Resistance Data Human Medicine
Resistance trends vary between microorganism-antibiotic combinations. While resistance rates are decreasing for methicillin in Staphylococcus aureus and penicillin in Streptococcus pneumoniae, increasing trends have been observed for quinolones and third/fourth generation cephalosporins in Enterobacterales (e.g. E. coli and K. pneumoniae). However, these upward trends have flattened out in recent years. As clearly visible in the animated graph below, higher resistance rates are also reflected in an increase in the burden of disease.
Resistance rates of a selection of highly resistant microorganisms in Switzerland
Resistance rates of a selection of highly resistant microorganisms in Switzerland
Select a region of interest or a unit of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph. A map of different ANRESIS regions can be found here.
ESCR-E.coli: Extended-spectrum cephalosporin-resistant Escherichia coli
ESCR-K.pneumoniae: Extended-spectrum cephalosporin resistant Klebsiella pneumoniae
FQR-E.coli: Fluoroquinolone-resistant Escherichia coli
MRSA: Methicillin-resistant Staphylococcus aureus
PNSP: Penicillin-non-susceptible Streptococcus pneumoniae
VRE: Vancomycin-resistant enterococci
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Burden of a selection of antibiotic-resistant bacteria in Switzerland
Estimation of infections, disability-adjusted life-years (DALYs) and attributable deaths caused by a selection of 16 antibiotic-resistant bacteria in Switzerland 2010-2019. The bubble size is proportional to the number of DALYs.
Burden of a selection of antibiotic-resistant bacteria in Switzerland
Estimation of infections, disability-adjusted life-years (DALYs) and attributable deaths caused by a selection of 16 antibiotic-resistant bacteria in Switzerland 2010-2019. The bubble size is proportional to the number of DALYs.
Move the mouse over the graph in order to show data on hover. Zoom in to visualize smaller bubbles.
DALYs: disability-adjusted life-years
ColRACI: colistin-resistant Acinetobacter spp.
CRACI: carbapenem-resistant Acinetobacter spp.
MDRACI: multidrug-resistant Acinetobacter spp.
VRE: vancomycin-resistant Enterococcus faecalis and Enterococcus faecium.
ColREC: colistin-resistant Escherichia coli.
CREC: carbapenem-resistant E coli.
3GCREC: third-generation cephalosporin-resistant E coli.
ColRKP: colistin-resistant Klebsiella pneumoniae.
CRKP: carbapenem-resistant K pneumoniae.
3GCRKP: third-generation cephalosporin-resistant K pneumoniae.
ColRPA: colistin-resistant Pseudomonas aeruginosa.
CRPA: carbapenem-resistant P aeruginosa.
MDRPA: multidrug-resistant P aeruginosa.
MRSA: meticillin-resistant Staphylococcus aureus.
PRSP: penicillin-resistant Streptococcus pneumoniae.
PMRSP: penicillin-resistant and macrolide-resistant S pneumoniae.
The methodology of Cassini et al. 2018 (1) was adapted to estimate the outcome of different parameters (infections, DALYs, deaths) in Switzerland. Regionally stratified data from the ANRESIS database was used as data source for bloodstream infections. As Cassini and colleagues did, we used the Burden of Communicable Disease in Europe toolkit for the estimation of the outputs based on 10’000 Monte Carlo simulations, without time discounting.
1: Cassini A et al. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013. Euro Surveill. 2018;23(16).
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Microorganisms
Acinetobacter spp.
Acinetobacter spp.
Currently a stable resistance situation is observed for this microorganism, which is intrinsically resistant to numerous antibiotics.
Infections with Acinetobacter spp. are mainly observed in hospital environments, particularly in intensive care units and in already weakened patients. These microorganisms can cause respiratory, urinary tract and wound infections as well as septicaemia and meningitis. The resistance situation is stable in Switzerland since 10 years. In contrast to other European countries an increase in Carbapanem resistance has not been observed.
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Swiss Antibiotic Resistance report 2022. Chapter 7.4. Acinetobacter spp.
Prevalence of carbapenem-resistant Acinetobacter baumannii from 2005 to 2016 in Switzerland.
Aspergillus spp.
Aspergillus spp.
Aspergillus are ubiquitous in nature and cause a broad spectrum of disease in humans.
Aspergillus species can cause life-threatening invasive aspergillosis in immunocompromised hosts. Infections are most frequently caused by Aspergillus fumigatus. Nevertheless, non-fumigatus Aspergillus spp. are increasingly reported. Additionally, azole resistance among A fumigatus has emerged worldwide and has been associated with a high mortality rate in immunocompromised hosts.
