1/11)
DE130312 (2/21)
DE030101 (1/10)
DE090716 (2/20)
DE030108 (1/10)
DE150402 (2/20)
DE100109 (1/9)
DE030103 (1/9)
DE091126 (1/9)
DE090841 (2/17)
DE130201 (3/25)
DE090718 (1/8)
DE070101 (5/40)
DE150401 (5/39)
DE120301 (4/30)
DE011024 (2/14)
DE091101 (1/7)
DE130403 (5/34)
DE0102A (8/53)
DE0401C (1/6)
DE011005 (1/6)
DE011085 (1/6)
DE011086 (1/6)
DE130307 (2/11)
DE100138 (1/5)
DE011018 (1/5)
DE040202 (1/5)
DE011027 (1/5)
DE011025 (1/5)
DE011020 (2/10)
DE2020 (1/5)
DE011012 (1/5)
DE011062 (1/5)
DE040201 (3/14)
DE110101 (6/27)
DE090709 (4/17)
DE100101 (5/20)
DE091135 (2/8)
DE011101 (20/73)
DE091134 (2/7)
DE091120 (2/7)
DE091122 (6/21)
DE091132 (5/16)
DE011058 (2/5)
DE091133 (5/11)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
25
50
75
76
0
0
11.1
20
45.5
100
129
SURVEILLANCE REPORT
Greece
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
-
S. aureus
Labs
Isolates
34
682
35
610
35
682
42
828
41
819
46
907
48
1025
44
902
39
826
38
877
E. coli
Labs
Isolates
35
1076
39
1131
35
1140
41
1253
43
1234
44
1462
49
1831
45
1549
37
1437
37
1397
Enterecocci
Labs
Isolates
32
621
34
565
34
737
39
949
39
999
42
992
47
1190
43
1105
36
1122
36
1121
K. pneumoniae
Labs
Isolates
33
774
38
841
38
972
41
1093
47
1649
40
1703
38
1671
37
1462
P. aeruginosa
Labs
Isolates
33
699
38
818
37
802
42
920
47
1123
42
1014
35
948
34
913

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
130
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
45
44
42
43
48
41
40
39
39
41
44
6
12
6
<1
46
6
12
6
<1
46
7
12
7
<1
46
7
14
6
<1
48
9
19
8
<1
50
15
22
10
<1
51
14
23
10
<1
52
16
24
14
<1
55
17
27
15
<1
55
18
29
16
1
4
52
7
4
59
4
3
54
4
5
57
5
4
65
7
3
52
7
4
61
6
3
43
3
4
37
6
5
28
7
89
40
18
84
52
20
85
34
37
88
35
42
91
44
37
85
52
28
86
63
27
93
53
23
93
43
23
94
35
17
60
54
61
28
54
50
58
33
54
55
62
42
55
64
66
37
60
66
69
44
62
71
75
49
69
72
76
68
63
70
71
60
30
27
39
41
39
39
34
48
48
45
38
40
47
50
50
34
37
49
48
48
33
34
44
42
45
39
40
43
43
46
31
37
54
38
39
34
31
48
41
44
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
100
-
40
-
100
<1
28
46
100
-
7
-
100
-
20
-
97
3
73
90
97
3
50
73
10
5
84
39
45
40
9
12
80
29
23
28
8
7
85
4
4
7
12
6
82
31
33
18
7
5
88
61
60
75
7
5
88
42
29
53
4
<1
2
3
90
25
67
32
37
41
4
<1
3
6
87
27
22
22
29
28
6
2
3
89
13
4
4
6
3
3
4
90
15
17
41
20
4
<1
1
3
92
70
17
57
61
74
4
<1
2
2
92
51
25
18
36
52
14
68
11
2
5
52
38
43
18
41
5
74
11
3
6
33
26
42
9
27
33
48
14
2
4
13
3
2
0
10
29
49
17
3
2
22
20
15
32
19
46
35
14
2
4
91
54
70
15
73
44
38
15
1
2
62
40
47
16
48
131
SURVEILLANCE REPORT
Greece
(2011-2012)

(2011-2012)
No data reported
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
GR052X (1/17)
GR048X (1/12)
GR061X (1/7)
GR062X (4/27)
38
5.9
30
38.1
47.5
71.4
GR057X (1/6)
GR028X (5/24)
GR030X (27/103)
GR031X (25/89)
GR049X (9/31)
GR032X (6/20)
GR035X (11/34)
GR055X (4/12)
GR042X (6/18)
GR018X (5/15)
GR051X (5/15)
GR047X (43/127)
Hospital codes
GR070X (19/55)
GR011X (3/8)
GR027X (28/74)
GR001X (25/65)
GR040X (70/177)
GR015X (13/31)
GR024X (12/28)
GR026X (10/23)
GR050X (16/36)
GR037X (18/39)
GR075X (26/56)
GR041X (31/66)
GR012X (19/40)
GR007X (28/58)
GR068X (16/32)
GR043X (15/29)
GR033X (43/80)
GR039X (56/99)
GR005X (12/21)
GR014X (39/66)
GR038X (5/8)
GR071X (5/7)
25
50
% MRSA
132
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
GR026X (0/36)
GR068X (3/35)
GR011X (3/34)
GR027X (13/130)

37
0
19.2
25.3
35
50.6
GR052X (3/10)
GR051X (5/13)
GR062X (5/11)
GR051X (3/24)
35
27.8
59.2
70.8
79.6
87.6
GR070X (37/76)
GR052X (4/32)
GR038X (7/14)
GR048X (2/15)
GR018X (8/16)
GR062X (5/28)
GR049X (16/29)
GR001X (24/126)
GR033X (71/120)
GR042X (10/52)
GR027X (86/145)
GR012X (13/67)
GR047X (92/153)
GR032X (8/40)
GR055X (8/13)
GR035X (25/115)
GR028X (21/33)
GR071X (4/18)
GR048X (8/12)
GR024X (11/47)
GR050X (22/93)
GR001X (62/90)
GR047X (79/317)
GR042X (7/10)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
GR011X (5/18)
GR064X (2/8)
GR043X (22/87)
GR041X (36/141)
GR005X (34/48)
GR043X (63/89)
GR035X (66/91)
GR018X (7/27)
GR031X (100/138)
GR005X (19/68)
GR014X (95/130)
GR070X (24/85)
GR075X (104/141)
GR033X (41/125)
GR012X (71/96)
GR040X (72/217)
GR050X (66/88)
GR031X (42/121)
GR041X (120/158)
GR038X (7/20)
GR026X (23/30)
GR055X (7/20)
GR030X (218/274)
GR030X (63/175)
GR032X (25/31)
GR075X (40/109)
GR039X (203/252)
GR015X (25/64)
GR007X (60/73)
GR014X (35/88)
GR040X (275/330)
GR037X (22/55)
GR049X (10/24)
GR068X (99/118)
GR028X (16/37)
GR024X (44/51)
GR007X (22/44)
GR015X (60/69)
GR037X (127/145)
GR039X (39/77)
25
50
75
100
25
50
75
100
133
SURVEILLANCE REPORT
Hungary
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
20
134
26
143
23
133
23
151
22
146
22
166
22
143
27
140
27
139
26
160
S. aureus
Labs
Isolates
27
858
30
1020
28
1083
27
1127
26
1199
26
1181
26
1068
30
1224
28
1156
28
1143
E. coli
Labs
Isolates
27
842
28
967
27
1046
26
1135
25
1179
25
1057
25
1057
29
1385
30
1227
28
1415
Enterecocci
Labs
Isolates
25
279
26
366
27
476
25
453
26
400
21
428
27
444
29
591
28
582
28
594
K. pneumoniae
Labs
Isolates
21
314
24
302
23
322
23
369
24
361
29
514
27
432
27
500
P. aeruginosa
Labs
Isolates
24
507
25
546
24
518
25
513
25
518
28
636
29
606
29
619
Note: national data analysis allows for a more accurate validation. Due to differences in the validation algorithms used by EARS-Net and Hungary, there are small

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
3
24
25
<1
16
25
4
21
32
1
18
19
5
23
36
8
27
32
3
12
19
6
15
24
6
12
15
3
10
20
15
17
20
25
23
23
29
30
26
25
49
8
15
<1
<1
55
10
19
3
<1
51
9
22
4
<1
53
12
27
5
<1
54
11
26
5
<1
59
13
26
9
<1
60
16
30
13
<1
65
21
37
19
<1
65
15
31
15
<1
64
17
29
17
<1
<1
87
<1
2
57
<1
1
43
<1
3
47
<1
2
48
<1
3
53
<1
2
51
<1
1
51
<1
1
49
<1
2
56
<1
91
96
<1
95
80
<1
91
64
<1
88
67
<1
88
53
<1
96
62
3
97
70
1
97
62
2
95
45
<1
99
51
4
26
21
28
<1
20
13
20
<1
29
22
25
<1
36
33
35
<1
40
33
38
<1
48
43
46
5
53
51
53
2
41
42
43
3
10
10
18
32
28
9
8
16
23
21
11
9
19
26
24
13
11
26
26
26
19
12
27
29
27
14
11
25
29
27
11
12
21
18
20
19
18
27
27
22
Note: national data analysis allows for a more accurate validation. Due to differences in the validation algorithms used by EARS-Net and Hungary, there are small
134
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
68
32
10
13
100
-
26
-
100
-
30
-
100
-
0
-
100
-
2
-
98
2
48
55
96
4
24
22
54
43
2
9
14
0
57
42
2
25
26
19
44
55
1
31
29
28
57
42
1
0
0
0
52
47
2
1
4
0
59
40
1
51
41
80
58
40
2
26
22
23
6
7
49
37
<1
21
0
12
8
100
2
2
44
52
-
0
10
23
29
-
3
1
36
60
-
13
17
31
30
-
4
1
38
57
-
0
0
0
0
-
4
2
40
53
-
0
0
3
2
-
7
1
44
48
-
47
33
48
48
-
3
2
48
48
-
24
22
28
21
-
31
17
1
46
4
11
8
0
12
8
24
22
10
40
5
36
27
33
19
12
14
26
6
47
7
26
31
32
30
32
42
16
9
27
7
0
0
0
0
0
43
12
5
33
8
3
0
0
3
0
30
18
11
35
7
52
37
61
46
45
48
10
12
25
5
34
9
16
19
8
135
SURVEILLANCE REPORT
Hungary
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
HU038 (0/6)
HU020 (0/9)

(2011-2012)
22
0
0
10.8
16.7
25
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
HU038X (0/11)
HU034C (0/5)
HU025A (4/101)
HU034A (7/64)
HU009B (3/26)
HU040 (0/9)
45
0
15.3
26.2
36.1
75
HU019A (16/130)
HU002M (1/8)
HU035 (0/8)
HU006W (1/8)
HU022P (7/50)
HU024 (0/11)
HU012G (6/43)
HU020L (2/14)
HU006 (0/5)
HU024A (9/59)
HU022 (1/26)
HU028A (28/165)
HU002L (1/6)
HU026A (14/71)
HU029 (2/31)
HU038J (1/5)
HU002Y (2/10)
HU019 (1/13)
HU020C (1/5)
HU020A (10/49)
HU041A (14/66)
Hospital codes
Laboratory codes
HU028 (1/11)
HU034 (2/19)
HU005 (1/9)
HU035A (10/44)
HU022I (35/150)
HU032A (44/168)
HU006R (4/15)
HU040A (34/123)
HU038I (9/31)
HU009 (3/23)
HU037A (3/10)
HU025 (2/15)
HU033A (47/150)
HU039 (1/7)
HU029V (73/224)
HU026 (1/6)
HU002D (2/6)
HU033 (2/12)
HU002G (13/36)
HU005A (21/65)
HU019H (2/6)
HU002U (2/6)
HU006B (4/11)
HU001P (7/18)
HU041 (2/12)
HU007B (18/46)
HU006A (2/5)
HU012 (1/5)
HU009A (64/152)
HU039A (14/31)
HU032 (6/28)
HU012P (14/29)
HU004G (5/10)
HU027 (2/9)
HU031A (11/19)
HU007C (8/13)
HU002 (2/8)
HU022S (6/8)
25
50
75
136
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
HU002U (0/5)
HU020C (0/9)
HU002L (0/7)
HU020L (1/18)

43
0
16.8
28.2
38.8
66.7
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
HU026A (1/11)
HU024A (1/11)
HU019A (2/21)
HU009B (2/23)
28
9.1
31.6
48.5
62.5
100
HU007B (2/10)
HU038X (1/10)
HU004G (1/9)
HU034A (5/23)
HU034C (2/17)
HU040A (7/29)
HU002G (3/23)
HU037A (1/6)
HU041A (8/26)
HU024A (16/95)
HU022P (3/16)
HU009A (12/37)
HU007C (1/5)
HU039A (8/23)
HU034A (16/74)
HU006R (4/18)
HU025A (22/57)
HU019A (26/113)
HU001P (10/22)
HU040A (30/120)
HU022I (77/303)
HU029V (49/106)
HU031A (7/15)
HU033A (39/143)
Hospital codes
Hospital codes
HU012G (9/35)
HU026A (18/64)
HU025A (49/174)
HU012P (8/28)
HU038I (9/30)
HU033A (32/68)
HU006R (5/10)
HU032A (45/88)
HU029V (77/253)
HU028A (64/118)
HU041A (31/96)
HU039A (23/70)
HU005A (19/34)
HU027L (2/6)
HU035A (31/52)
HU035A (25/74)
HU032A (47/134)
HU038J (3/5)
HU002M (6/17)
HU004G (5/8)
HU001P (3/8)
HU028A (90/232)
HU038I (5/8)
HU008F (4/10)
HU020A (21/52)
HU020A (18/28)
HU027A (21/52)
HU027A (13/20)
HU002D (3/7)
HU009A (54/122)
HU002G (4/6)
HU005A (21/47)
HU012G (7/10)
HU019H (3/6)
HU031A (3/5)
HU012P (37/43)
HU007B (13/20)
HU038H (5/5)
HU006Z (4/6)
25
50
75
100
25
50
75
100
137
SURVEILLANCE REPORT
Iceland
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
2
35
2
54
2
37
2
52
2
42
2
46
2
36
2
37
2
32
2
28
S. aureus
Labs
Isolates
2
64
2
55
2
78
2
57
2
65
2
63
2
59
2
65
2
71
2
58
E. coli
Labs
Isolates
2
100
2
119
2
130
2
130
2
105
2
123
2
111
2
104
2
130
2
143
Enterecocci
Labs
Isolates
2
22
1
27
2
31
2
40
1
29
2
17
2
51
2
31
2
32
2
30
K. pneumoniae
Labs
Isolates
2
22
2
13
2
27
1
24
2
27
2
27
2
26
2
16
P. aeruginosa
Labs
Isolates
1
13
1
9
1
11
2
7
2
16
2
12
2
17
1
10

