Surveillance of antimicrobial resistance in Europe : annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) 2017.
Date: 2019-04-30
Institutions: European Centre for Disease Prevention and Control
Subjects: activity report, antibiotic, antimicrobial resistance, health control, medical research, medicinal product, therapeutics

SURVEILLANCE REPORT

Surveillance of antimicrobial 
resistance in Europe
2017

www.ecdc.europa.eu

Surveillance of antimicrobial  
resistance in Europe

Annual report of the European Antimicrobial 
Resistance Surveillance Network (EARS-Net)

2017

The European Centre for Disease Prevention and Control (ECDC) wishes 
to thank all EARS-Net participating laboratories and hospitals in the 
EU/EEA countries for providing data for this report.

ECDC would also like to thank the National Focal Points for 
Antimicrobial Resistance and the Operational Contact Points for 
Epidemiology, the Operational Contact Points for Microbiology and the 
Operational Contact Points for TESSy that contribute to EARS-Net by 
facilitating data transfers and providing valuable comments for this 
report. John Stelling (WHONET representative) is acknowledged for 
providing technical support to the countries during data preparation. 
Carlo Gagliotti (ECDC consultant) is acknowledged for his work in 
preparing the country summary sheets. In addition, ECDC wishes to 
thank the EARS-Net Disease Network Coordination Committee: José 
Campos, Tim Eckmanns, Vincent Jarlier, Alan Johnson, Jos Monen, 
Annalisa Pantosti, Gunnar Skov Simonsen, Alkiviadis Vatopoulos, 
Dorota Żabicka, Helena Žemličková, Christian Giske (observer, 
EUCAST), Hajo Grundmann (observer), Gunnar Kahlmeter (observer, 
EUCAST), Gian Maria Rossolini (observer) and Danilo Lo Fo Wong 
(observer, WHO Regional Office for Europe) for providing scientific 
advice.

Suggested citation: European Centre for Disease Prevention and Control. Surveillance of 
antimicrobial resistance in Europe – Annual report of the European Antimicrobial Resistance 
Surveillance Network (EARS-Net) 2017. Stockholm: ECDC; 2018.

Stockholm, November 2018

ISBN 978-92-9498-279-7
ISSN 2599-560X
doi:10.2900/230516
TQ-AZ-18-001-EN-N
© European Centre for Disease Prevention and Control, 2018.

Cover picture © istockphoto

Reproduction is authorised, provided the source is acknowledged.
For any use or reproduction of photos or other material that is not under the EU copyright, 
permission must be sought directly from the copyright holders.

ii

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Contents

Summary  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .

 .1

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .3

Antimicrobial resistance   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 3

EARS-Net. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 EARS-Net data collection and analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .5

Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Data validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 5

3 Antimicrobial resistance in Europe 2014 to 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .7

3.1 Escherichia coli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 7

3.2 Klebsiella pneumoniae  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 19

3.3 Pseudomonas aeruginosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

3.4 Acinetobacter species . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 41

3.5 Streptococcus pneumoniae  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

3.6 Staphylococcus aureus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  54

3.7 Enterococci. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 57

References  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .  .61

Annex  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

National institutions/organisations participating in EARS-Net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .64

Country summaries  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .  .66

iii

List of tables

Table 3.1. Escherichia coli. Total number of tested isolates and resistance combinations among invasive isolates tested against 
aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems (n=112 327), EU/EEA countries, 2017. 9

Table 3.2. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to aminopenicillins (%R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Table 3.3 Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to fluoroquinolones (%R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Table 3.4. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to third-generation 
cephalosporins (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Table 3.5. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to aminoglycosides (%R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Table 3.6. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to carbapenems (%R), including 
95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Table 3.7. Escherichia coli. Total number of isolates tested (N) and percentage with combined resistance to fluoroquinolones, third-
generation cephalosporins and aminoglycosides (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . .18

Table 3.8. Klebsiella pneumoniae. Total number of invasive isolates tested* and resistance combinations among isolates tested 
against fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems (n=30 409). EU/EEA countries, 2017 . . . . . . . . . . . .21

Table 3.9. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to fluoroquinolones 
(%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Table 3.10. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to third-generation 
cephalosporins (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Table 3.11. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to aminoglycosides 
(%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Table 3.12. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to carbapenems (%R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Table 3.13. Klebsiella pneumoniae. Total number of isolates tested (N) and percentage with combined resistance to fluoroquinolones, 
third-generation cephalosporins and aminoglycosides (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . 29