Select a specimen of interest and a unit of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis all isolates tested against the corresponding antifungal were considered. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Select a specimen of interest and a unit of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis all isolates tested against the corresponding antifungal were considered. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Campylobacter spp.
Campylobacter spp.
Campylobacter usually are acquired through contaminated food, especially undercooked poultry.
Infections may cause diarrhea, but may also be asymptomatic. In most cases no antibiotic therapy is needed. Overall resistance rates are higher in C. coli than in C. jejuni and for fluoroquinolones than for macrolides.
Select a specimen of interest and a unit of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Candida spp.
Candida spp.
The clinical manifestations of infection with Candida species range from local mucous membrane infections to candidemia and widespread dissemination with multisystem organ failure.
Candida albicans is still considered the main causative pathogen, a shift to non-albicans Candida species is observed globally. Candidemia is among the leading causes of hospital-acquired bloodstream infections, representing one of the most prevalent nosocomial invasive fungal infections worldwide. Moreover, the emergence of drug-resistant Candida species are major concerns.
Select a specimen of interest and a unit of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antifungals were considered only. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Select a specimen of interest and a unit of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antifungals were considered only. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Enterococci
Enterococci
After years of steady state, vancomycin resistance in enterococci (VRE) has increased since 2018.
Enterococci belong to the intestinal flora and are of low pathogenicity. However, especially in the hospital environment they can cause severe infections. Numbers of VRE in Switzerland remained stable until 2018, when several outbreaks including one of the ST 796 clone (see literature) caused a considerable increase. Subsequently, recommendations to contain VRE spread in health care facilities were published by Swissnoso, current cantonal VRE data are updated monthly (->Link).
Enterococcus faecalis
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Enterococcus faecium
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Current numbers of VRE isolates per canton
New VRE cases half-yearly and per canton. Only hospitalized patients are considered, doubles (same patients) are excluded. In case of multiple samples per patient, the most invasive sample is considered. Screening samples are defined as sample locations “anal”, “faeces”, “intact skin” or “mucosa-swab”.
Current numbers of VRE isolates per canton
New VRE cases half-yearly and per canton. Only hospitalized patients are considered, doubles (same patients) are excluded. In case of multiple samples per patient, the most invasive sample is considered. Screening samples are defined as sample locations “anal”, “faeces”, “intact skin” or “mucosa-swab”.
To activate / deactivate a sample type click on the icons in the legend. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
VRE: Vancomycin-resistant enterococci
year_1 and year_2: First (January-June) and second (July-December) six months of the year
From every patient the most invasive isolate which was sampled within one calendar year was included. Results are reported as delivered by laboratories. Results may be influenced by the changing number of laboratories participating.
Links / literature:
Swiss Antibiotic Resistance Report 2022. Chapter 7.6. Enterococci
Eindämmung der Verbreitung von Vancomycin-resistenten Enterokokken (VRE) in der Schweiz: Aktualisierung der nationalen Empfehlungen. Version 2.0 Dez. 2019
Emergence of vancomycin-resistant enterococci in Switzerland: a nation-wide survey.
Emergence of vancomycin-resistant enterococci in Switzerland: a nation-wide survey.
Outbreak of vancomycin-resistant Enterococcus faecium clone ST796, Switzerland, December 2017 to April 2018.
Outbreak of vancomycin-resistant Enterococcus faecium clone ST796, Switzerland, December 2017 to April 2018
Euro Surveill. 2018 Jul;23(30)
Increasing proportion of vancomycin resistance among enterococcal bacteraemias in Switzerland: a 6-year nation-wide surveillance, 2013 to 2018
Escherichia coli
Escherichia coli
The resistance against quinolones and third- / fourth-generation cephalosporins has steadily increased since 2004, but stabilized during the last years.
Escherichia coli are among the most frequent microorganisms in both the hospital and the ambulatory setting. E. coli is a colonizer of the intestinal tract and as such often causing urinary tract infections, pyelitis and bacteremia.
Fluoroquinolone resistance has steadily increased from 10.3 % in 2004 to 19.4 % in 2015, however they decreased significantly during the last four years. As fluoroquinolone consumption is an important trigger for fluoroquinolone resistance in E. coli, they should only be used in exceptional cases for uncomplicated lower urinary tract infections.