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
138
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
9
20
2
17
8
<1
8
17
<1
6
10
2
7
17
<1
9
22
<1
<1
9
3
5
11
6
9
22
4
4
7
<1
<1
<1
<1
<1
<1
42
2
6
1
<1
43
<1
2
<1
<1
38
<1
3
<1
<1
45
7
12
<1
<1
46
6
17
2
<1
44
7
6
<1
<1
50
7
7
2
<1
46
3
11
4
<1
48
6
14
6
-
44
4
10
5
-
<1
<1
<1
<1
5
<1
<1
<1
<1
7
3
<1
<1
13
<1
<1
30
<1
<1
15
<1
<1
13
<1
<1
<1
<1
<1
12
<1
57
<1
<1
63
13
<1
80
<1
<1
56
14
<1
57
14
<1
43
43
<1
68
36
8
38
13
6
69
15
<1
67
9
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
4
8
4
<1
<1
<1
<1
<1
<1
<1
4
<1
<1
4
8
-
<1
7
21
-
8
8
8
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
<1
13
6
<1
<1
13
8
8
<1
<1
17
6
6
6
<1
6
10
10
10
<1
10
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
85
15
2
33
100
-
2
-
100
-
12
-
100
-
0
-
100
-
0
-
100
-
13
-
100
-
7
-
61
39
6
9
66
34
2
2
43
57
16
9
51
49
0
0
60
40
0
0
63
38
16
7
70
30
11
0
5
2
58
36
33
0
6
5
6
5
40
49
0
0
4
2
3
1
41
55
0
0
10
14
49
51
0
0
4
4
48
44
0
0
0
0
58
43
9
18
44
56
0
13
7
8
2
83
-
0
20
0
6
-
2
24
4
69
2
0
0
0
3
0
2
15
4
80
-
25
14
33
10
-
11
24
11
51
3
0
0
0
0
0
24
4
12
60
-
0
0
0
0
-
3
13
5
75
5
0
20
50
10
0
15
19
4
63
-
0
20
0
6
-
139
SURVEILLANCE REPORT
Iceland
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum

(2011-2012)
2
5.7
5.7
11.2
16.7
16.7
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
IS003A (0/14)
Hospital codes
Laboratory codes
IS001 (3/53)
IS003 (1/6)
IS001A (3/110)
25
50
75
140
2
0
0
1.4
2.7
2.7
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum

4
0
0
5.7
24.4
37.5
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
1
11.8
11.8
11.8
11.8
11.8
IS001B (0/7)
Hospital codes
Hospital codes
IS001G (0/5)
IS001A (4/34)
IS001A (26/229)
IS001C (3/8)
25
50
75
100
25
50
75
100
141
SURVEILLANCE REPORT
Ireland
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
24
363
28
399
31
397
32
406
33
435
35
442
34
356
32
310
32
324
30
319
S. aureus
Labs
Isolates
26
1108
38
1286
38
1360
38
1347
41
1332
38
1242
41
1261
39
1207
39
1057
40
1038
E. coli
Labs
Isolates
26
978
37
1235
39
1424
39
1638
42
1750
41
1875
41
2012
40
2121
38
2167
40
2386
Enterecocci
Labs
Isolates
21
348
29
418
33
502
32
550
37
598
37
685
38
671
38
670
36
608
37
677
K. pneumoniae
Labs
Isolates
15
42
28
211
31
237
33
307
37
316
34
318
34
304
32
338
P. aeruginosa
Labs
Isolates
11
29
23
128
29
172
29
191
30
236
30
219
28
181
34
216

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
142
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
3
12
12
3
10
14
3
11
12
3
16
16
6
17
17
6
23
17
6
20
17
5
18
16
6
19
18
5
19
17
42
41
42
42
38
33
27
24
24
23
61
4
10
2
<1
65
5
12
2
<1
67
7
17
4
<1
69
7
21
4
<1
65
10
21
5
<1
67
9
23
6
<1
66
9
22
6
<1
67
10
23
8
<1
70
10
23
9
<1
67
11
24
9
<1
5
32
<1
<1
42
1
4
42
3
5
43
3
2
38
3
<1
31
3
3
34
<1
2
29
<1
<1
30
4
4
33
3
91
54
19
96
56
22
93
52
31
94
44
36
93
36
33
95
27
35
93
38
38
96
39
39
96
36
35
93
39
44
5
3
7
<1
9
16
9
<1
10
17
8
<1
9
11
11
<1
11
11
11
<1
7
8
8
<1
8
9
8
<1
9
7
10
<1
7
10
11
7
14
7
6
9
9
17
6
5
9
9
18
5
4
6
6
16
4
6
8
7
9
8
6
6
5
11
3
4
6
4
6
16
14
11
10
15
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
98
2
19
45
100
-
23
-
100
<1
24
50
100
-
3
-
100
-
40
-
100
0
9
0
99
1
9
0
54
46
21
17
66
34
23
24
47
53
29
19
66
34
3
3
60
40
39
40
58
42
9
8
63
37
7
12
9
2
37
52
25
27
18
19
7
4
38
50
7
11
17
31
3
1
30
66
9
6
20
26
6
1
34
58
0
0
5
3
1
1
40
58
0
29
45
37
3
1
43
53
30
0
8
8
3
2
33
61
0
13
14
7
2
10
1
31
55
13
22
29
16
21
3
10
3
24
61
25
29
38
16
24
3
11
4
27
55
29
26
25
21
24
5
7
5
17
65
3
5
0
2
4
9
8
5
9
69
44
29
23
32
43
3
9
5
22
62
10
9
7
4
10
3
9
4
21
63
8
6
0
12
9
143
SURVEILLANCE REPORT
Ireland
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
IE-32 (0/10)
IE-73 (0/5)
IE-61 (0/5)

(2011-2012)
26
0
12.6
20.7
28.6
33.3
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
IE-63 (0/6)
IE-67 (0/6)
IE-77 (0/9)
IE-71 (0/9)
IE-64 (0/7)
50
0
10
22.5
28.1
44.4
IE-21 (0/16)
IE-43 (1/17)
IE-15 (3/36)
IE-59 (1/16)
IE-2 (4/37)
IE-33 (1/14)
IE-48 (3/25)
IE-79 (1/12)
IE-76 (1/13)
IE-46 (5/53)
IE-65 (1/10)
IE-10 (11/87)
IE-37 (1/9)
IE-60 (3/22)
IE-35 (1/8)
IE-49 (2/15)
IE-43 (1/6)
IE-4 (14/91)
IE-48 (11/71)
IE-50 (8/47)
IE-32 (5/31)
IE-11 (5/30)
IE-4 (5/27)
IE-57 (2/11)
IE-52 (3/16)
IE-1 (22/113)
Hospital codes
Laboratory codes
IE-46 (3/16)
IE-25 (7/35)
IE-47 (3/14)
IE-34 (15/65)
IE-61 (2/10)
IE-30 (9/41)
IE-34 (28/121)
IE-70 (7/30)
IE-6 (10/43)
IE-31 (9/38)
IE-2 (49/204)
IE-31 (3/13)
IE-15 (34/139)
IE-51 (2/8)
IE-6 (5/21)
IE-74 (9/36)
IE-50 (37/147)
IE-1 (12/45)
IE-20 (32/118)
IE-44 (14/50)
IE-20 (6/22)
IE-29 (36/128)
IE-58 (9/32)
IE-49 (2/7)
IE-60 (16/56)
IE-44 (5/16)
IE-10 (24/79)
IE-62 (4/12)
IE-80 (5/16)
IE-70 (4/12)
IE-38 (4/12)
IE-62 (4/13)
IE-18 (5/15)
IE-12 (11/33)
IE-74 (3/9)
IE-73 (6/17)
IE-36 (5/14)
IE-58 (5/15)
IE-47 (12/32)
IE-13 (12/29)
IE-30 (6/18)
IE-26 (4/9)
25
50
75
144
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
IE-68 (0/9)
IE-57 (1/28)
IE-77 (1/27)
IE-59 (1/24)
IE-49 (1/16)
IE-37 (1/11)

54
0
14.9
22.4
28.6
50
IE-70 (0/6)
IE-6 (0/13)
30
0
0
4.8
12.5
25
IE-32 (0/8)
IE-46 (4/38)
IE-64 (1/9)
IE-73 (0/6)
IE-73 (5/45)
IE-63 (3/25)
IE-13 (0/9)
IE-81 (1/8)
IE-51 (5/40)
IE-48 (0/23)
IE-30 (13/90)
IE-30 (0/12)
IE-10 (25/168)
IE-18 (7/44)
IE-10 (0/20)
IE-2 (54/337)
IE-50 (39/234)
IE-43 (0/7)
IE-33 (5/29)
IE-60 (21/122)
IE-71 (0/5)
IE-44 (14/78)
IE-13 (17/90)
IE-12 (0/11)
IE-35 (5/25)
IE-31 (0/10)
IE-74 (22/107)
IE-61 (13/62)
IE-47 (0/7)
IE-26 (3/14)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
IE-80 (0/6)
IE-11 (23/107)
IE-47 (20/90)
IE-52 (9/40)
IE-38 (7/30)
IE-31 (25/106)
IE-15 (63/262)
IE-1 (2/62)
IE-34 (2/31)
IE-21 (1/12)
IE-74 (1/12)
IE-76 (5/20)
IE-43 (16/63)
IE-18 (1/12)
IE-20 (60/230)
IE-65 (7/26)
IE-2 (5/56)
IE-6 (34/126)
IE-48 (43/157)
IE-60 (1/9)
IE-80 (10/36)
IE-21 (12/43)
IE-29 (4/36)
IE-4 (49/174)
IE-58 (2/16)
IE-12 (22/77)
IE-70 (18/63)
IE-50 (4/29)
IE-62 (22/77)
IE-34 (60/208)
IE-15 (7/47)
IE-32 (36/125)
IE-36 (11/37)
IE-46 (1/6)
IE-1 (84/281)
IE-67 (3/10)
IE-20 (8/48)
IE-56 (2/6)
IE-11 (2/12)
IE-29 (91/243)
IE-58 (42/108)
IE-4 (6/33)
IE-79 (7/17)
IE-71 (12/26)
IE-44 (2/8)
IE-27 (3/6)
25
50
75
100
25
50
75
100
145
SURVEILLANCE REPORT
Italy
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
44
293
37
271
38
331
34
269
34
298
27
194
21
216
33
323
29
294
32
293
S. aureus
Labs
Isolates
46
1480
42
1225
41
1479
38
1164
38
1167
30
939
23
987
35
1886
31
1372
41
1767
E. coli
Labs
Isolates
17
923
14
645
16
1195
13
910
14
1052
14
957
9
863
23
2623
21
2098
41
3552
Enterecocci
Labs
Isolates
44
634
40
576
40
714
35
650
36
656
31
580
22
509
35
1106
31
841
41
947
K. pneumoniae
Labs
Isolates
38
344
32
321
37
391
27
331
22
313
34
739
30
688
37
979
P. aeruginosa
Labs
Isolates
12
183
10
185
11
168
10
195
23
517
21
355
40
773

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
146
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
5
13
37
5
14
29
5
9
31
<1
7
33
4
15
31
3
10
26
3
6
21
5
9
29
6
7
27
6
12
34
39
40
37
38
33
34
37
37
38
35
52
10
25
6
-
53
9
28
5
-
55
11
28
8
-
56
8
27
7
-
58
14
32
11
<1
62
14
38
16
<1
63
13
36
17
<1
64
15
39
21
<1
67
18
41
20
<1
68
21
42
26
<1
4
39
2
4
36
2
4
38
3
4
38
3
4
39
2
13
47
2
20
49
3
13
50
2
11
50
3
4
51
1
80
44
24
78
39
21
77
36
19
86
48
18
73
53
11
64
49
6
60
52
4
70
59
4
83
54
4
87
62
6
8
11
20
-
26
23
33
1
25
27
35
1
28
28
39
2
19
20
37
1
29
39
47
15
35
46
46
27
42
50
48
29
23
20
21
32
36
20
25
27
29
35
20
24
33
30
36
24
16
31
29
42
21
18
22
23
31
22
16
21
18
26
30
26
25
30
31
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
89
11
9
14
100
-
37
-
100
<1
41
23
100
-
2
-
100
-
5
-
99
1
47
57
98
2
23
45
46
41
14
7
9
19
50
37
13
36
38
31
46
44
9
46
34
51
46
26
28
2
2
3
51
34
15
6
4
8
50
35
15
47
40
62
51
30
18
23
22
28
4
3
20
38
34
15
9
8
9
9
3
1
17
37
42
32
26
28
42
36
1
0
15
38
46
12
39
39
41
43
4
1
12
32
51
0
0
2
3
2
3
1
16
34
46
0
0
4
6
6
3
1
18
33
46
41
67
49
47
46
3
1
21
33
43
18
38
30
18
25
6
35
4
51
4
6
4
23
13
7
10
41
16
25
7
45
38
38
31
33
6
40
17
34
3
41
39
44
42
50
22
35
14
21
8
1
2
2
2
4
19
33
18
26
4
10
5
2
6
0
21
33
16
24
6
63
45
41
37
56
20
29
18
29
4
36
22
17
20
30
147
SURVEILLANCE REPORT
Italy
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
IT064 (0/12)
IT024 (0/11)

(2011-2012)
16
0
0
6.1
10.8
21.1
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
IT0071 (0/9)
IT0509 (1/23)
IT0506 (5/28)
IT0028 (3/16)
IT0024 (4/21)
51
0
23.3
33.3
46.6
66.7
IT0502 (9/47)
IT004 (8/38)
IT0507 (9/42)
IT028 (0/5)
IT0025 (11/49)
IT0059 (43/191)
IT0015 (5/22)
IT086 (0/6)
IT0064 (8/35)
IT0077 (7/30)
IT0510 (4/16)
IT059 (0/17)
IT0047 (13/51)
IT0045 (16/62)
IT0088 (10/38)
IT0072 (23/85)
IT037 (1/42)
IT0097 (3/11)
IT0031 (14/51)
IT0061 (67/219)
IT091 (1/30)
IT0512 (4/13)
Hospital codes
Laboratory codes
IT0019 (30/94)
IT090 (1/21)
IT019 (2/27)
IT0085 (21/65)
IT0095 (23/71)
IT0023 (30/90)
IT0022 (20/58)
IT0034 (21/58)
IT0005 (37/101)
IT0090 (21/54)
IT072 (2/26)
IT0092 (30/76)
IT0067 (47/115)
IT0093 (7/17)
IT502 (1/13)
IT0049 (17/41)
IT0042 (13/30)
IT0098 (7/16)
IT0074 (16/35)
IT089 (2/22)
IT0501 (23/50)
IT0091 (76/163)
IT0070 (41/88)
IT022 (1/8)
IT0037 (57/118)
IT0508 (15/31)
IT0060 (13/26)
IT085 (2/15)
IT0040 (26/51)
IT0052 (18/34)
IT0089 (55/100)
IT060 (2/12)
IT0096 (28/50)
IT0035 (41/73)
IT0504 (7/12)
IT004 (4/19)
IT0099 (10/17)
IT0086 (38/57)
25
50
75
148
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
IT0507 (5/28)
IT0512 (4/21)
IT0031 (20/101)
IT0047 (12/52)

