http://bmj.com/cgi/content/full/324/7339/697/a

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BMJ 2002;324:697 ( 23 March )
 

News roundup

European surveillance shows north-south divide in resistant bacteria

Susan Mayor London

Most countries in northern Europe—with the exception of the United Kingdom—have much lower rates of antibiotic resistant bacteria than southern European countries, the latest figures from the European Antimicrobial Resistance Surveillance System show.

The European surveillance system is a network of national surveillance systems that monitors drug resistance in bacteria reported by centres in 15 countries in Europe, as well as Israel. It was set up by the European Commission in 1998.

The latest figures, for the first two quarters of 2001, show that the lowest rates of methicillin resistance in Staphylococcus aureus isolates were found in northern European countries, including Iceland, Sweden, Denmark, and the Netherlands, which all recorded a rate of resistance of less than 3% of isolates. In contrast, southern European countries had much higher rates, with 44.1% of S aureus isolates in Israel and 38.6% in Greece being resistant to methicillin.

However, the highest rate of methicillin resistant S Aureus (MRSA) was in the United Kingdom, at 46.1%.

Dr Stef Bronzwaer, project leader of the surveillance system, said: "The MRSA data are shocking—particularly for countries such as the UK, Italy, and Greece. There generally seems to be a north-south divide in antibiotic resistance."

He said that several factors could account for the difference in rates: "Appropriate use of antibiotics—especially in the community—helps to minimise the emergence of resistant strains of bacteria. Tight policies on infection control are also important."

Countries such as the Netherlands have adopted a "search and destroy" strategy for dealing with MRSA, in which a patient is isolated as soon as infection with the resistant bacteria is suspected.

"This is expensive, but it seems to work," Dr Bronzwaer argued.

The European figures show a steady increase in MRSA over the past few years in most countries, apart from some countries such as the Netherlands and Denmark, which had sustained very low rates.

For the first time the surveillance system reported results of susceptibility tests on invasive isolates of Escherichia coli, Enterococcus faecium, and Enterococcus faecalis. Results showed that Israel (22.3%) and Spain (16.1%) had the highest proportions of fluoroquinolone resistance in invasive E coli. Sweden had the lowest proportion of resistance (3.8%), followed by Poland (4.8%).

The proportion of E coli isolates not susceptible to third generation cephalosporins was generally low, with the highest rates of resistant isolates in Israel (10%), Bulgaria (8%), and Poland (8.3%). Enterococci have acquired resistance to several antibiotics, including b lactams, and to high concentrations of aminoglycosides, leaving glycopeptides as the last class of agents able to treat E faecium infections.

The development of resistance to glycosides such as vancomycin is of great concern, because there is a potential danger of the transmission of this resistance to more pathogenic bacteria such as MRSA—leaving it virtually untreatable with current antibiotics. Data showed that the highest proportions of vancomycin non-susceptibility in E faecium were found in Greece (23.8%) and Israel (15.4%).

Dr Bronzwaer outlined the importance of international collaboration in monitoring resistance to antibiotics. "The aim is to bring together validated resistance data across different countries as the first step in developing control over the problem. Those countries not doing so well can perhaps adopt strategies used in countries doing better with this problem."
 
 
 

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