Resistance rates to 3rd/4th generation cephalosporins were steadily increasing from 0.9% in 2004 to 11% in 2018, but stabilized since then. This increase was observed in both the inpatient and the outpatient setting. E. coli which are resistant to 3rd/4th generation cephalosporins were evidenced in numerous different settings such as in people returning from foreign travel, in animals or in water bodies.
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Swiss Antibiotic Resistance Report 2022. Chapter 7.1. Escherichia coli
Temporal trends of extended-spectrum cephalosporin resistant Escherichia coli and Klebsiella pneumoniae in Switzerland.
Assessment of the Prevalence of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Ready-to-Eat Salads, Fresh-Cut Fruit, and Sprouts from the Swiss Market.
Characteristics of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae Isolates from rivers and lakes in Switzerland.
High colonization rates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in Swiss travellers to South Asia- a prospective observational multicentre cohort study looking at epidemiology, microbiology and risk factors.
– ESBL-producing Enterobacteriaceae: occurrence, risk factors for fecal carriage and strain traits in the Swiss slaughter cattle population younger than 2 years sampled at abattoir level.
Klebsiella pneumoniae
Klebsiella pneumoniae
The resistance rate to 3rd/4th generation cephalosporins steadily increased from 2004 to 2014, but stabilized since then.
Equally to E. coli, Klebsiella pneumoniae, belong to the family of Enterobacteriales and are potentially causing urinary tract infections. In addition, they are known to cause pneumonia, particularly in the hospital setting. The resistance rate in K. pneumoniae to 3rd/4th generation cephalosporins increased from 1% in 2004 to 9.2% in 2014, which was comparable to the increase in E. coli. However, rates of 3rd/4th generation cephalosporin resistant K. pneumoniae remained constant during the last ten years.
Patients with a K. pneumoniae infection in the hospital setting are generally isolated, due to an increased risk of transmission.
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Swiss Antibiotic Resistance Report 2022. Chapter 7.2. Klebsiella pneumoniae
Enterobacteriaceae mit Breitspektrum Beta-Laktamasen (ESBL) im Spital: Neue Empfehlungen Swissnoso 2014.
Temporal trends of extended-spectrum cephalosporin resistant Escherichia coli and Klebsiella pneumoniae in Switzerland.
Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting
Neisseria gonorrhoeae
Neisseria gonorrhoeae
Increased resistance rates are observed for this sexually transmitted bacterium.
Infections with gonococci are steadily increasing. They are often observed in combination with other sexually transmitted diseases such as chlamydia, HIV, Hepatitis B or Syphilis. Although resistance rates to cephalosporines and azithromycin are increasing, ceftriaxone still is the first line therapy, but should be used in higher doses in order to prevent the development of new resistances (see SSI guidelines). Nowadays, urine samples containing gonococci are mainly genetically analysed using polymerase chain reaction (PCR). By this approach resistance results are not available which leads to the fact, that the resistance situation in Switzerland can’t be described appropriately. Therefore, it is suggested to culture the bacteria in case of a gonococcal infection.
Links / literature:
Swiss Antibiotic Resistance Report 2022. Textbox Neisseria gonorrhoeae
Swiss gonorrhoeae infection data (German):
General information on sexually transmitted diseases: Love-life
Swiss AIDS Federation
Guideline Swiss Society for Infectious Diseases
Pseudomonas aeruginosa
Pseudomonas aeruginosa
A stable resistance situation is currently observed for P. aeruginosa.
P. aeruginosa is intrinsically resistant to numerous antibiotics. Particularly from the inpatient setting it is known that P. aeruginosa can cause lung, urinary tract, and blood infections. Further, severe infections can occur after skin burns. The resistance situation of P. aeruginosa is stable since many years.
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Swiss Antibiotic Resistance Report 2022. Chapter 7.3. Pseudomonas aeruginosa
Salmonella spp.
Salmonella spp.
Human salmonellosis usually does not require antimicrobial treatment.
However in some patients Salmonella infection can cause serious illness and sepsis. During the last years resistance rates decreased for aminopenicillins, but increased for fluoroquinolones.
Select a specimen of interest and a unit of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Staphylococcus aureus
Staphylococcus aureus
Methicillin-resistance in S. aureus (MRSA) is declining.
Staphylococci are together with E. coli the most frequent causes for infections in human. Beside wound and soft tissue infections they also cause sepsis, joint, bone and cardiac valve infections. During recent years (2004-2021), the MRSA rate decreased considerably from 13% to 5%. Simultaneously a shift of MRSA from the inpatient to the outpatient setting was observed.