43
17.9
37.8
44.4
52.3
72.2
IT0061 (9/92)
IT0059 (7/55)
IT0024 (1/6)
IT0061 (139/508)
IT0090 (2/12)
IT0093 (5/17)
IT0022 (3/13)
IT004 (39/125)
IT0510 (3/13)
IT0059 (136/413)
IT0005 (11/46)
IT0090 (51/144)
IT0023 (11/39)
IT0034 (47/131)
IT0031 (11/36)
IT0037 (88/233)
42
4.8
33.3
48.1
62.1
93.3
IT0071 (2/6)
IT0045 (10/26)
IT0047 (2/6)
IT0089 (79/203)
IT0025 (12/34)
IT0023 (80/202)
IT0507 (8/22)
IT0086 (47/117)
IT0088 (21/55)
IT0035 (66/159)
IT0064 (7/18)
IT0070 (67/159)
IT0085 (12/29)
IT0067 (72/169)
IT0070 (14/33)
IT0072 (71/164)
IT004 (23/53)
IT0042 (17/39)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
IT0072 (1/21)
IT0092 (57/130)
IT0508 (12/27)
IT0019 (102/225)
IT0099 (13/28)
IT0035 (25/56)
IT0091 (42/89)
IT0034 (23/47)
IT0095 (19/38)
IT0052 (8/15)
IT0015 (9/19)
IT0067 (21/39)
IT0505 (4/8)
IT0019 (39/71)
IT0096 (14/28)
IT0502 (9/16)
IT0511 (3/6)
IT0089 (29/51)
IT0085 (50/100)
IT0086 (19/32)
IT0005 (101/197)
IT0015 (14/23)
IT0049 (28/54)
IT0037 (43/70)
IT0025 (73/140)
IT0077 (18/29)
IT0502 (23/44)
IT0091 (112/213)
IT0506 (7/11)
IT0509 (17/32)
IT0042 (9/14)
IT0095 (110/201)
IT0512 (6/9)
IT0506 (23/42)
IT0092 (36/52)
IT0088 (52/92)
IT0508 (26/36)
IT0097 (23/40)
IT0040 (55/74)
IT0040 (43/73)
IT0509 (6/8)
IT0510 (20/30)
IT0501 (27/34)
IT0501 (38/55)
IT0049 (31/39)
IT0098 (14/15)
IT0098 (13/18)
25
50
75
100
25
50
75
100
149
SURVEILLANCE REPORT
Latvia
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
4
5
7
6
3
7
4
5
7
17
36
37
31
18
30
38
51
64
S. aureus
Labs
Isolates
7
7
11
12
12
12
10
11
11
E. coli
Labs
Isolates
87
127
172
169
164
188
155
197
211
10
9
10
9
8
9
10
Enterecocci
Labs
Isolates
62
76
90
86
98
132
154
10
8
9
8
8
8
7
56
57
51
48
61
59
73
K. pneumoniae
Labs
Isolates
6
7
11
10
8
9
8
28
27
40
44
64
65
78
P. aeruginosa
Labs
Isolates
9
6
6
7
6
4
6
16
16
11
18
21
12
18

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
150
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
<1
7
<1
<1
3
<1
<1
3
<1
<1
<1
6
6
<1
<1
<1
3
5
5
5
10
13
<1
5
5
4
26
20
19
12
14
10
44
5
10
6
<1
43
14
17
14
<1
48
10
14
11
<1
43
13
24
12
2
50
11
14
12
<1
55
11
17
16
<1
54
12
14
15
<1
9
50
<1
30
<1
5
27
<1
12
38
<1
5
47
<1
18
26
<1
7
29
<1
94
73
<1
77
<1
<1
90
78
7
82
79
18
100
83
13
96
42
9
89
28
6
25
26
36
<1
22
27
44
<1
52
45
58
3
43
34
55
<1
55
52
55
<1
34
38
38
<1
51
46
64
<1
17
29
13
47
33
31
13
6
31
13
30
36
40
45
45
17
17
7
22
12
19
10
14
29
19
9
9
8
25
25
12
22
11
22
22
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
81
19
2
30
100
-
9
-
100
0
16
0
100
-
0
-
100
-
8
-
99
1
52
100
100
-
10
-
67
33
-
6
12
-
53
47
-
12
6
-
40
59
0
23
11
0
56
44
-
0
0
-
48
53
-
5
10
-
59
41
-
51
54
-
60
40
-
11
8
-
8
1
62
30
-
38
100
3
6
-
8
4
46
42
<1
3
6
10
9
100
7
2
42
49
-
0
0
14
20
-
5
4
44
48
-
0
0
0
0
-
40
60
-
13
4
-
9
1
49
40
1
46
100
53
53
0
33
67
-
20
5
-
54
12
35
-
5
17
8
-
22
43
9
26
-
16
6
14
9
-
28
28
5
39
<1
31
11
21
6
100
42
24
12
22
-
0
0
0
0
-
58
23
10
10
-
9
0
25
0
-
41
23
3
33
1
47
55
50
57
100
43
20
13
23
-
8
17
0
14
-
151
SURVEILLANCE REPORT
Latvia
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
LV003 (0/22)

(2011-2012)
5
0
1.9
12.5
16.7
50
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LV006A (0/8)
11
0
0
6.3
13.4
33.3
LV005A (0/13)
LV009A (0/5)
LV004 (1/52)
LV008A (0/6)
Hospital codes
Laboratory codes
LV012A (1/27)
LV012 (1/8)
LV002A (2/32)
LV001A (9/130)
LV003A (4/40)
LV001 (2/12)
LV004A (16/119)
LV013A (4/15)
LV002 (4/8)
LV011A (2/6)
25
50
75
152
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LV006A (0/5)

7
0
0
16.7
18.5
31.4
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LV004A (15/40)
6
37.5
50
56.3
72.2
90.9
LV002A (0/19)
LV001A (22/44)
LV003A (2/66)
Hospital codes
Hospital codes
LV003A (5/9)
LV012A (3/18)
LV002A (8/14)
LV005A (1/6)
LV012A (13/18)
LV004A (20/108)
LV013A (10/11)
LV001A (16/51)
25
50
75
100
25
50
75
100
153
SURVEILLANCE REPORT
Lithuania
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
9
35
10
67
11
48
10
46
9
40
8
48
9
37
S. aureus
Labs
Isolates
13
167
12
240
12
278
13
258
11
257
10
279
11
323
E. coli
Labs
Isolates
11
171
13
235
12
304
13
297
10
333
10
385
11
462
Enterecocci
Labs
Isolates
8
30
10
56
10
67
11
57
10
59
9
74
11
96
K. pneumoniae
Labs
Isolates
8
35
10
41
11
54
12
68
9
81
10
137
11
186
P. aeruginosa
Labs
Isolates
7
14
7
21
7
21
8
21
8
31
6
30
9
28

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
154
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
16
<1
1
4
9
<1
2
6
7
9
7
8
13
<1
2
19
27
14
16
26
13
11
11
14
10
55
15
12
5
<1
50
12
9
7
<1
54
12
14
6
<1
58
15
15
8
<1
56
15
14
9
<1
48
10
13
7
<1
52
10
15
5
<1
5
50
<1
3
41
<1
5
33
<1
3
48
<1
13
41
<1
10
44
<1
5
51
2
75
75
<1
100
81
<1
88
78
<1
95
64
11
88
87
8
96
88
8
86
78
6
26
3
23
<1
37
8
27
<1
41
23
36
<1
56
37
57
<1
52
36
51
<1
55
55
61
<1
63
55
64
<1
21
31
21
29
46
5
<1
30
33
38
14
10
24
38
35
20
14
19
19
33
6
10
27
13
16
13
21
20
13
17
11
7
18
14
11
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
92
8
19
0
100
-
8
-
100
-
14
-
100
-
2
-
100
-
6
-
99
1
62
100
100
-
19
-
68
32
-
21
11
-
55
44
0
8
7
0
35
65
0
20
11
0
64
36
-
1
0
-
55
45
-
9
4
-
63
37
-
69
52
-
60
40
-
11
30
-
25
2
49
24
-
33
0
12
15
-
4
4
46
44
0
15
0
7
9
0
3
1
38
58
0
4
36
15
13
0
6
1
39
54
-
0
0
0
2
-
2
2
44
52
2
0
100
11
0
0
4
1
43
52
0
75
100
61
62
100
2
43
55
-
0
24
16
-
36
34
29
-
6
31
16
-
22
48
11
19
0
12
7
9
6
0
19
48
6
27
-
16
11
12
18
-
31
37
10
22
-
0
0
0
4
-
37
31
8
24
-
4
0
0
20
-
35
28
10
26
-
68
58
56
64
-
45
19
5
31
-
15
36
0
17
-
155
SURVEILLANCE REPORT
Lithuania
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
LT013 (2/28)

(2011-2012)
5
7.1
11.1
18.8
20
50
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LT002A (0/13)
LT001C (0/5)
17
0
0
7.3
15.5
40
LT009F (0/13)
LT013B (0/18)
LT011A (0/20)
LT007 (1/9)
LT003A (0/22)
LT001A (5/122)
Hospital codes
Laboratory codes
LT012A (2/29)
LT001 (3/16)
LT013A (4/55)
LT007A (7/88)
LT015A (2/18)
LT005A (11/89)
LT005 (1/5)
LT004A (11/71)
LT013D (1/6)
LT002E (1/6)
LT011 (7/14)
LT001E (2/7)
LT001B (2/5)
25
50
75
156
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LT001C (0/5)
LT013C (0/13)

17
0
6.7
11.1
16.7
27.3
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LT009F (2/5)
12
40
51.3
55.8
73
90.9
LT001A (28/57)
LT013D (0/6)
LT005A (2/128)
LT013A (17/34)
LT011A (1/15)
LT003A (10/19)
LT002A (2/22)
LT015A (8/15)
LT009F (3/32)
Hospital codes
Hospital codes
LT004A (6/55)
LT007A (10/90)
LT007A (17/31)
LT005A (21/37)
LT015A (5/39)
LT013A (19/128)
LT001B (6/10)
LT012A (4/27)
LT001C (4/6)
LT013B (3/18)
LT012A (27/34)
LT002F (1/5)
LT003A (9/39)
LT004A (47/53)
LT001A (45/182)
LT011A (10/11)
LT001B (3/11)
25
50
75
100
25
50
75
100
157
SURVEILLANCE REPORT
Luxembourg
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
7
54
6
36
5
47
5
31
6
48
6
59
6
67
6
50
5
52
6
39
S. aureus
Labs
Isolates
8
95
7
96
5
83
5
77
6
117
5
117
6
113
6
134
5
127
6
131
E. coli
Labs
Isolates
8
227
7
216
5
188
5
167
6
275
6
303
6
301
6
354
5
354
6
335
Enterecocci
Labs
Isolates
7
41
5
28
5
31
4
42
5
37
5
61
5
54
6
70
5
76
5
74
K. pneumoniae
Labs
Isolates
4
21
6
52
6
52
3
28
6
59
4
48
4
50
P. aeruginosa
Labs
Isolates
1
1
4
23
5
36
4
33
6
35
6
32
5
32
5
31

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
158
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
15
28
6
11
33
7
12
24
5
5
26
3
6
24
5
11
14
11
19
16
4
12
18
2
8
15
3
3
16
21
16
13
19
20
13
17
20
15
49
4
12
<1
<1
49
4
18
<1
<1
49
7
19
3
<1
46
6
20
2
<1
49
5
21
4
<1
56
8
22
6
<1
57
9
26
8
<1
63
6
26
9
<1
52
8
24
8
<1
51
6
24
11
<1
5
32
<1
<1
18
<1
<1
24
<1
<1
32
<1
<1
44
<1
3
17
3
10
28
10
6
46
4
2
44
4
7
22
<1
100
<1
<1
50
<1
<1
36
23
<1
75
30
<1
67
10
<1
76
21
5
93
29
36
77
19
32
71
40
4
80
44
<1
<1
6
10
<1
4
12
2
<1
13
12
19
<1
18
21
25
<1
5
7
5
<1
29
33
35
<1
26
32
34
<1
<1
<1
<1
<1
<1
9
10
7
4
10
15
11
20
22
36
3
3
25
6
15
14
14
15
9
11
6
<1
9
9
22
16
9
16
16
19
16
3
6
6
19
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
88
12
7
0
100
-
18
-
100
-
24
-
100
-
2
-
100
-
2
-
99
1
34
100
97
3
11
0
57
43
4
9
66
34
17
19
42
58
26
23
74
26
1
4
64
36
4
0
59
41
31
40
51
49
19
3
6
7
37
49
-
0
17
3
8
-
4
3
38
55
-
10
11
14
21
-
2
1
27
71
-
7
0
18
27
-
1
27
72
-
0
3
1
-
23
75
2
0
3
0
6
36
58
-
67
43
26
-
3
29
68
-
0
6
14
-
16
7
4
51
22
0
17
0
7
6
13
11
9
44
24
24
18
14
12
26
7
10
15
41
27
36
21
18
25
24
18
10
10
38
24
0
0
0
0
8
34
7
9
30
20
0
0
0
8
0
9
9
12
45
24
56
22
33
39
25
22
13
8
35
22
14
0
20
14
7
159
SURVEILLANCE REPORT
Luxembourg
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum

(2011-2012)
4
2.9
5.4
9
10
10
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LU001A (3/36)
8
8.3
16.1
17.2
19.4
37.5
LU001 (1/35)
LU003C (4/25)
LU007A (5/31)
LU003 (2/25)
Hospital codes
Laboratory codes
LU001B (1/6)
LU004A (3/17)
LU006 (1/10)
LU006A (8/43)
LU003A (17/84)
LU004 (1/10)
LU003B (3/8)
25
50
75
160
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LU001B (0/6)

