Resistance Data Human Medicine

Interactive Database Query

Inspect the most relevant resistance data of Switzerland in a tabular view and customize the query according to your preferences.

Inspect resistance data

infect.info by ANRESIS

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.

Visit INFECT.info

Carbapenem Resistance

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).

CRE is defined as non-susceptibility to at least one out of imipenem and meropenem. For Morganella morganii, Proteus spp. and Providencia spp. only meropenem is considered. In this analysis, only data from laboratories sending data continuously from 2008-2019 are considered, double patients in the same calendar year are excluded (query from 5.12.2019).

Species distribution among all CRE and all Enterobacterales isolated from 2008. CRE is defined as non-susceptibility to at least one out of imipenem and meropenem. For Morganella morganii, Proteus spp. and Providencia spp. only meropenem is considered. In this analysis, only data from laboratories sending data continuously from 2008-2019 are considered, double patients in the same calendar year are excluded (query from 5.12.2019).

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.

CPE are classified according to the amino acid sequence similarities of their carbapenemases. The most prevalent CPE genotypes in Switzerland are currently the OXA-48-types and KPCs. 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.

Maps and Tables below are outdated.
We are currently working on a connection to NARA to may present actual data continously. A new approach for representing CPE data is currently elaborated in collaboration with NARA.

Switzerland all

	KPC	NDM	OXA-48	OXA-other	VIM	Other	Total
E. coli	2	12	24	3	1	13	55
K. pneumoniae	20	13	23	1	0	13	70
Other	3	8	9	0	15	4	39
Total	25	33	56	4	16	30	164

Data 2018, last update 26.10.2018

Microorganisms

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.

Links / literature:

Ramette A, Kronenberg A and the Swiss Centre for Antibitoic Resistance (ANRESIS).

Prevalence of carbapenem-resistant Acinetobacter baumannii from 2005 to 2016 in Switzerland.

BMC Infect Dis. 2018 Apr 3; 18(1):159. boris.unibe.ch/123007

Last update: 5.9.2019

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.

Links / literature:

D. Vuichard-Gysin, M. Schlegel, N. Troillet, L. Senn, J. Marschall, D. Blanc, N. Buetti, A. Egli, M. Eyer, S. Kuster, A. Kronenberg, C. Balmelli, L. Nartey, V. Masserey Spicher, C. Gardiol, A. F. Widmer, S. Harbarth, für die VRE Taskforce im Auftrag von Swissnoso.

Eindämmung der Verbreitung von Vancomycin-resistenten Enterokokken (VRE) in der Schweiz: Aktualisierung der nationalen Empfehlungen. Version 2.0 Dez. 2019

Eindämmung der Verbreitung von Vancomycin-resistenten Enterokokken (VRE) in der Schweiz: Aktualisierung der nationalen Empfehlungen Dez. 2019

Buetti N, Wassilew N, Rion V, Senn L, Gardiol C, Widmer A, Marschall J; for Swissnoso.

Emergence of vancomycin-resistant enterococci in Switzerland: a nation-wide survey.

Antimicrob Resist Infect Control. 2019 Jan 17;8:16. doi: 10.1186/s13756-019-0466-x. eCollection 2019. PMID: 3067534 Emergence of vancomycin-resistant enterococci in Switzerland: a nation-wide survey.

Wassilew N, Seth-Smith HM, Rolli E, Fietze Y, Casanova C, Führer U, Egli A, Marschall J, Buetti N.

Outbreak of vancomycin-resistant Enterococcus faecium clone ST796, Switzerland, December 2017 to April 2018.

Euro Surveill. 2018 Jul;23(29). doi: 10.2807/1560-7917.ES.2018.23.29.1800351. Erratum in: Euro Surveill. 2018 Jul;23(30):. Outbreak of vancomycin-resistant Enterococcus faecium clone ST796, Switzerland, December 2017 to April 2018 Euro Surveill. 2018 Jul;23(30)

Escherichia coli

The resistance against quinolones and third- / fourth-generation cephalosporins has constantly increased during the last 10 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 non-susceptibility has steadily increased from 10.6 % in 2004 to 20.5 % in 2018. 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.

Non-susceptibility rates to 3rd/4th generation cephalosporins were steadily increasing from 0.9% in 2004 to 11.6% in 2018. This increase was observed in both the inpatient and the outpatient setting. E. coli which are not susceptible 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.

Links / literature:

Kronenberg A, Hilty M, Endimiani A, Mühlemann K.

Temporal trends of extended-spectrum cephalosporin resistant Escherichia coli and Klebsiella pneumoniae in Switzerland.

Euro Surveill 2013 May 23; 18(21): 1-10. boris.unibe.ch/43826

Nüesch-Inderbinen M, Zurfluh K, Peterhans S, Hächler H, Stephan R.