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Swiss Antibiotic Resistance Report 2022. Chapter 7.7. Staphylococcus aureus
Staphylococcus aureus and methicillin resistance in Switzerland: regional differences and trends from 2004 to 2014.
Streptococcus pneumoniae
Streptococcus pneumoniae
Penicillin resistance in pneumococci stabilized on a low level due to vaccination.
Pneumococci mainly cause infections of the lungs (pneumonia) and blood (sepsis). The resistance rate stabilized on 4% in 2021. One reason for this trend is probably the pneumococcal vaccine. Since its introduction both the morbidity and the resistance rates have decreased considerably.
Select a region of interest, a unit, an antibiotic or a year of choice from the drop-down menus. Use the checkboxes to activate or deactivate time series and confidence intervals. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
95% CI: 95% confidence interval
For this analysis invasive isolates (blood and cerebrospinal fluid) tested against the corresponding antibiotic (category) were considered only. If multiple antibiotics within the same antibiotic category were tested, the most resistant result was selected. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Results are reported as delivered by laboratories. Statistics may be influenced by the changing number of laboratories participating. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
Links / literature:
Swiss Antibiotic Resistance Report 2022. Chapter 7.5. Streptococcus pneumoniae
Fact-sheet about the pneumococcal vaccine in children from infovac (German)
Invasive pneumococcal diseases 2013–2017. BAG Bulletin 03/2019, p. 10-19.
Serotype/serogroup-specific antibiotic non-susceptibility of invasive and non-invasive Streptococcus pneumoniae, Switzerland, 2004 to 2014.
National Center for Invasive Pneumococci (NZPn)
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Inspect the most relevant resistance data of Switzerland in a tabular view and customize the query according to your preferences.
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Carbapenem-resistant Enterobacterales
Although on a relatively low-level, numbers of carbapenem-resistant Enterobacterales have constantly increased during the last years.
Carbapenem-resistant Enterobacterales (CRE)
Carbapenems are broad spectrum antibiotics, used for severe infections with some multidrug-resistant microorganisms, in particular extended-spectrum betalactamase-producing Enterobacterales. Resistance to this class of reserve antibiotics is therefore crucial to survey. ANRESIS analyses carbapenem resistance in Enterobacterales continuously and publishes data on this web-site.
Carbapenem non-susceptibility can be mediated via different mechanisms such as permeability defects, efflux pumps or by the production of carbapenemase enzymes. The resistance mechanism cannot be predicted from the resistance test alone, genomic analyses are needed. Due to their multiresistance and their rapid spread a separate focus is laid on the carbapenemase-producing enterobacterales (see next section).
Temporal Course of CRE in Switzerland
Select a region of interest or a microorganism of choice from the drop-down menus. Use the checkboxes to activate or deactivate a sample type. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph. A map of different ANRESIS regions can be found here.
CRE is defined as resistant to at least one out of imipenem and meropenem. For Morganellaceae (Morganella spp, Proteus spp. and Providencia spp.) only full resistance to meropenem is considered. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Be aware that number of isolates may be dependent on changing numbers of participating laboratories, too. Results are reported as delivered by laboratories.
CRE Distribution of Microorganisms
Select a region of interest or a year of choice from the drop-down menus. Move the mouse over the graph in order to display detailed data on hover. A map of different ANRESIS regions can be found here.
CRE is defined as resistant to at least one out of imipenem and meropenem. For Morganellaceae (Morganella spp, Proteus spp. and Providencia spp.) only full resistance to meropenem is considered. In case of multiple isolates, the first isolate per patient, microorganism and calendar year was included only. Be aware that number of isolates may be dependent on changing numbers of participating laboratories, too. Results are reported as delivered by laboratories.
Carbapenemase Producers
Enterobacterales which are in possession of carbapenemase enzymes (the so-called carbapenemase-producing Enterobacterales or CPE) are particularly resistant to numerous other antibiotic classes than carbapenems. Due to this multresistance and due to their rapid spread, they pose a particular threat. The reporting of CPE has therefore been declared as mandatory by the Swiss government on January 2017 and since January 2019 all CPE isolates must be sent to the National Reference Centre for Emerging Antibiotic Resistance (NARA) for a detailed analysis of the resistance mechanisms and for early detection of outbreaks. An overview on CPE was published in EUROSURVEILLANCE in 2021.