11
0
9.1
23.6
25.2
39.1
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
LU003C (1/6)
7
16.7
20
31.6
50
60
LU003D (0/10)
LU007A (1/5)
LU003B (1/11)
LU001D (2/14)
LU006A (5/20)
Hospital codes
Hospital codes
LU004A (16/77)
LU003A (55/233)
LU001A (6/19)
LU007A (16/66)
LU003A (12/32)
LU001A (15/61)
LU006A (34/135)
LU001D (3/6)
LU003C (15/45)
LU003B (3/5)
LU004B (9/23)
25
50
75
100
25
50
75
100
161
SURVEILLANCE REPORT
Malta
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
1
9
1
18
1
13
1
31
1
13
1
17
1
8
1
11
1
11
1
18
S. aureus
Labs
Isolates
1
121
1
94
1
77
1
90
1
105
1
108
1
85
1
108
1
130
1
102
E. coli
Labs
Isolates
1
91
1
91
1
85
1
94
1
117
1
128
1
158
1
192
1
219
1
214
Enterecocci
Labs
Isolates
1
26
1
41
1
38
1
53
1
37
1
32
1
36
1
37
1
53
1
30
K. pneumoniae
Labs
Isolates
.
.
.
.
1
18
1
32
1
28
1
36
1
38
1
57
1
52
1
56
P. aeruginosa
Labs
Isolates
.
.
.
.
1
45
1
51
1
36
1
31
1
58
1
42
1
42
1
31

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
162
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
<1
38
<1
<1
25
8
15
46
3
7
45
<1
<1
8
24
47
35
<1
14
13
11
22
18
10
50
13
<1
39
50
43
56
56
67
52
56
59
48
49
47
39
18
24
2
<1
48
20
36
4
<1
51
7
31
1
<1
56
15
32
4
<1
54
20
35
13
<1
52
22
34
21
<1
54
21
30
15
1
44
22
34
16
<1
53
16
32
13
<1
54
14
31
14
<1
5
29
<1
<1
44
<1
3
32
<1
2
<1
3
<1
<1
<1
5
<1
<1
<1
<1
<1
4
<1
33
50
<1
43
<1
<1
25
<1
<1
14
<1
40
<1
60
<1
75
<1
100
<1
64
<1
67
<1
17
11
6
<1
6
6
6
<1
<1
11
7
<1
<1
8
<1
<1
<1
3
<1
<1
12
16
12
<1
10
13
13
4
27
25
27
4
22
11
18
16
44
47
30
20
8
24
11
3
11
8
11
45
33
30
23
19
36
29
21
21
22
36
14
24
31
24
24
12
24
33
19
10
6
3
6
<1
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
96
4
44
0
100
-
48
-
100
0
32
0
100
-
0
-
100
-
0
-
99
1
21
0
99
1
15
0
46
46
7
31
54
50
56
32
13
51
42
52
37
52
11
41
25
34
60
33
6
0
0
0
70
20
10
0
0
0
48
40
12
27
19
0
62
30
8
13
14
33
21
21
57
50
50
38
6
2
29
63
50
50
44
50
2
1
22
75
0
0
19
37
14
6
17
62
0
0
0
0
5
5
90
0
0
0
4
1
35
60
0
0
18
23
3
5
47
45
0
0
21
12
11
89
-
0
48
-
7
33
9
48
2
65
42
77
44
60
2
15
6
73
4
22
32
35
31
41
8
16
11
62
3
0
0
0
0
0
10
30
15
45
-
0
0
0
0
-
8
20
10
58
3
44
23
18
16
33
25
19
10
41
5
39
0
14
10
0
163
SURVEILLANCE REPORT
Malta
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum

(2011-2012)
1
42.9
42.9
42.9
42.9
42.9
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
3
42.9
42.9
47,4
70
70
Hospital codes
Laboratory codes
MT001E (3/7)
MT001 (12/28)
MT001A (102/215)
MT001F (7/10)
25
50
75
164
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum

3
30.7
30.7
34.2
39.4
39.4
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
2
20.4
20.4
26.9
33.3
33.3
MT001A (111/362)
Hospital codes
Hospital codes
MT001A (20/98)
MT001E (13/38)
MT001F (2/6)
MT001F (13/33)
25
50
75
100
25
50
75
100
165
SURVEILLANCE REPORT
Netherlands
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
24
891
22
758
23
815
22
1006
21
940
17
723
17
746
22
971
25
1289
26
1246
S. aureus
Labs
Isolates
23
1422
22
1339
23
1407
23
1636
21
1471
16
1191
16
1035
21
1565
23
1815
25
1963
E. coli
Labs
Isolates
23
2133
21
2111
23
2201
22
2905
21
2801
16
2283
16
2398
21
3422
23
4436
25
4738
Enterecocci
Labs
Isolates
23
480
22
444
23
563
23
776
21
827
17
632
16
522
20
834
23
1108
24
1062
K. pneumoniae
Labs
Isolates
16
301
18
458
19
497
15
463
15
408
20
647
23
729
25
694
P. aeruginosa
Labs
Isolates
16
210
19
330
19
338
15
345
15
235
21
376
23
434
24
408

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
166
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
1
5
<1
2
8
<1
1
11
<1
1
8
<1
2
7
<1
2
7
<1
1
5
<1
2
6
<1
1
5
<1
2
4
<1
<1
<1
<1
45
3
7
1
<1
43
3
7
1
<1
48
4
10
2
<1
47
3
11
3
<1
49
5
13
4
<1
48
6
14
5
<1
45
4
11
4
<1
48
7
14
5
<1
49
8
14
6
<1
49
7
15
6
<1
4
29
1
3
37
<1
3
38
<1
5
28
<1
5
38
<1
<1
34
<1
2
31
<1
3
34
<1
1
33
<1
1
31
<1
30
20
<1
42
20
<1
61
40
<1
73
50
<1
83
62
<1
86
53
<1
89
76
<1
89
65
<1
91
66
1
91
63
<1
5
6
4
<1
4
4
4
<1
5
4
7
<1
7
7
8
<1
3
4
6
<1
7
7
7
<1
8
7
8
<1
6
5
7
<1
4
5
5
7
9
2
5
2
5
9
2
4
2
3
5
6
6
6
4
8
3
4
3
2
7
4
3
3
3
4
6
5
3
5
7
5
3
3
4
6
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
95
5
1
3
100
-
1
-
100
0
15
0
100
-
0
-
100
-
1
-
100
<1
7
17
99
1
3
10
50
50
-
1
1
-
61
39
-
1
2
-
50
50
0
19
11
0
69
31
-
0
0
-
60
40
-
1
1
-
59
41
-
9
6
-
66
34
-
4
3
-
2
2
40
55
-
2
0
2
1
-
5
3
32
60
-
1
2
2
1
-
2
1
27
71
0
6
13
16
15
0
3
1
26
70
0
0
0
0
0
0
2
1
36
61
-
0
0
1
1
-
2
1
28
70
-
4
25
10
6
-
1
1
28
70
-
0
17
5
3
-
10
9
2
40
40
2
3
2
1
1
9
13
6
30
41
4
0
1
1
1
7
15
4
31
42
15
13
16
15
16
14
11
6
28
39
0
0
0
0
0
42
9
5
14
29
0
2
0
2
0
11
14
5
28
42
17
6
17
6
6
16
12
6
29
38
7
2
2
2
4
167
SURVEILLANCE REPORT
Netherlands
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
NL139 (0/94)
NL125 (0/118)

(2011-2012)
23
0
0
1.2
3.2
8.3
NL132 (0/72)
NL030 (0/141)
NL119 (0/90)
NL134 (0/88)
NL145 (0/93)
NL131 (0/167)
NL112 (0/65)
NL126 (1/93)
Hospital codes
Laboratory codes
NL031 (1/117)
NL141 (1/86)
NL111 (3/204)
NL026 (1/60)
NL002 (3/139)
NL113 (4/171)
NL023 (2/68)
NL101 (3/93)
NL133 (1/29)
NL005 (1/27)
NL007 (3/59)
NL014 (3/39)
NL104 (1/12)
25
50
75
168
100
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
NL139B (0/96)
NL030I (0/50)
NL145B (0/31)
NL030C (0/18)
NL118C (0/90)
NL139C (0/23)
NL139D (0/39)
NL131C (0/7)
NL030B (0/21)
NL133A (0/88)
NL014G (0/26)
NL030A (0/12)
NL125C (0/70)
NL030J (0/5)
NL112B (0/32)
NL131E (0/7)
NL118A (0/69)
NL026C (0/29)
NL023B (0/26)
NL014B (0/27)
NL113C (0/43)
NL030G (0/28)
NL030D (0/28)
NL112X (0/37)
NL112A (0/9)
NL113A (0/106)
NL145A (0/129)
NL132A (0/103)
NL126A (0/30)
NL113E (0/10)
NL113B (0/27)
NL101B (0/27)
NL126C (0/54)
NL007B (1/99)
NL111B (1/93)
NL101A (1/84)
NL002B (1/75)
NL134B (1/75)
NL111C (1/78)
NL030F (1/73)
NL134A (1/68)
NL131B (2/136)
NL031A (1/61)
NL030E (1/60)
NL002A (2/109)
NL111D (1/56)
NL126B (2/94)
NL023A (2/97)
NL030H (1/45)
NL005A (1/46)
NL111A (1/40)
NL131A (2/78)
NL118B (1/39)
NL125A (1/39)
NL125B (1/37)
NL031B (2/75)
NL141A (5/178)
NL104A (3/103)
NL113D (1/35)
NL119A (4/134)
NL007X (3/80)
NL026B (4/102)
NL131F (1/16)
NL131X (1/9)
25
50
% MRSA
75
64
0
0
0
2.2
11.1
100
SURVEILLANCE REPORT
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
NL014C (0/8)
NL131C (1/26)
NL113E (2/38)
NL014G (6/84)
NL030J (3/40)
NL111A (8/107)
NL030D (10/113)
NL002B (21/227)
NL112A (5/53)
NL014V (1/10)
NL111D (15/148)
NL118C (23/226)
NL030A (5/48)
NL118B (17/162)
NL002A (25/234)
NL113C (11/100)
NL014B (10/88)
NL131A (22/191)
NL031B (24/209)
NL126B (24/195)
NL145A (38/297)
NL023B (12/93)
NL139C (9/68)
NL126A (7/53)
NL131X (5/38)
NL119A (38/282)
NL030H (20/147)
NL118A (25/182)
NL134B (20/146)
NL104A (25/179)
NL005A (19/135)
NL101C (1/7)
NL125A (12/84)
NL030C (9/62)
NL031A (21/145)
NL030F (22/151)
NL126C (19/129)
NL026C (4/27)
NL030B (9/61)
NL134A (18/121)
NL125C (31/202)
NL132A (48/313)
NL014A (2/13)
NL111B (43/278)
NL111C (40/256)
NL131F (8/50)
NL101A (32/197)
NL023A (30/185)
NL113A (44/263)
NL026A (1/6)
NL131B (52/308)
NL125B (14/83)
NL112B (15/89)
NL030G (16/94)
NL113D (26/150)
NL030I (23/132)
NL133A (27/152)
NL030E (31/171)
NL112X (20/108)
NL113B (22/118)
NL139D (21/113)
NL007X (24/124)
NL145B (18/91)
NL139B (48/243)
NL134X (1/5)
NL026B (40/181)
NL131E (2/9)
NL141A (64/272)
NL007B (33/134)
NL101B (12/46)
NL014X (3/10)

71
0
11.5
14.6
17
30
Hospital codes
Hospital codes

(2011-2012)
25
50
75
100
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
NL014B (0/12)
NL125A (0/7)
NL112A (0/7)
NL030A (0/8)
NL131F (0/10)
NL005A (0/13)
NL030B (0/10)
NL113B (0/9)
NL139C (0/7)
NL125B (0/17)
NL131X (0/7)
NL030G (0/11)
NL126A (0/6)
NL030D (0/10)
NL145B (0/10)
NL139B (0/30)
NL126B (0/24)
NL014G (0/11)
NL023B (0/10)
NL131C (0/6)
NL113D (0/19)
NL030F (0/14)
NL112B (0/10)
NL141A (1/49)
NL145A (1/49)
NL101A (1/34)
NL113A (1/33)
NL134B (1/31)
NL118A (1/29)
NL030E (1/29)
NL118C (1/28)
NL118B (1/20)
NL023A (2/38)
NL113C (1/16)
NL131B (4/60)
NL030I (1/14)
NL002B (2/27)
NL031A (2/27)
NL007B (2/26)
NL111B (4/50)
NL002A (5/60)
NL026B (4/46)
NL112X (3/26)
NL104A (2/17)
NL111C (4/32)
NL111A (2/16)
NL111D (3/24)
NL030C (1/8)
NL133A (4/31)
NL007X (3/23)
NL119A (7/51)
NL139D (2/14)
NL125C (5/33)
NL134A (4/26)
NL030H (3/19)
NL132A (7/44)
NL031B (5/29)
NL126C (4/22)
NL131A (6/31)
25
50
75
59
0
0
3.4
12.5
19.4
100
169
SURVEILLANCE REPORT
Norway
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
11
512
11
600
11
606
12
601
13
616
13
576
12
554
15
576
17
622
18
576
S. aureus
Labs
Isolates
11
506
11
516
11
553
12
734
13
794
13
837
12
909
15
1050
17
1223
18
1430
E. coli
Labs
Isolates
11
1179
11
1212
11
1331
12
1574
13
1713
13
1799
12
1846
15
2277
17
2620
18
3025
Enterecocci
Labs
Isolates
11
192
11
235
11
304
12
349
13
416
13
403
12
478
15
563
17
588
18
672
K. pneumoniae
Labs
Isolates
4
46
4
51
11
193
12
263
13
320
13
349
12
396
15
479
17
450
16
623
P. aeruginosa
Labs
Isolates
4
25
4
27
11
97
12
96
13
105
13
148
12
166
15
168
17
148
18
209

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
170
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
<1
8
<1
2
8
<1
2
14
<1
2
12
<1
2
10
<1
2
7
<1
2
6
<1
4
4
<1
3
4
1
6
5
<1
<1
<1
<1
<1
<1
<1
<1
<1
34
<1
2
<1
<1
32
<1
4
<1
<1
34
2
5
<1
<1
35
2
5
1
<1
38
3
7
2
<1
38
3
7
3
<1
37
3
9
2
<1
38
4
9
4
<1
39
4
9
4
<1
43
6
11
5
<1
4
38
<1
<1
27
<1
3
32
<1
3
33
<1
2
34
<1
2
29
<1
<1
36
<1
<1
34
<1
<1
22
<1
1
30
<1
43
14
<1
80
25
<1
72
44
<1
75
45
<1
81
52
<1
78
54
<1
76
38
<1
85
57
1
75
43
2
83
37
<1
<1
<1
<1
<1
2
<1
<1
<1
3
1
2
<1
<1
7
2
<1
<1
5
2
<1
1
4
2
<1
3
6
3
<1
2
7
2
<1
3
4
3
<1
2
4
3
<1
<1
<1
<1
<1
4
13
<1
4
4
5
3
3
3
<1
4
3
5
9
1
9
2
3
9
2
7
6
4
7
<1
3
4
5
5
<1
2
3
2
1
<1
4
5
3
4
<1
5
7
6
7
2
6
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
96
4
5
4
100
-
1
-
100
0
10
0
100
-
0
-
100
-
1
-
100
0
3
0
100
0
6
0
50
50
0
5
5
50
64
36
-
1
1
-
47
53
0
14
7
0
72
28
0
0
0
0
60
40
-
1
1
-
57
43
-
4
2
-
69
31
-
5
7
-
4
2
42
52
9
12
4
4
3
3
35
59
5
1
1
1
1
1
27
71
1
6
12
10
3
1
24
73
4
0
0
0
0
1
32
67
0
0
2
1
1
1
28
70
13
0
3
3
2
1
26
72
33
0
10
4
7
32
4
56
1
4
4
0
5
0
7
31
14
47
0
1
1
0
1
0
5
31
13
51
1
11
9
11
11
6
8
28
19
44
0
0
0
0
0
0
14
28
21
38
-
0
1
0
2
-
5
28
17
50
0
10
3
1
3
0
11
28
14
47
0
13
4
6
5
0
171
SURVEILLANCE REPORT
Norway
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
NO102 (0/6)
NO404 (0/47)

