Australian Group on Antimicrobial Resistance (AGAR) Australian Enterococcal Sepsis Outcome Programme (AESOP) Annual Report 2019

Abstract

From 1 January to 31 December 2019, thirty-nine institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2019 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the E. faecium isolates. Of the 1,361 unique episodes of bacteraemia investigated, 95.2% were caused by either E. faecalis (51.4%) or E. faecium (43.8%). Ampicillin resistance was not detected in E. faecalis but was detected in 91.1% of E. faecium. Vancomycin non-susceptibility was detected in 0.1% of E. faecalis and in 41.8% of E. faecium. Overall, 45.4% of E. faecium harboured vanA and/or vanB genes. For the vanA/vanB positive E. faecium isolates, 49.1% harboured vanA genes only and 50.6% vanB genes; 0.3% harboured both vanA and vanB genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is substantially higher than that seen in most European countries. E. faecium consisted of 78 multilocus sequence types (STs), of which 75.0% of isolates were classified into six major STs containing ten or more isolates. All major STs belong to clonal cluster (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. The predominant STs (ST1424, ST17, ST796, ST80, ST1421, and ST78) were found across most regions of Australia. The most prevalent clone was ST1424, which was identified in all regions except the Northern Territory and Western Australia. Overall, 51.4% of isolates belonging to the six predominant STs harboured vanA or vanB genes. In 2019, AESOP has shown that enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin-resistant vanA or vanB E. faecium which have limited treatment options.

Temporal and Geographic Variation in Antimicrobial Susceptibility and Resistance Patterns of Enterococci: Results From the SENTRY Antimicrobial Surveillance Program, 1997–2016

“…The SENTRY Antimicrobial Surveillance Program was designed to track antimicrobial resistance trends and the spectrum of microbial pathogens causing human infection on a global scale. The SENTRY Program has unique features that distinguish it from other excellent surveillance projects, such as the SCOPE Program [ 46 , 47 ], the NHSN [ 2 , 48 ], the European Antimicrobial Resistance Surveillance Network (EARS-Net) [ 49 ], and population-based surveillance programs conducted in the United States [ 5 , 29 ], Australia [ 14 ], Canada [ 13 , 16 , 17 ], China [ 18 ], India [ 15 ], South Korea [ 59 ], Norway [ 60 ], and Taiwan [ 19 ]. Whereas these cited programs are usually based in a single country, may track only nosocomial infections, and/or rely primarily on a wide variety of susceptibility testing results/methods from participating centers, the SENTRY Program monitors nosocomial and community-onset infections on a global scale using validated reference identification and antimicrobial susceptibility testing methods in a central monitoring laboratory design, including central quality assurance [ 10 , 24 , 33 , 35–42 ].…”

The Role of Whole Genome Sequencing in the Surveillance of Antimicrobial Resistant Enterococcus spp.: A Scoping Review

“…Seventy-two articles were included after the full-text review ( Figure 1 ). Of these, 70 were primary research articles and two were gray literature (government reports) ( 25 , 36 ). All articles were published in 2015 or later.…”

Budget impact analysis of routinely using whole-genomic sequencing of six multidrug-resistant bacterial pathogens in Queensland, Australia

“…For each pathogen, the multidrug resistance rates were based on Wozniak et al , 11 according to site of infection—bloodstream, urinary tract and respiratory tract 11 —and the Australian Group on Antimicrobial Resistance Sepsis Outcomes Programs: 2018 Report. 12 …”

“…For this analysis, annual changes to drug resistance were integrated in the analyses and were 0.3 percentage points for MRSA, 0.009 for ESBL E. coli , −2.8 for VRE (decreasing resistance) and 1.0 for ESBL K. pneumoniae . 12 13 No change in resistance rates was used for CPE and CRAB. 12 …”

“…Data on the frequency of deaths in hospital from patients infected with any of the six MROs were obtained from the Australian Group on Antimicrobial Resistance Sepsis Outcomes Programs: 2018 Report 12 and ranged from 6.7% for CPE to 36.6% for VRE E. faecium . Sensitivity analyses were performed on the 95% confidence limits of these mortality rates.…”