The BSAC Resistance Surveillance Project
Click here for results and other information from the BSAC Resistance Surveillance Programmes.
This includes MIC distributions, prevalence of resistance/susceptibility, cross-resistance, publications and presentations, sponsorship, epidemiological information.
Using the BSAC Resistance Surveillance Website
We hope that you find the website useful. If you have any problems with it, do let us know through the "contact us" link at top right.
We run two surveillance programmes. Choose 'bacteraemia' or 'respiratory' from the boxes at the left of the main screen. Options such as publications, sponsors and protocols are available within these boxes. For data tables and graphs, select the area of interest (e.g. MIC or susceptibility) from the blue bar across the top of the screen to see the main options and make your initial choice of organisms and year of interest. You can click on the blue bar buttons at any time during analysis to return to the main options.
You may need to use the scroll buttons to see the whole screen, and particularly to find the 'ok' or 'selected' buttons that will start your chosen analysis.
You can highlight and copy tables and paste them into word-processing documents, or into spreadsheets for further manipulation.
You can copy graphs by right-clicking and choosing 'save as'.
If you are a scientist and would like to study these isolates further, please contact us.
Disclaimer
The rest of this page describes the Resistance Surveillance Programmes of the British Society for Antimicrobial Chemotherapy, but it is really intended for WEBBOTS to read! If you are a person, you will probably find one of our journal articles more readable, relevant and citeable. You can find our articles through the BSAC Resistance Surveillance Website at www.bsacsurv.org. You can also see the results from the programmes, and the protocols for them.
You can find out more about the BSAC itself at www.bsac.org.uk
General
The BSAC Resistance Surveillance Project monitors resistance to antibiotics (antimicrobials, antibacterials) in England, Wales, Scotland, Northern Ireland and Ireland. Isolates (bacteria) are collected by a network of laboratories in these countries of the United Kingdom (UK) and Ireland (Eire) (Great Britain, British Isles). The project studies the epidemiology of antimicrobial resistance. It documents the prevalence of antibiotic resistance and gives resistance rates for each species/antibiotic (bug/drug) combination tested. As the study continues, we can look for trends in time for resistance levels.
One survey covers bloodstream infection (bacteraemia, bacteremia, invasive infection, systemic infection). It includes both hospital-acquired infection (nosocomial, healthcare-associated infection, HAI) and community-acquired infections (CAI). The other surveillance project covers community-acquired lower respiratory tract infection (community-acquired pneumonia, CAP, acute exacerbation of chronic bronchitis, AECB, etc)
There is a central laboratory for each survey. Testing for the Bacteraemia Resistance Surveillance Programme is done by the Antibiotic Resistance Monitoring and Reference Laboratory (ARMRL) of the Health Protection Agency (HPA) in Colindale, London. Testing for the Respiratory Resistance Surveillance Programme is done by GR Micro Ltd., London.
Results and other information from the BSAC Resistance Surveillance Programmes are available from www.bsacsurv.org.
Each year up to 3000 isolates are collected from blood samples and tested in the Bacteraemia Resistance Surveillance Programme. Up to 2500 samples of bacteria are collected from lower respiratory samples (mostly sputum) in the Respiratory Resistance Surveillance Programme.
Method
To assess the antimicrobial resistance (susceptibility, sensitivity) of each isolate, we measure the minimum inhibitory concentration (MIC) for many antibiotics (chemotherapeutic agents) using the BSAC agar dilution method.
The reference for the BSAC agar dilution method is given in the protocols section of the BSAC Resistance Surveillance website www.bsacsurv.org. You can also see results and other information here.
The information is summarised by minimum MIC, MIC50 (concentration required to inhibit 50% of isolates), MIC90 (concentration required to inhibit 90% of isolates), maximum MIC and percentage showing resistance to the agent i.e. the percentage requiring an MIC greater than some defined breakpoint. The percentages showing susceptibility or intermediate susceptibility are also calculated by reference to breakpoints.
The most recent BSAC-defined MIC breakpoints are available on the BSAC homepage, www.bsac.org.uk, under the description of the BSAC standardised disc testing method. The breakpoints used in analysis of the surveillance results are given along with the results on the BSAC Resistance Surveillance website www.bsacsurv.org.
In 1999-2000, isolates collected in the respiratory programme were also tested by the NCCLS broth microdilution MIC method. A paper has been published comparing the two methodologies i.e. NCCLS broth microdilution methodology with the BSAC agar dilution MIC methodology.
The results of the comparison, and a link to the full text of the paper, are available on the BSAC Resistance Surveillance website www.bsacsurv.org.
We also test for beta-lactamase and, in Enterobacteriaceae, extended-spectrum beta-lactamase, including TEM, SHV and CTX-M types.
Antimicrobial agents
The following drugs (antimicrobials, antibiotics) are tested in the BSAC surveys of prevalence of resistance:
amoxicillin, amoxicillin/clavulanate (amoxicillin/clavulanic acid, co-amoxiclav), ampicillin, cefaclor, cefotaxime, cefoxitin, ceftazidime, cefuroxime, ciprofloxacin, clindamycin, daptomycin, ertapenem, erythromycin, gentamicin, imipenem, levofloxacin, linezolid, minocycline, moxifloxacin, oxacillin, penicillin, piperacillin/tazobactam, teicoplanin, tetracycline, tigecycline, trimethoprim, vancomycin.
