1887
  1. Home
  2. Eurosurveillance
  3. Volume 28, Issue 34, 24/Aug/2023
  4. Article
Perspective Open Access
Like 0
Download

Abstract

Antimicrobial resistance (AMR) in Greece is among the highest across the European Union/European Economic Area (EU/EEA), with high AMR rates even to last-line antibiotics. To better understand the clinical microbiology laboratory practices and capacities in species identification and antimicrobial susceptibility testing (AST) across public healthcare establishments in Greece, we sent a questionnaire to 98 of 128 public hospital microbiology laboratories between 1 February and 1 April 2022. Of the 73.5% (72/98) that responded, 51.4% (37/72) reported using EUCAST guidelines. Two of three laboratories used an automated instrument for species identification and AST for all laboratory samples. Broth microdilution for colistin susceptibility testing was used by 46 of the laboratories, more frequently in larger (> 400 beds) versus smaller (< 400 beds) hospitals (90.5% (19/21) vs 52.9% (27/51) respectively, p = 0.011). MALDI-TOF mass spectrometry was available in one of 10 laboratories, and more often in larger compared to smaller hospitals (p = 0.035). Although the majority of laboratories had a laboratory information system (LIS) in place, only half had the capacity to extract data directly from the LIS for the purpose of AMR surveillance; 73.6% (53/72) used restrictive antibiograms. Public microbiology laboratory AMR capacities in Greece require improvement, prioritising interventions for EUCAST guidelines implementation.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.34.2200766
2023-08-24
2024-12-26
/content/10.2807/1560-7917.ES.2023.28.34.2200766
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/34/eurosurv-28-34-3.html?itemId=/content/10.2807/1560-7917.ES.2023.28.34.2200766&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Global antimicrobial resistance and use surveillance system (GLASS) report: 2021. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240062702
  2. Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2019. Atlanta: CDC; 2019. Available from: http://dx.doi.org/10.15620/cdc:82532
  3. European Centre for Disease Prevention and Control (ECDC). Health burden of infections with antibiotic-resistant bacteria in the European Union and the European Economic Area, 2016-2020. Stockholm: ECDC, 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/health-burden-infections-antibiotic-resistant-bacteria-2016-2020
  4. European Centre for Disease Prevention and Control (ECDC). Last-line antibiotics are failing: options to address this urgent threat to patients and healthcare systems. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/last-line-antibiotics-are-failing-options-address-urgent-threat-patients-and
  5. The Review on Antimicrobial Resistance. Tackling drug-resistant infections globally: Final report and recommendations, 2016. Chair: O’Neill J. Available from: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
  6. Organisation for Economic Co-operation and Development (OECD). Stemming the superbug tide: just a few dollars more, OECD Health Policy Studies. Paris: OECD Publishing; 2018. Available from:  https://doi.org/10.1787/9789264307599-en  https://doi.org/10.1787/9789264307599-en 
  7. European Centre for Disease Prevention and Control (ECDC). Surveillance Atlas of Infectious Diseases. Stockholm: ECDC. [Accessed: 8 Mar 2023]. Available from: https://atlas.ecdc.europa.eu/public/index.aspx
  8. Kouni S, Tsolia M, Roilides E, Dimitriou G, Tsiodras S, Skoutelis A, et al. Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece. J Hosp Infect. 2019;101(1):53-9.  https://doi.org/10.1016/j.jhin.2018.07.032  PMID: 30059747 
  9. Clinical and Laboratory Standards (CLSI). Performance standards for antimicrobial susceptibility testing. Thirty-second edition. Wayne, PA; CLSI supplement M100. 2022. Available from: https://clsi.org
  10. European Committee on Antimicrobial Susceptibility Testing (EUCAST). EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance – Version 2.0. Växjö: EUCAST; 2017. Available from: https://www.eucast.org/resistance_mechanisms
  11. European Commission. Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions (Text with EEA relevance.). Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 6.7.2018: L170. Available from: https://eur-lex.europa.eu/eli/dec_impl/2018/945/oj
  12. European Centre for Disease Prevention and Control (ECDC). EARS-Net reporting protocol 2023. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/ears-net-reporting-protocol-2023
  13. Giske CG, Turnidge J, Cantón R, Kahlmeter G, EUCAST Steering Committee. Update from the European Committee on Antimicrobial Susceptibility Testing (EUCAST). J Clin Microbiol. 2022;60(3):e0027621.  https://doi.org/10.1128/jcm.00276-21  PMID: 34346716 
  14. National Public Health Organization (NPHO). WHONET – Greece. Athens: NPHO School of Public Health. [Accessed: 8 Mar 2023]. Available from: https://www.mednet.gr/whonet