CPE are classified according to the amino acid sequence similarities of their carbapenemases. The most prevalent CPE genotypes in Switzerland are currently OXA-48 and NDM. ANRESIS publishes the actual CPE data quarterly on this Website. Of note, these data cannot be compared directly to data before 2019 due to a change in the reporting system. All of the following graphs are based on data from NARA.
Regional Distribution of CPE in Switzerland
CPE: Carbapenemase-producing Enterobacterales
FOPH: Federal Office of Public Health (BAG)
NARA: National Reference Centre for Emerging Antibiotic Resistance
SAC: Swiss Antibiogram Committee
From 2013-2015 suspected human CPE isolates were characterized by expert laboratories, which were designated by the Swiss Antibiogram Committee (SAC) of the Swiss Society for Microbiology. Data were then collected by the SAC. From 2016, reporting of all CPE isolates to the Swiss Federal Office of Public Health (SFOPH) became mandatory, and SFOPH started collecting additional epidemiological data.
Since 2019 it is mandatory to send suspected human CPE isolates to the national reference laboratory (NARA) which performs the genotyping and stores the isolates physically. Deduplication was performed at the species and genotype level, by keeping only the first date of occurrence of an isolate for a given year from the same patient.
CPE Species and Gentoypes
Choose a region and year in the selection field.
CPE: Carbapenemase-producing Enterobacterales
IMP: Imipenemase
KPC: K. pneumoniae carbapenemase
NDM: New Delhi metallo-β-lactamase
OXA-48: oxacillinase 48
OXA-other: oxacillinase 181 (OXA-181), oxacillinase 232 (OXA-232) and oxacillinase 244 (OXA-244)
VIM: Verona integron–encoded metallo-β-lactamase
From 2013-2015 suspected human CPE isolates were characterized by expert laboratories, which were designated by the Swiss Antibiogram Committee (SAC) of the Swiss Society for Microbiology. Data were then collected by the SAC. From 2016, reporting of all CPE isolates to the Swiss Federal Office of Public Health (SFOPH) became mandatory, and SFOPH started collecting additional epidemiological data.
Since 2019 it is mandatory to send suspected human CPE isolates to the national reference laboratory (NARA) which performs the genotyping and stores the isolates physically. Deduplication was performed at the species and genotype level, by keeping only the first date of occurrence of an isolate for a given year from the same patient.
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INterface For Empirical antimicrobial ChemoTherapy
INFECT is an interactive web application which is directed particularly towards health professionals. It gives a fast and intuitive access to ANRESIS resistance data and connects them with the latest national treatment guidelines. The INFECT project has been developed with support from the Federal Office of Public Health and the Institute for Infectious Diseases Bern.
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In this section resistance data on new reserve antibiotics are shown. Graphics are updated on a monthly basis. All isolates from all sites from 2020 onwards are considered. Doubles according to the ANRESIS algorithm and results with n<5 are excluded. Results are reported as delivered by laboratories and may be biased due to varying testing strategies. Data are provided for surveillance purposes and are not intended to be used for therapeutic decisions solely.
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Quantitative resistance data (disc diffusion (DD) or minimal inhibitory concentration (MIC)) should be preferred over categorical resistance data (s, i, r) for several reasons. Among others, quantitative data allow detection of slow, gradual development of resistance, they help clinicians to decide whether treatment can be modified by administering higher dosage and they allow reclassification of resistance categories after changes in breakpoint definitions to detect susceptibility trends over a longer period of time.
Within this submenu we graphically depict the distribution of disc diffusion and MIC data of clinical samples collected within ANRESIS. Of note, qualitative resistance data are not delivered for all resistance tests. For wildtype distributions please refer to EUCAST.
Select a bug-drug combination of interest from the drop-down menus microorganism and antibiotic. When the mouse is moved over the graph a toolbar appears, which allows zooming, showing data on hover and downloading of the graph.
DD: disc diffusion
MIC: minimal inhibitory concentraion
Histograms represent data delivered to the ANRESIS database of the last five years. Isolates of a particular patient and microorganism showing identical resistance patterns were removed using the ANRESIS double algorithm. Only microorganisms are included for which at least 20 different isolates were reported. Data are displayed as delivered by laboratories. Quantitative data are provided by a subset of reporting laboratories. This can lead to a selection bias. Since numbers of participating laboratories change over time, displayed data may also vary. Data are provided for surveillance purposes only and are not intended to guide therapeutic decisions.
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