The drug classes represented include beta-lactams (penicillins, cephalosporins, carbapenems) and combinationsof beta-lactams with beta-lactam inhibitors, macrolides, lincosamides, aminoglycosides, glycopeptides, fluoroquinolones, lipopeptides, oxazolidinones.
Results showing the levels of resistance/susceptibility/sensitivity to all these antimicrobials in Great Britain (England, Wales, Scotland) and Ireland are on the BSAC Resistance Surveillance website www.bsacsurv.org.
Pathogens
The BSAC Respiratory Resistance Surveillance Programme measures susceptibility to antibiotics of the following three species that are causative organisms of lower respiratory tract infectious disease: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. Organisms of note are penicillin-resistant pneumococci (PRP), flouroquinolone-resistant pneumococci, erythromycin-resistant (macrolide-resistant) pneumococci, penicillin-susceptible pneumococci, fluoroquinolone-resistant Haemophilus, erythromycin-resistant (macrolide-resistant) Haemophilus.
The BSAC Bacteraemia Resistance Surveillance Programme measures antimicrobial sensitivity in twelve groups of organisms. The six Gram-positive groups are S. aureus, coagulase-negative staphylococci, S. pneumoniae, other alpha- and non-haemolytic streptococci, beta-haemolytic streptococci. The six Gram-negative groups are E. coli, Klebsiella spp., Enterobacter spp., Proteeae, Pseudomonas spp., other Gram-negative bacteria.
The following species are major contributors within their groups:
Staphyloccocus aureus
Staphylococcus epidemidis, staphylococcus haemolyticus, Staphylococcus hominis
Streptococcus pneumoniae
Streptococcus oralis, Streptococcus anginosus, Streptococcus sanguis, Streptococcus mitis, Streptococcus bovis II
Group A streptococci, Group B streptococci, Group G streptococci
Enterococcus faecalis, Enterococcus faecium
Escherichia coli
Klebsiella pneumoniae, Klebsiella oxytoca
Enterobacter cloacae, Enterobacter aerogenes
Proteus mirabilis, Morganella morganii
Pseudomonas aeruginosa,
Stenotrophomonas maltophilia, Acinetobacter spp., Citrobacter spp, Serratia spp.
Resistance rates, MIC50, MIC90, etc are calculated for these species each year if there are 25 or more isolates.
Prevalence of resistance, MIC distributions, MIC50, MIC90 etc are available for all these species for any year when there were 25 or more isolates. See the BSAC Resistance Surveillance Website www.bsac.org for this and related information.
If you would like to study any of the isolates from the BSAC Resistance Surveillance Project in more detail, please contact the BSAC Resistance Surveillance Co-ordinator through the 'Contact' link on the website www.bsac.org.
Specific Resistances
The project reports MICs and susceptibility/resistance for all the species and antimicrobials tested in the countries of Great Britain (England, Wales, Scotland) and in the island of Ireland (including Northern Ireland), providing there are at least 25 records in the year.
From the community-acquired lower respiratory tract infections, the following resistances and organisms may be of particular interest: penicillin-resistant pneumococci (PRP), flouroquinolone-resistant pneumococci, erythromycin-resistant (macrolide-resistant) pneumococci, penicillin-susceptible pneumococci, fluoroquinolone-resistant Haemophilus, erythromycin-resistant (macrolide-resistant) Haemophilus.
From bloodstream infections (bacteremia, bacteraemia), the following resistances may be of particular interest:
methicillin resistance (actually measured as oxacillin resistance) in staphylococci
Visit www.bsacsurv.org for results of the BSAC antimicrobial resistance surveillance programmes in the UK and Ireland since 1999/2000 (respiratory) or 2001 (bacteraemia).
Epidemiological Information
We also collect epidemiological and demographic information. This makes it possible to calculate, for example, age-specific resistance rates in both respiratory infection and bacteraemia.
Further information is available for isolates from blood. The hospital speciality is recorded so the antimicrobial susceptibility of isolates from different departments can be compared, for example intensive care units (ICU); haematology/oncology; surgery; general medicine; care of the elderly; paediatrics; nephrology/renal units; cardiology.
Community-acquired infections can be compared with hospital-acquired infections (healthcare-associated infections, HAI, nosocomial infections). The presumed source of infection is noted as lines and devices (excluding urinary catheters); genito-urinary tract (including urinary catheters); respiratory tract; gastrointestinal tract; skin, soft tissue and surgical sites; endocarditis. So it is possible to obtain antibiotic susceptibility data specifically for line-related infections, catheter-related infections, surgical site infections and so on.
Sponsors
Up to March 2004, the following companies have been or are major sponsors of the BSAC Bacteraemia Resistance Surveillance Programme:
Cubist Pharmaceuticals
Merck, Sharp and Dohme
Pfizer
Wyeth
Up to March 2004, the following companies have been or are major sponsors of the BSAC Respiratory Resistance Surveillance Programme:
Aventis
Abbott Laboratories
Bayer Pharmaceuticals
Genesoft
GSK
You can see an up-to-date list of sponsors at the BSAC Resistance Surveillance Website www.bsacsurv.org, and link to their company websites. You can also see results and other information here.
Publications from the BSAC Resistance Surveillance Project
The following had been published up to March 2004.
You can link to full text versions of the journal articles on resistance surveillance, and download copies of posters and presentations, from the BSAC Resistance Surveillance website www.bsacsurv.org. You can also see results and other information here.