  15. Vatopoulos AC, Kalapothaki V, Legakis NJ, The Greek Network for the Surveillance of Antimicrobial Resistance. An electronic network for the surveillance of antimicrobial resistance in bacterial nosocomial isolates in Greece. Bull World Health Organ. 1999;77(7):595-601. PMID: 10444883 
  16. Brown D, Cantón R, Dubreuil L, Gatermann S, Giske C, MacGowan A, et al. Widespread implementation of EUCAST breakpoints for antibacterial susceptibility testing in Europe. Euro Surveill. 2015;20(2):21008.  https://doi.org/10.2807/1560-7917.ES2015.20.2.21008  PMID: 25613780 
  17. European Centre for Disease Prevention and Control (ECDC). Antimicrobial consumption in the EU/EEA (ESAC-Net) – Annual Epidemiological Report 2021. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-consumption-europe-2021
  18. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011-2012. Stockholm: ECDC; 2013. Available from: https://www.ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-0
  19. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516.  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516  PMID: 30458912 
  20. CLSI-EUCAST joint Polymyxin Breakpoints Working Group. Recommendations for MIC determination of colistin (polymyxin E) as recommended by the joint CLSI-EUCAST Polymyxin Breakpoints Working Group. Växjö: EUCAST; 2016. Available from: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/General_documents/Recommendations_for_MIC_determination_of_colistin_March_2016.pdf
  21. Dingle TC, Butler-Wu SM. Maldi-tof mass spectrometry for microorganism identification. Clin Lab Med. 2013;33(3):589-609.  https://doi.org/10.1016/j.cll.2013.03.001  PMID: 23931840 
  22. Sepulveda JL, Young DS. The ideal laboratory information system. Arch Pathol Lab Med. 2013;137(8):1129-40.  https://doi.org/10.5858/arpa.2012-0362-RA  PMID: 23216205 
  23. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-77.  https://doi.org/10.1086/510393  PMID: 17173212 
  24. Larrosa MN, Benito N, Cantón R, Canut A, Cercenado E, Fernández-Cuenca F, et al. From CLSI to EUCAST, a necessary step in Spanish laboratories. Enferm Infecc Microbiol Clin (Engl Ed). 2020;38(2):79-83. English, Spanish.  https://doi.org/10.1016/j.eimce.2018.09.010  PMID: 30409509 
  25. Hazırolan G. Transition from CLSI to EUCAST: How our antibiotic susceptibility tests will be affected. Turk Hij Deney Biyol Derg. 2021;78(3):287-98.  https://doi.org/10.5505/TurkHijyen.2021.25428 
  26. Sánchez-Bautista A, Coy J, García-Shimizu P, Rodríguez JC. From CLSI to EUCAST guidelines in the interpretation of antimicrobial susceptibility: What is the effect in our setting? Enferm Infecc Microbiol Clin (Engl Ed). 2018;36(4):229-32. English, Spanish.  https://doi.org/10.1016/j.eimce.2018.02.012  PMID: 28479139 
  27. Kassim A, Omuse G, Premji Z, Revathi G. Comparison of Clinical Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines for the interpretation of antibiotic susceptibility at a university teaching hospital in Nairobi, Kenya: a cross-sectional study. Ann Clin Microbiol Antimicrob. 2016;15(1):21.  https://doi.org/10.1186/s12941-016-0135-3  PMID: 27068515 
  28. Cusack TP, Ashley EA, Ling CL, Roberts T, Turner P, Wangrangsimakul T, et al. Time to switch from CLSI to EUCAST? A Southeast Asian perspective. Clin Microbiol Infect. 2019;25(7):782-5.  https://doi.org/10.1016/j.cmi.2019.03.016  PMID: 30922928 
  29. European Centre for Disease Prevention and Control (ECDC). EU laboratory capability monitoring system (EULabCap): report on 2018 survey of EU/EEA country capabilities and capacities. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/eu-laboratory-capability-monitoring-system-eulabcap-2018
Antimicrobial susceptibility testing and reporting practices of public hospital microbiology laboratories in Greece, 2022: A national observational survey and call for action
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sofia+Karagiannidou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Karagiannidou Sofia</a>, <a href="/search?value1=Ioannis+Kopsidas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kopsidas Ioannis</a>, <a href="/search?value1=Michalis+Polemis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Polemis Michalis</a>, <a href="/search?value1=Kyriaki+Tryfinopoulou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tryfinopoulou Kyriaki</a>, <a href="/search?value1=Theoklis+Zaoutis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zaoutis Theoklis</a></span>. Antimicrobial susceptibility testing and reporting practices of public hospital microbiology laboratories in Greece, 2022: A national observational survey and call for action. <a href="/content/ecdc">Euro Surveill.</a> 2023;28(34):pii=2200766. <a href="https://doi.org/10.2807/1560-7917.ES.2023.28.34.2200766" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2023.28.34.2200766</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 21 Sept 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 08 May 2023 </span> </p>
/content/10.2807/1560-7917.ES.2023.28.34.2200766
/content/10.2807/1560-7917.ES.2023.28.34.2200766
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error