(2011-2012)
18
0
0
3.3
5.5
9.7
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
NO203C (0/101)
NO501E (0/19)
NO206O (0/74)
NO106T (0/23)
NO502L (0/17)
46
0
0
0
1.2
10.5
NO103E (0/130)
NO402 (0/25)
NO102B (0/26)
NO501F (0/10)
NO106Q (0/57)
NO501 (0/43)
NO204I (0/79)
NO201A (0/39)
NO304M (0/5)
NO401 (0/19)
NO404F (0/56)
NO502D (0/13)
NO203 (1/65)
NO304J (0/45)
NO106V (0/32)
NO401A (0/27)
NO105 (1/56)
NO502I (0/21)
NO106P (0/54)
NO403E (0/32)
NO106U (0/9)
Hospital codes
Laboratory codes
NO403 (2/78)
NO304 (1/33)
NO106 (4/114)
NO104J (0/232)
NO204M (0/11)
NO501A (0/63)
NO501G (0/24)
NO404G (0/25)
NO502K (0/21)
NO301 (3/70)
NO304K (0/10)
NO206Q (0/15)
NO204 (6/136)
NO401C (0/30)
NO204E (0/149)
NO402B (0/53)
NO206 (4/87)
NO403D (1/146)
NO301A (1/131)
NO105K (1/86)
NO502 (3/55)
NO206P (1/71)
NO101C (1/65)
NO103 (3/48)
NO303D (2/128)
NO101D (1/64)
NO502H (2/108)
NO104 (9/121)
NO106S (1/47)
NO101A (6/226)
NO101 (11/126)
NO203K (1/23)
NO501C (1/15)
NO501B (1/15)
NO303 (6/62)
NO402H (2/19)
25
50
75
172
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
NO501G (0/43)
NO204L (0/13)
NO501C (1/46)
NO501E (1/40)
NO106Q (4/142)

47
0
6.2
8.8
13
27.5
NO105K (0/38)
NO502I (0/7)
NO502K (0/6)
NO502I (2/67)
38
0
0
0
3.8
9.5
NO101D (0/11)
NO106P (4/126)
NO501E (0/8)
NO502L (2/34)
NO106T (0/10)
NO402H (3/50)
NO501A (7/113)
NO402H (0/20)
NO204I (10/162)
NO501B (0/6)
NO106V (8/130)
NO403D (0/47)
NO401C (4/64)
NO206Q (0/5)
NO106U (2/27)
NO106P (0/16)
NO101C (11/149)
NO403E (7/95)
NO102B (0/11)
NO304J (8/107)
NO204I (0/30)
NO404F (7/89)
NO401C (0/12)
NO501B (3/37)
NO502L (0/5)
NO106T (5/62)
NO402B (9/105)
NO403E (0/12)
NO403D (28/321)
NO401A (0/8)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
NO204E (0/59)
NO501F (2/23)
NO401A (6/68)
NO101D (9/101)
NO304M (1/11)
NO106S (6/64)
NO106S (0/5)
NO304J (0/17)
NO501G (0/5)
NO204M (0/5)
NO104J (47/497)
NO106V (0/18)
NO204E (30/311)
NO301A (1/69)
NO304K (1/10)
NO204M (5/49)
NO103E (2/87)
NO203K (6/56)
NO206O (1/41)
NO102B (6/56)
NO106Q (1/29)
NO502H (19/153)
NO203C (2/54)
NO101A (38/301)
NO206P (1/26)
NO203C (28/216)
NO103E (46/340)
NO501A (1/22)
NO105K (31/226)
NO104J (4/82)
NO301A (48/338)
NO502H (2/33)
NO303D (45/279)
NO303D (5/79)
NO502D (7/39)
NO201A (4/22)
NO101C (2/24)
NO502K (6/32)
NO203K (1/12)
NO206P (8/42)
NO101A (6/69)
NO404G (4/21)
NO501C (1/11)
NO206Q (3/14)
NO402B (2/21)
NO206O (14/51)
25
50
75
100
25
50
75
100
173
SURVEILLANCE REPORT
Poland
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
11
16
11
16
6
6
4
9
10
22
34
84
21
71
26
76
41
166
30
121
S. aureus
Labs
Isolates
24
166
30
262
30
198
24
174
24
185
15
99
30
551
35
527
45
868
41
782
E. coli
Labs
Isolates
25
124
29
192
30
176
26
206
27
256
14
84
29
625
35
771
45
1188
41
1056
Enterecocci
Labs
Isolates
16
64
23
52
21
54
21
68
20
71
11
26
28
267
32
286
44
484
35
385
K. pneumoniae
Labs
Isolates
17
53
15
42
18
32
11
19
25
151
33
246
45
391
37
369
P. aeruginosa
Labs
Isolates
14
26
16
37
23
67
8
22
27
153
29
169
35
199
36
177

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
174
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
19
19
14
<1
<1
19
17
33
33
<1
<1
11
10
29
-
12
13
50
30
30
19
24
24
39
4
18
27
5
21
27
19
19
24
20
15
12
20
13
24
29
50
10
7
4
-
45
5
9
5
<1
56
7
20
5
<1
55
11
20
4
<1
56
6
13
2
<1
54
7
20
2
<1
65
7
23
9
<1
60
9
26
8
<1
62
8
27
12
<1
63
12
29
13
<1
<1
48
<1
2
33
<1
9
48
<1
2
50
<1
4
46
2
6
29
<1
<1
39
<1
3
36
<1
1
48
<1
1
39
<1
91
55
<1
86
100
<1
95
62
5
95
85
<1
88
84
<1
78
67
<1
98
75
1
95
65
8
93
70
8
98
66
8
57
34
66
<1
36
29
38
<1
31
3
34
<1
26
32
37
<1
29
32
49
<1
31
33
40
<1
48
58
60
<1
52
60
60
<1
50
31
27
54
31
43
42
30
46
41
36
21
18
40
37
32
27
14
27
13
30
21
25
28
26
29
22
25
30
28
31
23
24
33
30
30
24
23
24
27
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
85
15
20
18
100
-
27
-
100
<1
28
11
100
-
0
-
100
-
8
-
99
1
60
75
98
2
23
43
56
43
0
19
21
0
63
37
<1
27
26
25
45
55
1
35
23
15
63
36
1
0
1
0
59
41
1
9
7
0
64
36
0
64
54
0
63
36
1
24
22
50
8
6
48
31
7
43
41
18
14
11
5
2
49
38
6
19
29
27
29
15
4
1
38
53
4
9
23
29
29
29
6
0
42
44
7
0
0
0
0
0
5
2
47
38
8
0
33
13
4
0
6
3
46
42
3
57
29
64
58
72
4
3
48
38
7
13
36
28
18
24
8
26
1
37
28
32
16
33
25
13
10
22
9
30
29
40
25
38
16
30
9
27
6
29
29
29
23
43
30
28
24
15
14
26
21
0
0
0
1
0
31
10
11
35
13
3
6
3
17
4
35
10
8
26
21
76
42
59
56
48
30
10
10
30
21
37
12
35
17
14
175
SURVEILLANCE REPORT
Poland
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
PL121 (0/6)
PL138 (0/9)

(2011-2012)
24
0
11.3
18.8
34.3
83.3
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
PL0141 (0/12)
PL0136 (0/10)
PL0149 (0/5)
PL0122 (0/9)
PL0148 (0/45)
PL117 (0/10)
46
0
6.9
12.9
29
77.8
PL0120 (0/10)
PL0118 (0/25)
PL107 (0/10)
PL0145 (0/10)
PL0140 (1/21)
PL123 (1/19)
PL0109 (4/65)
PL0108 (1/16)
PL148 (2/20)
PL0138 (5/72)
PL114 (1/8)
PL0104 (2/29)
PL0103 (2/26)
PL150 (3/23)
PL0113 (2/25)
PL0127 (3/35)
PL141 (1/7)
PL0132 (1/11)
PL0123 (5/53)
PL126 (1/7)
PL0137 (3/29)
PL0150 (6/56)
PL0107 (6/54)
Hospital codes
Laboratory codes
PL142 (1/6)
PL110 (3/16)
PL143 (3/16)
PL0117 (2/16)
PL0105 (5/39)
PL0121 (3/23)
PL0131 (2/11)
PL0101 (14/75)
PL116 (3/16)
PL0130 (10/52)
PL00 (1/5)
PL135 (1/5)
PL0134 (1/5)
PL0106 (7/29)
PL139 (2/8)
PL0112 (15/62)
PL0110 (13/52)
PL147 (2/7)
PL0116 (18/71)
PL0119 (7/25)
PL102 (2/7)
PL0133 (9/31)
PL133 (2/5)
PL0143 (21/59)
PL127 (5/12)
PL0147 (32/79)
PL0129 (2/5)
PL0139 (21/50)
PL106 (3/7)
PL0115 (23/48)
PL0142 (26/46)
PL137 (3/6)
PL0114 (56/86)
PL0126 (33/50)
PL101 (6/10)
PL0102 (28/42)
PL0135 (32/44)
PL112 (5/6)
PL0124 (14/18)
25
50
75
176
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
PL0132 (0/7)
PL0104 (1/18)
PL0139 (6/52)
PL0122 (1/8)
PL0101 (8/62)

44
0
20.5
28.7
35.6
58.3
PL0138 (0/8)
PL0127 (1/12)
PL0110 (1/5)
PL0124 (5/32)
35
0
30.8
60
70.8
90
PL0124 (2/9)
PL0117 (6/38)
PL0106 (2/8)
PL0118 (4/25)
PL0148 (2/7)
PL0109 (13/78)
PL0143 (34/174)
PL0143 (9/31)
PL0140 (5/25)
PL0149 (4/13)
PL0129 (4/19)
PL0142 (5/15)
PL0127 (19/88)
PL0102 (3/8)
PL0110 (25/113)
PL0134 (4/18)
PL0113 (4/10)
PL0136 (4/18)
PL0123 (6/14)
PL0133 (4/17)
PL0117 (3/6)
PL0123 (21/84)
PL0150 (4/8)
PL0148 (20/76)
PL0137 (4/8)
PL0116 (28/105)
PL0150 (13/48)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
PL0121 (0/6)
PL0108 (6/21)
PL0107 (23/80)
PL0103 (10/34)
PL0112 (20/67)
PL0133 (7/12)
PL0139 (3/5)
PL0119 (3/5)
PL0130 (32/53)
PL0138 (20/65)
PL0126 (18/29)
PL0135 (14/45)
PL0115 (24/37)
PL0137 (13/41)
PL0102 (13/41)
PL0120 (4/6)
PL0114 (26/76)
PL0132 (4/6)
PL0113 (13/38)
PL0101 (17/25)
PL0115 (28/80)
PL0109 (20/29)
PL0119 (7/20)
PL0147 (21/58)
PL0114 (17/24)
PL0121 (22/60)
PL0116 (35/46)
PL0105 (14/38)
PL0112 (44/57)
PL0149 (7/18)
PL0135 (14/18)
PL0141 (4/10)
PL0126 (31/73)
PL0107 (29/37)
PL0131 (15/33)
PL0103 (8/10)
PL0130 (35/73)
PL0131 (17/21)
PL0142 (25/50)
PL0104 (14/16)
PL0106 (16/30)
PL0105 (9/10)
PL0120 (7/12)
25
50
75
100
25
50
75
100
177
SURVEILLANCE REPORT
Portugal
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
12
95
14
166
13
202
15
183
12
202
14
260
17
237
12
156
17
455
16
330
S. aureus
Labs
Isolates
22
1033
23
1063
19
1153
17
1306
20
1383
20
1557
20
1824
18
1633
18
1507
18
1455
E. coli
Labs
Isolates
21
792
19
761
19
1171
18
1331
20
1432
21
1625
20
2040
19
1980
18
1963
18
2158
Enterecocci
Labs
Isolates
18
398
19
410
17
405
17
464
19
518
20
588
19
675
19
621
18
684
18
687
K. pneumoniae
Labs
Isolates
1
1
13
315
18
370
21
543
20
564
19
596
18
619
19
781
P. aeruginosa
Labs
Isolates
11
266
16
340
19
467
18
536
19
548
18
526
18
588

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
178
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
20
-
<1
27
20
<1
17
19
<1
17
21
<1
16
23
<1
18
22
18
18
22
15
15
22
8
10
15
5
8
19
45
46
47
48
48
53
49
53
55
54
53
9
26
7
-
58
13
27
8
-
58
12
29
12
-
59
12
28
10
-
59
12
30
10
<1
58
14
29
10
<1
58
11
28
9
<1
56
12
27
10
<1
57
16
27
11
<1
59
16
30
14
<1
4
34
3
5
29
6
<1
38
5
2
41
5
4
41
4
4
43
4
7
34
4
17
39
2
24
30
4
12
43
3
88
55
47
83
66
42
92
68
34
76
53
26
93
49
29
86
28
24
91
49
23
91
53
23
81
38
20
94
58
23
<1
<1
-
13
20
21
-
11
18
17
<1
19
22
26
<1
20
28
28
<1
27
31
28
1
32
36
35
<1
32
36
39
<1
15
19
21
17
21
14
16
15
16
19
17
16
18
11
23
17
13
16
12
21
18
12
16
14
20
19
15
20
15
26
20
15
20
15
26
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
98
2
9
29
100
-
54
-
100
0
29
0
100
-
3
-
100
-
22
-
99
1
37
42
99
1
20
38
59
40
0
10
9
0
63
37
-
54
54
-
45
55
-
34
25
-
59
41
-
4
3
-
61
39
-
19
27
-
61
39
-
39
34
-
62
38
<1
21
19
50
9
3
39
49
<1
17
12
10
8
33
4
2
30
64
0
21
9
43
63
0
2
1
30
67
0
8
17
25
31
0
4
1
26
69
-
0
0
4
3
-
1
2
38
60
-
0
14
24
21
-
4
2
36
55
3
31
48
39
38
11
1
2
36
60
0
8
32
24
18
0
4
18
1
78
-
10
6
0
10
-
10
24
10
56
<1
60
63
62
48
36
5
16
6
72
1
34
29
28
28
28
14
18
13
55
1
2
4
5
3
17
18
14
16
52
-
24
21
30
19
-
11
17
9
63
0
37
38
42
36
0
13
16
12
59
<1
26
12
20
21
100
179
SURVEILLANCE REPORT
Portugal
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
PT022 (0/7)
PT021 (0/9)

