EARSS - The European antimicrobial resistance surveillance system

EC contribution: : € 734.142
Duration: : 36 months
Starting date: : 01/09/2003
Funding scheme: : N/A
Keywords: : surveillance, antimicrobial resistance, monitor trends, invasive pathogens, public health action
Contract/Grant agreement number: : 2003212
Project web-site: : http://www.rivm.nl/earss/

Background:

The European Antimicrobial Resistance Surveillance System (EARSS), funded by DG SANCO of the European Commission and coordinated by the Dutch National Institute for Public Health and the Environment (RIVM), is an international network of national surveillance systems, which collects comparable and validated antimicrobial susceptibility data for public health purposes. EARSS performs ongoing surveillance of antimicrobial susceptibility in Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, and Enterococcus faecalis/faecium causing invasive infections, and monitors variations of antimicrobial resistance in time and from place to place. In December 2001, around 600 microbiological laboratories serving some 970 hospitals in 27 countries provided susceptibility data on around 65 000 invasive isolates.

Problem:

Antimicrobial resistance (AMR) is an emerging public health problem with local, national, and international dimensions as described in 'the Copenhagen Recommendations'. Antimicrobial resistance is clearly an emerging problem. However, the precise impact of this problem is less clear to the European and scientific community. Before being able to quantify the impact on public health it is necessary to have more comparable surveillance data available. One of the recommendations made at the EU Conference 'The Microbial Threat' in 1998 was that a European surveillance system of antimicrobial resistance should be set up, therefore EARSS has been established.

Aim:

EARSS aims to obtain comparable and reliable antimicrobial resistance data of main indicator pathogens in Europe to monitor antimicrobial resistance in time and from place to place. EARSS also aims to assess risk factors for antimicrobial resistance and to enable policy makers and health care workers to monitor the impact of their interventions.

Expected and obtained results:

For pathogens (Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, and Enterococcus faecalis/faecium) causing invasive infections, resistance levels are available for important groups of antimicrobials from 27 European countries. In the EARSS annual report 2001, results are described in detail for all four pathogens collected in 2001, as well as trends in penicillin non-susceptible S. pneumoniae (PNSP) and methicillin resistant S. aureus (MRSA) during the period 1999-2001. Aggregated information is directly available to health care workers, policy makers, and a wider public, at an interactive website (http://www.earss.rivm.nl). From EARSS data, it can be concluded that proportions of antimicrobial resistance vary markedly between European countries, most likely as a result of differences in hospital infection control and the consumption of antibiotics.

Potential applications:

Policies to combat resistance should be tailored specific to country and hospital level. The results as presented in the EARSS annual report 2001 emphasise the need to implement the Council Recommendations on the Prudent Use of Antibiotics in Human Medicine. As laid down in the Council Recommendations, it has recently been decided that multi-disciplinary organisations, called Intersectorial Coordinating Mechanisms (ICMs), will be established at the national level. The ICMs will be responsible for information exchange and co-operation between the parties involved at the national level. The ICMs are responsible for implementing the Council's recommendations and should consider the recommendations as formulated in the EARSS Annual Report 2001. This applies particularly to countries with high proportions of resistance for all bacterial species.

In order to get more insight into the causes and mechanisms of these striking differences, in the near future several research initiatives will be set up in close cooperation with the EARSS network. EARSS already cooperates closely with the project 'European Surveillance on Antimicrobial Consumption'(ESAC). EARSS and ESAC have recently started to collaborate with the project 'Self-medication of Antimicrobials and Resistance Levels in Europe' (SAR), and future cooperation is planned with the project 'Antibiotic Resistance in Mediterranean countries' (ARMed).

Coordinator:

Dr Edine W. Tiemersma
National Institute for Public Health and the Environment
P.O. Box 1
3720 BA Bilthoven, Netherlands
Tel.+31 30 27 43 096 (M, T, Th, F)
Fax +31 30 27 44 409

Project leader :

Dr Hajo Grundmann
National Institute for Public Health and the Environment
P.O. Box 1
3720 BA Bilthoven, Netherlands
Tel. +31 30 27 44 239
Fax +31 30 27 44 409

Partners:

Overview of EARSS National Representatives by country:

Austria (AT)
H. Mittermayer
W. Koller

Belgium (BE)
H. Goossens
E. Hendrickx

Bulgaria (BG)
B. Markova

Croatia (HR)
S. Kalenic
A.Tambic
Andrasevic

Cyprus (CY)
D. Bagatzouni

Czech Rep. (CZ)
P. Urbaskova

Denmark (DK)
D. Monnet
R. Skov

Estonia (EE)
P. Naaber

Finland (FI)
O. Lyytikäinen
A. Nissinen

France (FR)
B. Coignard
V. Jarlier

Germany (DE)
W. Witte
K. Heckenbach

Greece (GR)
A. Tsakris
A. Vatopoulus

Hungary (HU)
M. Füzi

Ireland (IE)
D. Igoe
O. Murphy

Iceland (IS)
K. Kristinsson

Israel (IL)
R. Raz

Italy (IT)
A. Pantosti
P. D 'Ancona

Latvia (LV)
A. Balode

Lithuania (LT)
J. Miciuleviciene

Luxembourg (LU)
R. Hemmer

Malta (MT)
M. Borg

Netherlands (NL)
E. Tiemersma
A. de Neeling

Norway (NO)
A. Hoiby
G. Simonsen

Poland (PL)
W. Hryniewicz

Portugal (PT)
M. Caniça

Romania (RO)
I. Codita

Slovakia (SK)
L. Langsadl

Slovenia (SI)
M. Mueller-Premru
J. Kolman

Spain (ES)
F. Baquero
J. Campos

Sweden (SE)
B. Liljequist

Turkey (TR)
D. Gür

United Kingdom (UK)
A. Johnson, R. Hill
(England & Wales)
H. Hughes
(Northern Ireland)
A. Eastaway
(Scotland)