BackgroundAntibiotic resistance, either intrinsic or acquired, is a major obstacle for treating bacterial infections.AimOur objective was to compare the country-specific species distribution of the four Gram-negative species Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species and the proportions of selected acquired resistance traits within these species.MethodWe used data reported for 2016 to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 countries in the European Union and European Economic Area.ResultsThe country-specific species distribution varied considerably. While E. coli accounted for 31.9% to 81.0% (median: 69.0%) of all reported isolates, the two most common intrinsically resistant species P. aeruginosa and Acinetobacter spp. combined (PSEACI) accounted for 5.5% to 39.2% of isolates (median: 10.1%). Similarly, large national differences were noted for the percentages of acquired non-susceptibility to third-generation cephalosporins, carbapenems and fluoroquinolones. There was a strong positive rank correlation between the country-specific percentages of PSEACI and the percentages of non-susceptibility to the above antibiotics in all four species (rho > 0.75 for 10 of the 11 pairs of variables tested).ConclusionCountries with the highest proportion of P. aeruginosa and Acinetobacter spp. were also those where the rates of acquired non-susceptibility in all four studied species were highest. The differences are probably related to national differences in antibiotic consumption and infection prevention and control routines.

Assistance Publique Hôpitaux de Paris Pitié Salpêtrière hospital Laboratoire de Bactériologie Hygiène Paris France

Clinical Microbiology Central Hospital Växjö Sweden

Department of Clinical Microbiology Faculty of Medicine and University Hospital Charles University Hradec Kralove Czech Republic

Department of Clinical Microbiology Karolinska University Hospital Stockholm Sweden

Department of Epidemiology and Clinical Microbiology National Medicines Institute Warsaw Poland

Department of Experimental and Clinical Medicine University of Florence Italy

Department of Infectious Diseases Istituto Superiore di Sanità Rome Italy

Department of Laboratory Medicine Karolinska Institute Stockholm Sweden

Department of Microbiology and Infection Control University Hospital of North Norway Tromsø Norway

Department of Public Health Policy School of Public Health University of West Attica Athens Greece

European Centre for Disease Prevention and Control Solna Sweden

Medical Center University of Freiburg Department for Infection Prevention and Hospital Epidemiology Freiburg Germany

Microbiology and Virology Unit Florence Careggi University Hospital Florence Italy

National Infection Service Public Health England London United Kingdom

National Institute for Public Health and the Environment Bilthoven the Netherlands

National Institute of Public Health National Reference Laboratory for Antibiotics Prague Czech Republic

Pan American Health Organization World Health Organization Washington DC United States

Reference and Research Laboratory on Antimicrobial Resistance Centro Nacional de Microbiología Instituto de Salud Carlos 3 Madrid Spain

Research Group for Host Microbe Interaction Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway

Robert Koch Institute Department for Infectious Disease Epidemiology Berlin Germany

Sorbonne Universités UMR 1135 Paris France

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