(2011-2012)
19
0
2
8.3
18.6
27.9
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
PT021A (1/26)
PT006A (2/28)
23
3.8
36
50
62.7
80
PT026B (1/6)
PT003 (0/84)
PT031A (6/29)
PT005 (0/5)
PT026A (11/35)
PT031 (3/148)
PT011A (67/186)
PT029A (22/53)
PT026 (1/19)
PT030A (42/99)
PT024 (3/43)
PT001A (87/186)
PT001 (6/80)
PT006 (1/12)
Hospital codes
Laboratory codes
PT003A (95/199)
PT012 (1/12)
PT019 (8/73)
PT031B (74/152)
PT032A (45/90)
PT023A (78/144)
PT012A (88/162)
PT016 (2/16)
PT027A (27/49)
PT007 (8/59)
PT031D (45/73)
PT029 (5/33)
PT019A (170/276)
PT016A (74/118)
PT011 (8/43)
PT031C (18/28)
PT027 (2/9)
PT007A (284/442)
PT032 (6/25)
PT005A (121/188)
PT030 (5/18)
PT008A (130/183)
PT008 (12/43)
PT027C (4/5)
25
50
75
180
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
PT031A (0/17)
PT031C (6/29)

24
0
24
28.9
34.6
39.4
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
PT023A (2/44)
PT021A (1/20)
PT011A (59/284)
23
4.5
22.6
32.6
46.2
80
PT026A (1/10)
PT021A (16/73)
PT031A (3/17)
PT024A (35/156)
PT011A (16/89)
PT003A (114/492)
PT016A (7/31)
PT023A (63/253)
PT006A (18/75)
PT026B (2/8)
PT003A (41/145)
PT027A (18/69)
PT029A (11/37)
PT032A (31/111)
PT031C (6/19)
Hospital codes
Hospital codes
PT007A (170/595)
PT026A (13/45)
PT012A (38/131)
PT032A (17/53)
PT030A (14/43)
PT024A (14/43)
PT016A (29/100)
PT008A (9/26)
PT019A (81/278)
PT031B (36/102)
PT031B (90/302)
PT022A (3/8)
PT005A (59/184)
PT005A (41/89)
PT001A (54/165)
PT031D (42/91)
PT008A (35/96)
PT019A (58/124)
PT006A (41/111)
PT007A (102/207)
PT022A (10/27)
PT031D (73/194)
PT001A (38/62)
PT029A (48/126)
PT012A (26/42)
PT030A (89/226)
PT027A (12/15)
25
50
75
100
25
50
75
100
181
SURVEILLANCE REPORT
Romania
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
5
26
4
9
5
18
8
29
5
27
4
14
3
17
2
13
3
36
5
50
S. aureus
Labs
Isolates
9
85
15
95
13
93
11
83
9
42
5
39
6
48
5
47
5
109
8
236
E. coli
Labs
Isolates
9
50
12
48
13
84
9
41
9
63
4
58
7
90
5
35
3
95
7
178
Enterecocci
Labs
Isolates
5
12
4
9
7
14
9
28
5
14
4
16
5
27
2
19
3
31
-
K. pneumoniae
Labs
Isolates
1
3
5
32
6
30
3
6
4
27
3
17
4
25
8
96
P. aeruginosa
Labs
Isolates
2
23
2
3
2
4
3
8
4
24
5
10
4
10
7
41

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
182
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
21
33
29
11
11
<1
22
39
31
10
28
25
22
33
19
54
69
27
24
29
33
31
31
36
61
61
44
37
37
37
46
71
60
54
26
33
34
39
50
54
70
21
14
19
<1
79
33
21
23
3
78
14
9
17
<1
85
41
41
41
3
76
35
27
27
<1
55
24
27
24
<1
60
11
18
14
<1
83
12
24
21
<1
71
18
28
21
<1
62
24
27
26
<1
<1
25
<1
29
<1
<1
<1
50
<1
<1
15
<1
25
50
<1
10
22
<1
13
42
<1
<1
<1
11
<1
86
63
<1
100
100
<1
100
70
<1
100
80
<1
100
67
<1
100
50
<1
100
71
<1
80
<1
90
<1
100
33
100
<1
91
34
94
<1
80
23
80
<1
60
20
50
<1
32
11
65
<1
71
29
71
<1
50
30
44
<1
54
52
58
14
61
52
61
65
64
33
<1
<1
33
33
25
<1
<1
25
25
25
13
13
38
25
31
30
46
38
31
63
60
70
50
56
57
56
60
60
67
48
49
51
49
51
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
54
46
42
56
100
-
53
-
99
1
27
100
99
1
55
0
94
6
52
67
58
38
4
48
47
67
67
31
1
52
52
60
40
60
-
32
25
-
64
35
1
57
52
0
61
39
-
52
55
-
9
6
33
25
27
86
60
15
60
62
6
5
51
25
13
68
28
45
68
57
2
3
48
44
4
0
17
28
28
43
9
2
38
34
17
64
100
63
49
40
14
2
51
27
6
43
100
50
50
100
5
67
28
75
40
64
10
6
5
64
15
83
60
67
44
60
5
11
2
64
17
40
24
67
26
28
3
-
23
4
7
48
18
93
40
75
40
43
25
6
8
55
6
62
0
75
46
100
183
SURVEILLANCE REPORT
Romania
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum

(2011-2012)
4
44.4
44.4
45.9
73.7
100
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
RO002I (3/23)
10
13
40
52.2
58.3
87.5
RO01A (8/18)
RO001C (3/9)
RO001D (2/5)
RO001A (33/72)
RO01E (16/36)
Hospital codes
Laboratory codes
RO001E (51/101)
RO001B (7/13)
RO (9/19)
RO002A (20/37)
RO002T (7/12)
RO002M (37/49)
RO01B (5/5)
RO001F (14/16)
25
50
75
184
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
RO002A (7/53)

5
13.2
20.8
37.8
38.1
42.9
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
RO001C (2/6)
7
33.3
40
60.6
87.5
100
RO002A (4/10)
RO00 (11/53)
Hospital codes
Hospital codes
RO001E (21/47)
RO001F (17/45)
RO00 (20/33)
RO001B (4/5)
RO001A (8/21)
RO001D (7/8)
RO001E (3/7)
RO001F (8/8)
25
50
75
100
25
50
75
100
185
SURVEILLANCE REPORT
Slovakia
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
14
27
9
17
4
8
7
26
10
22
S. aureus
Labs
Isolates
16
269
15
289
12
147
11
572
14
478
E. coli
Labs
Isolates
16
239
15
310
13
134
11
740
14
696
Enterecocci
Labs
Isolates
10
75
12
82
8
46
11
305
14
274
K. pneumoniae
Labs
Isolates
11
466
14
378
P. aeruginosa
Labs
Isolates
11
267
14
199

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
186
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
4
11
<1
24
29
33
<1
<1
40
4
8
12
5
5
27
14
16
26
22
54
6
20
<1
<1
62
11
24
7
<1
59
7
14
8
<1
68
18
42
31
<1
65
21
41
31
<1
<1
35
<1
7
37
<1
7
40
<1
2
50
<1
2
50
<1
92
60
<1
91
45
9
100
33
<1
96
79
4
95
86
5
66
71
68
<1
63
67
63
6
41
25
31
53
59
38
35
41
42
56
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
70
30
6
7
100
-
24
-
99
1
42
40
100
-
0
-
100
-
4
-
98
2
65
82
97
3
35
43
50
50
4
9
60
40
23
26
46
54
49
35
63
37
0
0
58
42
4
5
63
37
70
59
61
39
35
34
15
4
57
24
14
0
0
18
5
2
47
46
7
14
23
27
4
2
37
57
8
34
43
43
5
3
47
46
0
0
0
1
3
1
56
41
0
0
5
4
6
3
43
48
72
50
67
64
9
4
48
39
24
53
37
33
28
26
2
43
-
8
0
0
10
-
17
54
8
20
2
30
24
27
18
26
12
44
10
32
2
44
44
41
37
39
28
32
13
26
1
1
0
0
0
0
34
28
10
28
1
2
6
6
6
0
27
30
10
33
1
75
57
66
65
75
30
24
10
35
1
50
24
35
30
0
187
SURVEILLANCE REPORT
Slovakia
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum

(2011-2012)
3
0
0
9.1
14.3
14.3
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SKSK15G (0/7)
SKSK15F (0/16)
24
0
14
21.2
29.8
43.5
SKSK19A (0/8)
SKSK18A (2/26)
SK005 (0/9)
SKSK16A (8/63)
SKSK15E (3/23)
SKSK10B (3/20)
SKSK10A (4/26)
SKSK15I (6/37)
SKSK09A (18/92)
Hospital codes
Laboratory codes
SKSK15H (2/10)
SK008 (1/11)
SKSK07A (24/114)
SKSK17B (3/14)
SKSK08A (20/90)
SKSK15B (29/111)
SKSK15C (13/49)
SKSK04A (14/52)
SKSK17A (4/14)
SKSK12A (9/29)
SKSK06A (27/83)
SK009 (1/7)
SKSK15A (5/15)
SKSK11A (23/55)
SKSK05A (24/57)
SKSK10C (10/23)
25
50
75
188
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SKSK15F (2/12)
SKSK19A (4/24)

24
16.7
26.9
38.8
48.4
77.8
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SKSK08A (12/37)
SKSK15H (2/5)
SKSK10C (1/5)
22
32.4
55.6
63.6
71.8
100
SKSK12A (12/29)
SKSK10B (6/28)
SKSK15I (27/55)
SKSK15E (3/13)
SKSK15F (8/16)
SKSK18A (10/39)
SKSK15E (5/9)
SKSK10A (11/39)
SKSK15G (5/9)
SKSK05A (23/66)
SKSK19A (8/14)
SKSK08A (28/80)
SKSK15A (3/5)
SKSK11A (40/109)
SKSK07A (68/109)
Hospital codes
Hospital codes
SKSK15G (5/13)
SKSK15I (41/106)
SKSK16A (35/90)
SKSK04A (44/107)
SKSK16A (22/35)
SKSK10B (18/28)
SKSK10A (11/17)
SKSK07A (73/176)
SKSK15C (18/27)
SKSK12A (21/50)
SKSK18A (13/19)
SKSK17A (5/11)
SKSK05A (50/72)
SKSK06A (51/109)
SKSK15B (51/71)
SKSK15A (7/14)
SKSK06A (66/88)
SKSK09A (65/128)
SKSK09A (54/72)
SKSK15B (60/109)
SKSK04A (39/51)
SKSK15C (49/88)
SKSK17B (3/5)
SKSK11A (51/61)
SKSK15H (7/9)
SKSK10C (6/6)
25
50
75
100
25
50
75
100
189
SURVEILLANCE REPORT
Slovenia
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
11
172
10
166
11
208
11
167
10
195
10
209
10
253
10
232
10
252
10
251
S. aureus
Labs
Isolates
11
299
11
347
11
349
11
365
10
422
10
418
10
471
10
476
10
464
10
445
E. coli
Labs
Isolates
11
401
11
573
11
657
11
717
10
851
10
874
10
893
10
952
10
1002
10
1168
Enterecocci
Labs
Isolates
10
76
9
91
11
119
10
145
9
183
10
196
10
198
10
196
10
208
10
225
K. pneumoniae
Labs
Isolates
10
78
10
145
10
170
9
157
10
189
10
196
10
232
10
254
P. aeruginosa
Labs
Isolates
8
38
10
72
9
88
10
95
10
107
10
95
10
118
10
134

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
190
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2
15
9
2
25
11
2
11
11
5
19
13
4
17
17
3
15
16
1
15
17
<1
16
17
<1
12
24
1
10
21
13
12
10
10
12
10
41
2
11
<1
<1
40
5
12
1
<1
42
4
12
2
<1
44
7
15
2
<1
49
7
17
4
<1
49
7
17
4
<1
53
10
18
5
<1
48
9
19
7
<1
54
10
21
9
<1
50
9
21
10
<1
<1
49
<1
<1
37
<1
1
46
<1
1
40
<1
<1
50
<1
<1
40
<1
<1
43
<1
2
43
<1
<1
36
<1
<1
35
<1
83
82
<1
76
56
<1
93
47
<1
86
54
6
92
63
5
96
57
13
94
56
4
95
66
2
90
66
<1
93
63
<1
17
14
19
<1
19
21
24
<1
24
26
28
<1
23
25
26
<1
28
27
31
<1
23
25
22
<1
22
35
30
<1
20
33
28
<1
21
11
13
21
29
18
8
6
15
21
13
7
19
10
17
21
14
16
13
24
16
8
15
12
13
15
5
19
8
9
13
8
24
8
9
7
7
22
10
15
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Hospital department
ICU
Internal med.
Surgery
Other
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
96
4
11
15
100
.
9
.
100
0
21
33
100
.
0
.
100
.
0
.
98
2
29
50
97
3
22
43
56
44
11
12
61
39
9
8
42
58
24
19
65
35
0
0
58
42
0
0
58
42
30
29
65
35
22
24
21
4
37
38
14
0
9
13
2
3
39
55
5
7
9
9
3
1
26
70
3
4
21
22
5
1
27
67
0
0
0
0
1
2
42
55
0
0
0
0
2
1
35
62
0
0
34
28
3
2
35
61
38
25
31
17
13
34
1
52
6
11
17
13
12
40
11
37
14
7
11
8
8
47
6
39
24
20
19
22
19
30
15
36
0
0
0
0
34
30
11
25
0
0
0
0
19
37
12
33
38
23
44
26
27
26
15
33
30
18
27
18
191
SURVEILLANCE REPORT
Slovenia
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
SI011 (1/27)

