Surveillance of antimicrobial resistance in Bulgaria - a synopsis from BulSTAR 2003

Abstract

We introduce Bulgarian Surveillance Tracking Antimicrobial Resistance (BulSTAR) and make the first report on surveillance data for 2003. This longitudinal surveillance programme monitors the isolation and antimicrobial susceptibility of all clinically significant microorganisms isolated from blood cultures, cerebrospinal fluid, upper and lower respiratory tract, urine and wound samples in the participating microbiology laboratories. Twenty eight public, 45 hospital and 6 private laboratories from all 28 counties of the Republic of Bulgaria participated in BulSTAR 2003. The total number of isolates from monitored sources during the surveillance period was 98 929. Seven microorganisms represented 72% of all isolated bacteria in BulSTAR 2003: Escherichia coli, Staphylococcus aureus, Proteus-Providencia-Morganella group, Klebsiella spp., Pseudomonas spp, Streptococcus pneumoniae and Streptococcus pyogenes. Generally the resistance of clinically significant Gram positive and Gram negative bacteria in Bulgaria was estimated to be at a medium level when compared with many other surveillance sources worldwide. A unique 32-year experiment on the population by treating all severe infections with an ampicillin/gentamicin combination resulted in twofold higher levels of resistance to amynoglycosides compared with other countries worldwide. This is due to the extremely conservative treatment schemes used in the former socialist countries, based on national directives and cheap domestic production of gentamicin and ampicillin. The forthcoming introduction of a computer network and improvements in detecting mistakes are expected to increase the sensitivity and the significance of BulSTAR surveillance system - an indispensable tool in the combat against increasing worldwide antibiotic resistance.

Problematic clinical isolates of Pseudomonas aeruginosa from the university hospitals in Sofia, Bulgaria: current status of antimicrobial resistance and prevailing resistance mechanisms

“…In all the university hospitals monitored in Sofia, widespread dissemination of bla VEB-1 in clinical isolates of P. aeruginosa was found. Recently, Bachvarova et al (2005) reported a significantly lower (P,0.01) rate of prevalence of VEB-1-type b-lactamases among ceftazidime-resistant strains of P. aeruginosa obtained from distinct regions of Bulgaria during 1998-2003 than that determined in our study (36.8 vs 57.0 %). Thus, the observed trend towards an increasing rate of VEB-1-producing P. aeruginosa strains in Bulgaria relates to the last 2 years.…”

“…Polymyxin B remained active against all isolates. The antimicrobial resistance to antibiotics of the investigated problematic strains of P. aeruginosa was higher than the mean P. aeruginosa resistance found in Bulgaria in 2003, according to data from the national program BulSTAR: 45.8 vs 24.5 % to ceftazidime, 42.3 vs 8.3 % to imipenem, 59.1 vs 24.9 % to amikacin, 79.7 vs 38.7 % to gentamicin and 80.3 vs 30.7 % to ciprofloxacin (Petrov et al, 2005). Approximately half of our isolates (49.8 %) were multidrug resistant.…”

Guidance on the Selection of Appropriate Indicators for Quantification of Antimicrobial Usage in Humans and Animals

“…A number of countries report annual antimicrobial usage data that are compared to the usage observed in previous years. Reports on antimicrobial usage are communicated either separately for human medicine (Petrov et al., ; Mölstad et al., ; Meyer et al., ; Australia Infection Control Service, ; Health Protection Scotland, ) and veterinary medicine (Federal Agency for Medicines and Health Products, ; Ministry of Agriculture, Forestry and Fisheries of Japan, ; Veterinary Medicines Directorate, ; Anses, ; Food and Drug Administration, ) or in a joint report (NORM and NORM‐VET, ; SWEDRES and SVARM, ; Public Health Agency of Canada, ). European countries also report their antimicrobial usage trends over time in a joint report and using a standardized approach between countries.…”

A Cluster of Cases Caused by CTX-M-3-Producing Salmonella Brandenburg Among Children in Bulgaria

“…strains in the country produced ESBLs [7]. However, these enzymes remained rare in Salmonella until the second half of the 1990s.…”