Carbapenem non-susceptibility of isolates in hospitals from 2011 to 2016, data from the German Antimicrobial Resistance Surveillance (ARS).

BACKGROUND

Carbapenem resistance in is of significant public health concern and recently spread across several countries. We investigated the extent of carbapenem non-susceptibility in isolates in Germany.

METHODS

We analysed 2011-2016 data from the German Antimicrobial Resistance Surveillance (ARS) System, which contains routine data of antimicrobial susceptibility testing from voluntarily participating German laboratories. isolates tested resistant or intermediate against an antibiotic were classified as non-susceptible.

RESULTS

We included 154,734 isolates from 655 hospitals in the analysis. Carbapenem non-susceptibility in isolates was low in Germany 0.63% (95% CI 0.51-0.76%). However, in continuously participating hospitals the number of isolates almost doubled and we found evidence for a slowly increasing trend for non-susceptibility (OR = 1.20 per year, 95% CI 1.09-1.33,  < 0.001). Carbapenem non-susceptibility was highest among isolates from patients aged 20-39 in men but not in women. Moreover, carbapenem non-susceptibility was more frequently reported for isolates from tertiary care, specialist care, and prevention and rehabilitation care hospitals as well as from intensive care units. Co-resistance of carbapenem non-susceptible isolates against antibiotics such as tigecycline, gentamicin, and co-trimoxazole was common. Co-resistance against colistin was 13.3% (95% CI 9.8-17.9%) in carbapenem non-susceptible isolates.

CONCLUSION

Carbapenem non-susceptibility in isolates in Germany is still low. However, it is slowly increasing and in the light of the strong increase of isolates over the last year this poses a significant challenge to public health. Continued surveillance to closely monitor trends as well as infection control and antibiotic stewardship activities are necessary to preserve treatment options.