(2011-2012)
10
3.7
6.3
12.1
15
21.6
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SI004B (0/15)
SI010A (0/24)
15
0
0
8.8
10.4
21.2
SI005 (1/23)
SI001B (0/7)
SI003B (0/24)
SI010 (2/32)
SI004A (3/91)
SI004 (7/101)
SI011A (1/26)
Hospital codes
Laboratory codes
SI003A (5/123)
SI002 (2/17)
SI001 (20/161)
SI002A (3/34)
SI004C (1/11)
SI008A (6/64)
SI003 (10/72)
SI001C (3/30)
SI009 (3/20)
SI009A (5/48)
SI005A (5/44)
SI007 (2/13)
SI001A (40/335)
SI008 (8/37)
SI007A (7/33)
25
50
75
192
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SI010A (5/56)
15
8.9
16
20.4
24.7
29.1
SI003B (1/10)
SI004B (6/40)
SI008A (3/27)
SI004C (4/25)
SI011A (1/9)
SI003B (8/47)
SI010A (1/7)
SI002A (21/119)
SI004A (7/48)
SI004A (45/245)
SI004B (1/6)
SI001B (10/49)
SI001A (33/144)
SI001A (138/620)
SI001B (5/20)
SI008A (26/115)
SI007A (5/15)
SI009A (45/182)
SI001C (6/17)
SI001C (14/50)
SI005A (7/14)
SI005A (25/88)
SI004C (3/6)
SI007A (25/86)
SI003A (65/125)
25
50
75
100
15
7.4
11.1
18.2
35.3
52
SI002A (2/11)
SI003A (71/325)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SI009A (2/27)
Hospital codes
Hospital codes
SI011A (14/123)

25
50
75
100
193
SURVEILLANCE REPORT
Spain
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
35
656
36
684
34
740
35
625
35
862
31
695
32
708
41
862
40
763
40
619
S. aureus
Labs
Isolates
36
1391
36
1527
34
1337
35
1483
35
1645
32
1505
33
1715
41
1986
40
1965
41
1904
E. coli
Labs
Isolates
29
2650
36
3471
34
2997
35
3364
35
3678
32
3626
33
3821
41
5696
40
5605
40
5675
Enterecocci
Labs
Isolates
36
608
36
710
35
623
34
755
35
885
32
1002
33
1093
41
1467
39
1478
41
1508
K. pneumoniae
Labs
Isolates
14
56
33
564
33
618
30
639
32
628
41
1161
40
1145
40
1153
P. aeruginosa
Labs
Isolates
13
70
32
405
35
448
32
548
33
544
41
749
40
839
40
853

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
194
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
7
32
27
9
29
27
9
25
23
8
27
22
8
22
18
7
23
22
8
22
19
10
30
27
10
30
25
10
27
26
24
26
27
25
25
27
26
25
22
24
58
7
21
4
<1
60
7
25
7
<1
62
10
28
8
<1
64
9
28
7
<1
62
10
30
7
<1
63
11
33
9
<1
65
13
31
11
<1
65
14
33
12
<1
66
15
34
12
<1
65
16
34
14
<1
1
36
<1
2
36
<1
<1
36
<1
2
36
<1
1
42
<1
3
41
<1
3
43
<1
1
41
<1
<1
39
<1
2
38
<1
64
11
3
66
17
2
67
16
3
73
21
3
79
40
2
79
35
1
83
38
3
83
27
1
82
23
1
87
26
1
4
11
7
<1
7
8
9
<1
9
17
10
<1
9
15
12
<1
9
16
11
<1
9
14
10
<1
10
17
13
<1
14
17
17
<1
4
6
17
4
14
9
7
12
11
19
8
10
15
15
25
8
11
13
18
23
8
8
16
20
25
6
7
18
18
25
6
9
16
19
24
7
9
16
17
21
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
91
9
28
38
100
.
23
.
100
<1
34
3
100
.
0
.
100
.
1
.
99
1
15
17
98
2
16
13
62
38
.
28
30
.
66
34
0
24
22
0
52
48
<1
39
29
13
65
35
.
0
0
.
61
39
0
1
2
0
62
38
0
17
11
0
66
34
0
16
17
0
10
3
38
47
2
37
15
24
31
19
5
3
34
57
1
11
6
17
29
25
4
1
28
68
<1
12
30
30
37
28
12
1
29
58
<1
0
0
0
0
14
3
1
33
62
0
0
0
2
1
0
7
1
35
57
0
13
5
17
14
22
4
1
39
56
0
8
15
23
13
0
14
29
1
49
7
30
27
20
29
28
9
39
9
33
9
20
26
33
18
21
7
32
7
45
9
35
37
34
31
38
15
29
11
34
11
0
0
0
0
0
16
33
13
27
10
2
2
1
1
0
13
29
12
35
11
20
13
18
11
23
22
28
10
32
8
27
12
14
13
16
195
SURVEILLANCE REPORT
Spain
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
ES062 (3/68)
ES021 (6/50)
ES016 (4/33)
41
4.4
23.8
30.8
41.2
66.7
ES005 (5/37)
ES0051 (4/29)
ES064 (15/92)
ES0043 (10/71)
ES043 (2/12)
ES0020 (2/14)
ES005 (6/34)
ES003 (6/40)
ES047 (2/10)
ES0032 (6/40)
ES065 (4/17)
ES0044 (12/74)
ES041 (5/21)
ES0038 (22/135)
ES054 (26/105)
ES0064 (20/114)
ES011 (15/58)
ES0053 (39/208)
ES004 (6/23)
ES0048 (16/83)
ES058 (15/57)
ES0047 (6/31)
ES029 (3/11)
ES0062 (33/166)
ES019 (8/28)
ES0018 (14/67)
ES038 (16/55)
ES0021 (29/133)
ES044 (8/27)
ES0041 (25/113)
ES031 (12/39)
ES015 (2/6)
ES046 (11/33)
ES026 (6/18)
41
10.5
16.3
23.3
27.8
42.3
ES0049 (16/71)
ES0056 (27/116)
ES0019 (42/171)
ES0054 (46/185)
ES0046 (15/60)
ES048 (15/44)
ES002 (21/84)
ES057 (6/17)
ES0059 (10/40)
ES042 (26/68)
ES0031 (28/112)
ES053 (23/60)
ES0058 (24/95)
ES049 (4/10)
ES0057 (9/33)
ES032 (6/15)
ES0011 (25/91)
ES018 (7/17)
ES004 (49/176)
ES063 (14/34)
ES0060 (32/113)
ES060 (10/24)
ES0010 (16/56)
ES003 (8/19)
ES0026 (51/172)
ES020 (6/14)
ES0015 (3/10)
ES061 (30/69)
ES0016 (22/72)
ES002 (14/31)
ES0017 (19/60)
ES051 (6/12)
ES0013 (33/103)
ES056 (8/15)
ES0065 (55/156)
ES012 (7/12)
ES0012 (37/99)
ES013 (4/6)
ES0029 (22/52)
25
50
75
196
ES0042 (11/97)
ES0061 (24/188)
ES059 (4/29)
ES017 (3/10)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
ES0063 (8/76)
Hospital codes
Laboratory codes
ES010 (3/23)

(2011-2012)
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
ES0011 (83/361)
ES0026 (52/210)
ES0010 (70/264)
ES0064 (133/470)

40
0
30.1
34.8
38.2
45.8
ES0057 (0/13)
ES0011 (1/48)
ES0013 (1/44)
ES0032 (48/168)
40
0
5.3
9.9
18
50
ES0049 (1/36)
ES0062 (124/420)
ES005 (1/36)
ES0015 (8/27)
ES0018 (1/35)
ES0018 (88/295)
ES0048 (2/56)
ES0021 (123/409)
ES0064 (3/65)
ES0016 (44/145)
ES0012 (2/38)
ES0054 (70/224)
ES0058 (4/74)
ES0041 (80/251)
ES0010 (2/37)
ES0048 (95/297)
ES0017 (1/15)
ES0053 (154/471)
ES0016 (2/28)
ES0019 (225/681)
ES0059 (3/40)
ES0012 (96/290)
ES0021 (3/38)
ES0061 (186/556)
ES0063 (8/90)
ES0043 (82/242)
ES0047 (2/22)
ES0065 (88/256)
ES0032 (2/22)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
ES0051 (0/36)
ES0046 (52/150)
ES0038 (124/356)
ES0058 (100/283)
ES0053 (8/81)
ES0015 (1/10)
ES0065 (5/43)
ES0013 (47/131)
ES0041 (6/49)
ES0042 (184/509)
ES0054 (14/101)
ES002 (106/292)
ES0026 (9/64)
ES005 (86/235)
ES0062 (19/134)
ES0057 (52/139)
ES0046 (6/41)
ES0044 (112/295)
ES0043 (8/54)
ES0060 (99/260)
ES0061 (40/249)
ES0049 (34/89)
ES0042 (16/89)
ES0047 (29/76)
ES0044 (14/76)
ES004 (128/334)
ES0019 (10/52)
ES0059 (91/230)
ES0060 (14/61)
ES003 (71/176)
ES0029 (3/13)
ES0031 (110/273)
ES002 (9/39)
ES0063 (81/197)
ES004 (14/56)
ES0017 (60/142)
ES0038 (26/89)
ES0051 (51/118)
ES0056 (34/102)
ES0056 (167/374)
ES0031 (26/69)
ES0029 (55/120)
ES003 (25/50)
25
50
75
100
25
50
75
100
197
SURVEILLANCE REPORT
Sweden
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
21
919
21
955
21
1025
21
996
21
1032
21
1219
19
1063
19
1008
18
1015
18
1030
S. aureus
Labs
Isolates
21
1855
21
1906
21
1774
21
1968
21
2163
21
2410
19
2460
19
2867
18
3113
18
3262
E. coli
Labs
Isolates
21
3350
21
3372
21
3241
20
3539
20
3749
20
4032
18
4247
18
4846
17
5253
17
5541
Enterecocci
Labs
Isolates
21
850
21
856
21
821
21
884
21
932
21
1059
19
967
18
1038
18
1239
18
1211
K. pneumoniae
Labs
Isolates
18
282
20
621
20
649
20
826
18
706
18
878
17
966
17
976
P. aeruginosa
Labs
Isolates
17
149
18
300
20
343
20
315
18
338
18
377
17
412
17
357

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
198
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
<1
5
5
<1
3
5
<1
4
6
<1
2
5
<1
3
5
<1
2
6
2
3
4
2
4
4
3
3
5
5
5
5
<1
<1
<1
<1
<1
<1
<1
<1
29
1
7
<1
-
23
1
8
<1
-
26
1
6
1
<1
28
2
8
2
<1
33
2
10
2
<1
32
2
10
2
<1
33
3
8
3
<1
35
4
11
3
<1
35
5
8
4
<1
5
11
4
<1
<1
17
<1
<1
16
<1
<1
19
<1
<1
20
<1
<1
16
<1
<1
20
<1
<1
19
<1
2
15
<1
1
19
<1
15
<1
77
11
2
78
7
1
74
4
<1
76
12
<1
79
14
<1
82
25
2
76
24
<1
82
22
<1
89
22
<1
20
<1
1
5
1
<1
<1
5
1
<1
1
6
1
<1
1
7
2
<1
<1
2
2
<1
2
5
2
<1
2
4
2
<1
2
4
3
<1
9
5
18
<1
6
<1
6
5
<1
5
2
4
7
<1
6
1
5
4
<1
5
2
7
8
<1
7
1
6
7
3
6
4
5
8
1
6
6
6
5
2
7
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
98
2
4
6
100
.
1
.
100
0
10
0
100
.
0
.
100
.
0
.
100
.
3
.
100
.
7
.
51
49
5
4
62
38
1
1
48
52
13
7
72
28
0
0
62
38
0
0
59
41
3
2
64
36
7
6
2
2
39
55
2
10
3
4
4
5
3
3
29
63
2
0
2
1
1
0
1
1
24
72
2
3
10
13
9
10
3
1
23
71
2
0
0
0
0
0
1
2
31
65
2
0
0
0
0
0
1
1
23
73
2
0
21
4
2
0
2
3
26
68
2
8
15
9
5
14
6
47
5
39
4
4
3
2
5
6
4
40
15
35
5
0
1
0
1
0
3
37
19
36
5
9
9
11
11
7
5
33
24
33
5
0
0
0
0
0
11
27
28
31
3
0
0
0
0
0
4
33
24
34
5
4
2
1
3
2
5
39
16
37
3
24
4
4
8
12
199
SURVEILLANCE REPORT
Sweden
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
SE240 (0/73)
SE230 (0/57)

(2011-2012)
18
0
1.7
3.6
4.3
8.4
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SE730D (0/15)
SE620B (0/19)
SE250B (0/87)
SE220A (0/137)
SE110B (0/33)
SE730C (0/35)
56
0
0
0
0.9
4
SE240C (0/15)
SE730E (0/44)
SE450 (0/87)
SE220D (0/6)
SE620A (0/194)
SE350C (0/95)
SE600 (1/80)
SE200D (0/9)
SE730B (0/36)
SE400C (0/33)
SE440 (2/115)
SE240B (0/32)
SE730F (0/116)
SE610B (0/50)
SE250 (2/96)
SE120B (0/44)
SE620C (0/54)
SE440B (0/36)
SE620 (2/93)
SE450B (0/39)
SE110A (0/106)
SE400B (0/122)
SE110 (2/55)
SE200C (0/47)
Hospital codes
Laboratory codes
SE610A (0/221)
SE540 (1/28)
SE430 (2/56)
SE320B (0/49)
SE310A (0/57)
SE600C (0/22)
SE220B (0/74)
SE230A (0/139)
SE350B (0/57)
SE610C (0/122)
SE220C (0/30)
SE350 (3/78)
SE450D (0/40)
SE200A (1/251)
SE120A (1/273)
SE320 (3/79)
SE600A (1/284)
SE100B (1/200)
SE430A (1/222)
SE610 (3/74)
SE200B (1/174)
SE250A (1/158)
SE310B (2/272)
SE120 (17/391)
SE100E (3/326)
SE440A (2/177)
SE320A (2/177)
SE310 (5/93)
SE450A (2/189)
SE100D (4/297)
SE400A (2/158)
SE100 (27/385)
SE240A (2/151)
SE540A (1/68)
SE100C (1/49)
SE730 (6/84)
SE440C (1/42)
SE350A (3/117)
SE100A (10/348)
SE400 (10/119)
SE100F (3/78)
SE430D (2/52)
25
50
75
200
100
25
50
% MRSA
75
100
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SE200D (0/23)
SE440B (1/46)
SE610B (2/64)
SE730C (2/62)
SE610A (9/240)
SE100C (3/76)