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.

J Food Prot. 2015 Jun;78(6):1178-81. doi: 10.4315/0362-028X.JFP-15-018. pubmed.ncbi.nlm.nih.gov/26038909

Zurfluh K, Hächler H, Nüesch-Inderbinen M, Stephan R.

Characteristics of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae Isolates from rivers and lakes in Switzerland.

Appl Environ Microbiol. 2013 May;79(9):3021-6. doi: 10.1128/AEM.00054-13. Epub 2013 Mar 1. Characteristics of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae Isolates from rivers and lakes in Switzerland.

Kuenzli E, Jaeger VK, Frei R, Neumayr A, DeCrom S, Haller S, Blum J, Widmer AF, Furrer H, Battegay M, Endimiani A, Hatz C.

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.

BMC Infect Dis. 2014 Oct 1;14:528. doi: 10.1186/1471-2334-14-528. 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.

Reist M, Geser N, Hächler H, Schärrer S, Stephan R.

– 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.

PLoS One. 2013 Aug 20;8(8):e71725. doi: 10.1371/journal.pone.0071725. eCollection 2013. 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.

Last update: 5.9.2019

Klebsiella pneumoniae

The non-susceptibility rate to 3rd/4th generation cephalosporins steadily increased over the last 10 years.

Equally to E. coli, Klebsiella pneumoniae, belong to the family of Enterobacteriaceae and are potentially causing urinary tract infections. In addition, they are known to cause pneumonia, particularly in the hospital setting. The non-susceptibility rate in K. pneumoniae to 3rd/4th generation cephalosporins increased from 1.3% in 2004 to 10.4% in 2018, which was comparable to the increase in E. coli. Patients with a K. pneumoniae infection in the hospital setting are generally isolated, due to an increased risk of transmission.

Links / literature:

Tissot F, Widmer AF, Kuster SP, Zanetti G. für Swissnoso.

Enterobacteriaceae mit Breitspektrum Beta-Laktamasen (ESBL) im Spital: Neue Empfehlungen Swissnoso 2014.

Swissnono Band 18 No 2, S. 1-8 Swissnoso Bulletin

Kronenberg A, Hilty M, Endimiani A, Mühlemann K.

Temporal trends of extended-spectrum cephalosporin resistant Escherichia coli and Klebsiella pneumoniae in Switzerland.

Euro Surveill 2013 May 23; 18(21): 1-10. boris.unibe.ch/43826

Hilty M, Betsch BY, Bögli-Stuber K, Heiniger N, Stadler M, Küffer M, Kronenberg A, Rohrer C, Aebi S, Endimiani A, Droz S, Mühlemann K.

Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting

Clin Infect Dis. 2012 Oct;55(7):967-75. doi: 10.1093/cid/cis581. Epub 2012 Jun 20. Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting.

Last update: 5.9.2019

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. As resistances to cephalosporines and azithromycin are increasing, ceftriaxone should be prescribed TOGETHER with azithromycin (synergism) 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 gonorrhoeae infection data (German):

Link

General information on sexually transmitted diseases: Love-life

Link

Swiss AIDS Federation

Link

Guideline Swiss Society for Infectious Diseases

Link

Last update: 5.9.2019

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.

Last update: 5.9.2019

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 (2004-2018), the MRSA rate decreased considerably from 12.8% to 4.6%. Simultaneously a shift of MRSA from the inpatient to the outpatient setting was observed.

Links / literature:

Olearo F, Albrich WC, Vernaz A, Harbarth A, Kronenberg A. and the Swiss Centre for Antibiotic Resistance (ANRESIS).

Staphylococcus aureus and methicillin resistance in Switzerland: regional differences and trends from 2004 to 2014.

Download PDF

Streptococcus pneumoniae

Penicillin resistance in pneumococci has slightly decreased due to vaccination.

Pneumococci mainly cause infections of the lungs (pneumonia) and blood (sepsis). The non-susceptibility rate to penicillin has decreased from 9.5% in 2004 to 6.3% in 2018. One reason for this trend is probably the pneumococcal vaccine. Since its introduction both the morbidity and the resistance rates have decreased considerably.

Links / literature:

Fact-sheet about the pneumococcal vaccine in children from infovac (German)

Download PDF

Malattie pneumococciche invasive 2013 – 2017. Bollettino dell’UFSP 03/2019, Pag. 10-19.

Download PDF

Hauser C, Kronenberg A, Allemann A, Mühlemann K. Hilty M.

Serotype/serogroup-specific antibiotic non-susceptibility of invasive and non-invasive Streptococcus pneumoniae, Switzerland, 2004 to 2014.

Euro Surveill 2016 May 26;21(21).

Download PDF

National Center for Invasive Pneumococci (NZPn)

Link

Last update: 5.9.2019