RESEARCH – November 2020

Antimicrobial resistance among community-acquired pathogens

Authors: Epp Sepp, Irja Lutsar, Karolin Toompere, Piret Mitt, Kaidi Telling, Jana Lass, Paul Naaber

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Antimicrobial resistance (AMR) is a major problem in modern health care, the management of which requires AMR surveillance.

The aim of the study was to describe the resistance of community-acquired microbial strains in Estonia, comparing it to that of neighbouring countries, and the AMR of invasive microbial strains.

Methodology. AMR data from various laboratories of Estonia, from scientific publications and from the European Antimicrobial Resistance Surveillance Network were included.

Results. The resistance of S. pneumoniae, which causes upper respiratory tract infections, to penicillin was 1.5% and the resistance of H. influenzae strains to ampicillin was 16.7%. The AMR of Estonian S. pneumoniae and H. influenzae was similar to that of Finland while the Russian strains were more resistant. Of the E. coli microbial strains causing urological infections, more than 30% were resistant to ampicillin and piperacillin, more than 20% were resistant to trimethoprim and TMP-SMX, more than 10% were resistent to norfloxacin and levofloxacin, and less than 2% were resistant to nitrofurantoin. The resistance of E. coli was higher in men and increased with age in women. The microbial strains of E. coli and K. pneumoniae isolated in Russia were more resistant than Estonian and Finnish microbial strains. The microbial strains of K. pneumoniae isolated in Estonia were more resistant than the microbial strains isolated in Finland. The microbial strains of community acquired E. coli were more sensitive and the microbial strains of S. pneumoniae were more resistant than the invasive microbial strains isolated in hospital.

Summary. The AMR of microbial strains isolated from Estonian community is low, similar to Finland. Microbial strains isolated from Russia are more resistant. The AMR of pathogens isolated from the hospital were not similar to strains from the community. For containment of AMR, it is important to collect community-acquired microorganisms’ AMR data, on the basis of which we can monitor the spread of microbial strains with different resistance mechanisms. Community-acquired AMR data is important for the development of local knowledgebased treatment guidelines to improve the quality of treatment.