54
0
6.2
8.1
11.2
17.9
SE320B (0/16)
SE100C (0/17)
SE220A (0/32)
SE730B (2/48)
SE730E (0/15)
SE440C (3/70)
SE430D (0/16)
SE350C (8/159)
SE450D (0/24)
SE250B (9/175)
SE250B (0/35)
SE310B (26/456)
47
0
0
1.9
3.7
12.5
SE120B (0/10)
SE240B (8/45)
SE730F (0/41)
SE610C (9/149)
SE610C (0/32)
SE200C (5/81)
SE220C (4/63)
SE730C (0/12)
SE240A (37/252)
SE450B (0/20)
SE540A (8/123)
SE440C (0/17)
SE320A (21/324)
SE310B (0/66)
SE400B (16/231)
SE440A (0/65)
SE450A (23/331)
SE230A (0/32)
SE730E (6/86)
SE620B (3/40)
SE350A (0/37)
SE620A (19/252)
SE620A (0/53)
SE450D (6/80)
SE610A (0/57)
SE200B (27/350)
SE220B (0/12)
Hospital codes
Hospital codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
SE240B (0/8)
SE100F (0/10)
SE450B (7/91)
SE310A (4/50)
SE620C (8/98)
SE220D (1/12)
SE730D (3/36)
SE430A (1/55)
SE400B (1/53)
SE200B (1/49)
SE100E (1/51)
SE440A (27/316)
SE200A (2/102)
SE730F (16/177)
SE240A (1/43)
SE350A (19/206)
SE250A (1/42)
SE110A (20/211)
SE100B (1/39)
SE220B (9/95)
SE110A (1/35)
SE320B (8/82)
SE100A (2/66)
SE430D (10/102)
SE250A (26/243)
SE450A (3/85)
SE430A (35/309)
SE320A (2/54)
SE220A (29/247)
SE350C (1/25)
SE230A (31/263)
SE100D (3/71)
SE100E (42/348)
SE540A (1/24)
SE350B (15/122)
SE240C (1/22)
SE120A (39/316)
SE400C (14/109)
SE620C (1/18)
SE100B (35/273)
SE120A (4/57)
SE400A (37/286)
SE350B (1/14)
SE200A (61/445)
SE110B (1/13)
SE240C (10/69)
SE400A (8/89)
SE120B (8/53)
SE310A (1/10)
SE100F (8/50)
SE220C (1/10)
SE100A (52/322)
SE100D (48/274)
SE200C (1/10)
SE110B (14/78)
SE400C (2/16)
25
50
75
100
25
50
75
100
201
SURVEILLANCE REPORT
United Kingdom
Year
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
S. pneumoniae
Labs
Isolates
50
1334
54
1059
53
1375
51
1514
50
1785
51
1223
59
1396
50
1459
53
1513
54
2501
S. aureus
Labs
Isolates
51
3548
54
3562
58
3971
55
4132
55
4865
55
3355
69
2977
55
2730
53
3430
55
3285
E. coli
Labs
Isolates
19
2253
20
2091
23
2359
26
2438
20
2374
15
2456
28
4712
29
5389
29
5971
29
6527
Enterecocci
Labs
Isolates
27
591
22
547
18
435
14
274
26
712
28
651
28
723
27
887
K. pneumoniae
Labs
Isolates
23
420
22
404
18
382
15
350
27
725
28
840
28
1007
28
1075
P. aeruginosa
Labs
Isolates
25
438
24
353
19
370
14
345
26
639
28
588
28
599
28
681

Penicillin R
Penicillin RI
Macrolides RI
Escherichia coli
Aminopenicilins R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminopenicilins RI
HL Gentamicin R
Vancomycin R
Aminoglycosides R
Fluoroquinolones R
Carbapenems R
Piperacillin R
Ceftazidime R
Carbapenems R
Aminoglycosides R
Fluoroquinolones R
202
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1
5
13
<1
3
13
2
4
11
<1
3
12
2
4
10
1
5
6
1
3
4
<1
3
5
<1
5
6
<1
5
7
44
44
44
42
36
31
28
22
14
13
55
4
11
3
-
53
6
14
3
-
56
8
17
6
-
57
7
20
8
<1
55
7
18
9
<1
61
7
15
7
<1
62
7
18
9
<1
62
8
17
9
<1
63
8
18
10
<1
63
9
17
13
<1
2
47
2
3
52
1
4
31
2
2
42
4
2
38
2
6
39
1
4
16
2
4
29
1
84
53
33
78
18
18
82
35
21
83
7
28
91
38
13
84
31
10
90
56
9
93
54
13
6
12
12
<1
8
13
11
<1
9
12
13
<1
6
7
7
1
5
6
7
<1
5
7
10
<1
4
5
5
<1
6
7
12
<1
2
3
9
4
8
1
3
6
4
8
5
7
10
5
9
2
4
6
3
8
3
5
8
1
7
4
5
6
2
7
4
5
6
3
6
3
4
6
2
5
SURVEILLANCE REPORT
Characteristic
S. pneumoniae
% total
% PNSP
Isolate source
Blood
CSF
Gender
Male
Female
Unknown
Age (years)
04
519
2064
65 and over
Unknown
Hospital department
ICU
Internal med.
Surgery
Other
Unknown
S. aureus
% total
% MRSA
E. coli
% total
% FREC
E. faecalis
% total
% VRE
E. faecium
% total
% VRE
K. pneumoniae
% total % 3GCRKP
P. aeruginosa
% total
% CRPA
99
1
5
13
100
-
13
-
100
<1
17
9
100
-
2
-
100
-
11
-
100
0
9
0
100
0
6
0
50
50
1
5
6
0
61
39
0
14
12
25
47
52
<1
19
15
7
67
32
1
1
3
33
61
39
0
10
13
0
60
39
1
10
6
9
62
38
<1
6
5
67
5
4
43
49
0
6
2
4
6
0
5
3
41
47
4
6
4
10
19
0
2
1
26
71
-
8
12
15
18
-
11
2
27
61
-
5
17
0
2
-
3
2
40
55
-
5
25
15
9
-
3
1
30
65
-
11
19
9
8
-
3
1
29
67
-
12
38
10
3
-
2
8
1
16
74
7
6
13
5
5
1
4
1
8
86
16
28
22
19
12
100
17
100
100
11
100
100
203
SURVEILLANCE REPORT
United Kingdom
(2011-2012)
N laboratories
Minimum
First quartile
Median
Third quartile
Maximum
UK100 (0/24)
UK027 (0/20)
UK057 (0/24)
UK042 (0/45)
UK023 (0/38)

(2011-2012)
52
0
1.1
4.5
8.3
27.6
UK017X (0/74)
UK020X (0/26)
UK027X (0/33)
UK032X (0/75)
UK044C (0/9)
UK078B (0/5)
73
0
6.3
12.5
20.8
100
UK090X (0/41)
UK102 (0/7)
UK015X (1/169)
UK055 (0/10)
UK001X (1/30)
UK011 (0/19)
UK102X (4/82)
UK097 (0/43)
UK026X (13/235)
UK046 (0/23)
UK049X (3/50)
UK092X (7/122)
UK044D (1/16)
UK004 (0/60)
UK096X (6/96)
UK092 (1/96)
UK055X (3/46)
UK101 (1/100)
UK097X (6/91)
UK072X (1/15)
UK091 (1/91)
UK066X (4/59)
UK093 (1/69)
UK098X (9/129)
UK051 (1/70)
UK004X (10/125)
UK007 (2/103)
UK101X (21/254)
UK094 (1/47)
UK033X (7/80)
UK076D (1/12)
UK056X (7/72)
UK069 (1/46)
UK045X (30/307)
UK096 (1/42)
UK078C (2/20)
UK079A (1/10)
UK020 (1/39)
UK099X (22/216)
UK017 (2/52)
UK093X (18/162)
UK026 (2/49)
UK050X (13/114)
UK091X (21/182)
UK015 (6/143)
Hospital codes
Laboratory codes
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
UK008X (0/32)
UK047 (4/92)
UK049 (1/22)
UK008 (2/44)
UK095 (1/21)
UK076 (2/36)
UK064X (23/197)
UK100X (7/58)
UK00 (664/5388)
UK057X (7/56)
UK054X (13/103)
UK012X (10/76)
UK068X (70/524)
UK003X (3/22)
UK090 (2/35)
UK059X (30/215)
UK099 (7/123)
UK048X (10/68)
UK047X (55/369)
UK064 (4/67)
UK063X (12/80)
UK033 (1/15)
UK095X (6/40)
UK075A (8/53)
UK045 (5/75)
UK053X (11/71)
UK066 (2/29)
UK051X (34/216)
UK052X (8/47)
UK050 (4/58)
UK084A (17/95)
UK043 (3/43)
UK046X (9/50)
UK001 (1/13)
UK069X (30/158)
UK044B (3/15)
UK012 (5/60)
UK081C (1/5)
UK052 (2/24)
UK044A (18/81)
UK076A (10/45)
UK059 (4/46)
UK083A (23/100)
UK053 (3/32)
UK080A (12/39)
UK078 (5/52)
UK078A (42/129)
UK007X (2/6)
UK068 (11/103)
UK081A (5/14)
UK098 (6/50)
UK077A (13/32)
UK011A (4/5)
UK075 (2/14)
UK043X (16/17)
UK054 (4/28)
UK007A (25/26)
UK007B (8/8)
UK084 (4/28)
UK008A (6/6)
UK032 (4/23)
UK015A (10/10)
UK056 (3/14)
UK015B (7/7)
UK017B (20/20)
UK048 (7/30)
UK090A (6/6)
UK063 (8/29)
UK094X (25/25)
25
50
75
100
25
50
75
100
% MRSA
100% meticillin resistance rates for isolates of S. aureus reflect reporting of
MRSA only.
204
SURVEILLANCE REPORT

(2011-2012)
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
UK004X (38/409)
UK098X (54/517)
UK093X (44/406)

30
9.3
12.8
15.7
22.1
51.1
N hospitals
Minimum
First quartile
Median
Third quartile
Maximum
UK008X (0/17)
UK020X (0/20)
UK017X (1/87)
UK001X (15/139)
27
0
3.9
7.1
9.8
36.4
UK033X (1/50)
UK090X (32/284)
UK027X (1/31)
UK017X (56/448)
UK003X (1/30)
UK023X (81/634)
UK093X (3/77)
UK032X (91/713)
UK008X (15/107)
UK023X (4/85)
UK097X (47/334)
UK004X (4/81)
UK091X (85/588)
UK092X (2/38)
UK020X (27/182)
UK101X (9/158)
UK095X (29/192)
UK097X (2/34)
Hospital codes
Hospital codes
UK026X (91/599)
UK092X (59/384)
UK033X (52/323)
UK003X (34/198)
UK098X (5/77)
UK091X (10/140)
UK012X (4/56)
UK015X (15/181)
UK102X (39/224)
UK015X (200/1142)
UK099X (10/118)
UK012X (77/440)
UK102X (4/46)
UK007X (26/130)
UK096X (5/53)
UK099X (182/855)
UK042X (5/52)
UK096X (71/321)
UK032X (12/122)
UK101X (186/824)
UK100X (4/37)
UK100X (49/213)
UK011X (10/84)
UK027X (39/167)
UK007X (1/6)
UK011X (110/467)
UK026X (35/156)
UK042X (62/253)
UK094X (72/220)
UK001X (2/6)
UK043X (47/92)
UK094X (8/22)
25
50
75
100
25
50
75
100
205
HOW TO OBTAIN EU PUBLICATIONS

Free publications:
one copy:
via EU Bookshop (http://bookshop.europa.eu);
more than one copy or posters/maps:
from the European Unions representations (http://ec.europa.eu/represent_
en.htm);
from the delegations in non-EU countries (http://eeas.europa.eu/
delegations/index_en.htm);
by contacting the Europe Direct service (http://europa.eu/europedirect/
index_en.htm) or
calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU)*.
* The information given is free, as are most calls (though some operators, phone boxes or hotels may charge you).
Priced publications:
via EU Bookshop (http://bookshop.europa.eu).
Priced subscriptions:
via one of the sales agents of the Publications Office of the European Union
(http://publications.europa.eu/others/agents/index_en.htm).
TQ-AM-13-001-EN-C
European Centre for Disease

Prevention and Control (ECDC)
Postal address:
ECDC, SE-171 83 Stockholm, SWEDEN
Visiting address:
Tomtebodavgen 11a, Solna, SWEDEN
Tel. +46 858601000
Fax +46 858601001
http://www.ecdc.europa.eu
An agency of the European Union
http://www.europa.eu
ISBN: 978-92-9193-511-6

Antimicrobial Resistance Surveillance Europe 2012

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Antimicrobial Resistance Surveillance Europe 2012

Uploaded by

Copyright:

Available Formats

SURVEILLANCE REPORT

Antimicrobial resistance surveillance in Europe 2012

Suggested citation for full report:

Antimicrobial resistance surveillance in Europe 2012

Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National institutions/organisations participating in EARS-Net. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Antimicrobial resistance in Europe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Annex 1 External quality assessment 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Antimicrobial resistance surveillance in Europe 2012

Antimicrobial resistance surveillance in Europe 2012

Antimicrobial resistance surveillance in Europe 2012

Abbreviations and acronyms

Third generation cephalosporin-resistant

Antimicrobial susceptibility testing

British Society for Antimicrobial

Clinical and Laboratory Standards Institute

Deutsche Industrie Norm (German)

European Antimicrobial Resistance

European Antimicrobial Resistance

European Centre for Disease Prevention

European Economic Area

External quality assessment

Intensive care unit

Klebsiella pneumoniae carbapenemase

Minimum inhibitory concentration

Macrolide, lincosamide and streptogramin

Meticillin-resistant Staphylococcus aureus

New Delhi metallo-beta-lactamase

Norwegian Working Group on

Pneumococcal conjugate vaccine

Comit de lAntibiogramme de la Socit

Susceptible, intermediate, resistant

Swedish Reference Group for Antibiotics

The European Surveillance System (at

Temoneira extended-spectrum betalactamase gene

United Kingdom National External Quality

Antimicrobial resistance surveillance in Europe 2012

Federal Ministry of Health

Robert Koch Institute

Medical University Vienna

Elisabethinen Hospital, Linz

Hellenic Pasteur Institute

National School of Public Health

Scientific Institute of Public Health

National and Kapodistrian University of Athens, Medical

Alexander University Hospital, Sofia

National Centre for Epidemiology

National Reference Laboratory for Antibiotics

Paul Stradins Clinical University Hospital

Statens Serum Institut, Danish Study Group for

State Agency Infectology Centre of Latvia

Tartu University Hospital

Microbiology Laboratory, Luxembourgs Hospital Centre

National Institute for Health and Welfare, Finnish

Finnish Study Group for Antimicrobial Resistance (FiRe)

National Health Laboratory

University Hospital of North Norway

French National Observatory for the Epidemiology of

Norwegian Institute of Public Health

National Reference Centre for Pneumococci (CNRP)

Antimicrobial resistance surveillance in Europe 2012

National Medicines Institute

National Institute of Public Health

Department of Epidemiology and Clinical Microbiology