Table 3.14. Pseudomonas aeruginosa. Total number of tested isolates and resistance combinations among invasive isolates tested 
against at least three antimicrobial groups among piperacillin ± tazobactam, ceftazidime, fluoroquinolones, aminoglycosides and 
carbapenems (n = 16 885), EU/EEA countries, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Table 3.15. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to piperacillin ± 
tazobactam (%R), including 95 % confidence intervals (95 %CI), EU/EEA countries, 2014 to 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Table 3.16. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to fluoroquinolones 
(%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Table 3.17. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to ceftazidime (% R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Table 3.18. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to aminoglycosides 
(%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Table 3.19 Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to carbapenems 
(%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Table 3.20. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) with combined resistance (resistance to three or more 
antimicrobial groups among piperacillin ± tazobactam, ceftazidime, fluoroquinolones, aminoglycosides and carbapenems) including 95 % 
confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Table 3.21. Acinetobacter spp. Overall resistance and resistance combinations among invasive isolates tested to fluoroquinolones, 
aminoglycosides and carbapenems (n=5 853)*, EU/EEA countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Table 3.22. Acinetobacter spp. Total number of invasive isolates tested (N) and percentage with resistance to fluoroquinolones (%R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Table 3.23. Acinetobacter spp. Total number of invasive isolates tested (N) and percentage with resistance to aminoglycosides (%R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Table 3.24. Acinetobacter spp. Total number of invasive isolates tested (N) and percentage with resistance to carbapenems (%R), 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

Table 3.25. Acinetobacter spp. Total number of isolates tested (N) and percentage with combined resistance to fluoroquinolones, 
aminoglycosides and carbapenems (%R), including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . 48

Table 3.26. Streptococcus pneumoniae. Total number of tested isolates (N) and percentages non-susceptible to penicillin (%IR), 
including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Table 3.27. Streptococcus pneumoniae. Total number of tested isolates (N) and percentages non-susceptible to macrolides (%IR), 
including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Table 3.28. Streptococcus pneumoniae. Total number of tested isolates (N) and percentages non-susceptible to penicillins and 
macrolides (%IR), including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

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SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.29. Staphylococcus aureus. Total number of tested isolates* and resistance combinations among invasive isolates tested 
against meticillin, fluoroquinolones and rifampicin (n=49 424), EU/EEA countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Table 3.30. Staphylococcus aureus. Total number of invasive isolates tested (N) and percentage with resistance to meticillin (MRSA) 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  56

Table 3.31. Enterococcus faecalis. Total number of invasive isolates tested (N) and percentage with high-level resistance to gentamicin 
including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Table 3.32. Enterococcus faecium. Total number of invasive isolates tested (N) and percentage with resistance to vancomycin, including 
95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

v

List of figures

Figure 3.1. Escherichia coli. Distribution of isolates: fully susceptible and resistant to one, two, three, four and five antimicrobial 
groups (among isolates tested against aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and 
carbapenems), EU/EEA countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Figure 3.2. Escherichia coli. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA countries, 2017. . . . . . .10

Figure 3.3. Escherichia coli. Percentage (%) of invasive isolates with resistance to third-generation cephalosporins, by country, EU/EEA 
countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 10
Figure 3.4. Escherichia coli. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country, EU/EEA countries, 2017   . . . . . . 11
Figure 3.5. Escherichia coli. Percentage (%) of invasive isolates with resistance to carbapenems, by country, EU/EEA countries, 2017  . . . . . . . . . . . 11

Figure 3.6. Escherichia coli. Percentage (%) of invasive isolates with combined resistance to third-generation cephalosporins, 
fluoroquinolones and aminoglycosides, by country, EU/EEA countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Figure 3.7. Klebsiella pneumoniae. Distribution of isolates: fully susceptible and resistant to one, two, three and four antimicrobial 
groups (among isolates tested against fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems), 
EU/ EEA countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 20
Figure 3.8. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA countries, 2017 22

Figure 3.9. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to third-generation cephalosporins, by country, 
EU/EEA countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Figure 3.10. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country, EU/EEA 
countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 23
Figure 3.11. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to carbapenems, by country, EU/EEA countries, 2017  23

Figure 3.12. Klebsiella pneumoniae. Percentage (%) of invasive isolates with combined resistance to fluoroquinolones, third-
generation cephalosporins and aminoglycosides, by country, EU/EEA countries, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Figure 3.13. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to piperacillin ± tazobactam, by country, 
EU/EEA countries, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 31

Figure 3.14. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA 
countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 32

Figure 3.15. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to ceftazidime, by country, EU/EEA 
countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 32

Figure 3.16. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country, EU/EEA 
countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 33

Figure 3.17. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to carbapenems, by country, EU/EEA 
countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 33

Figure 3.18. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with combined resistance (resistance to three or more 
antimicrobial groups among piperacillin ± tazobactam, ceftazidime, fluoroquinolones, aminoglycosides and carbapenems), by 
country, EU/EEA countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 34

Figure 3.19. Acinetobacter spp. Distribution of isolates: fully susceptible and resistant to one, two and three antimicrobial groups 
(among isolates tested against fluoroquinolones, aminoglycosides and carbapenems),  
EU/EEA countries, 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 42
Figure 3.20. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country, EU/EEA countries, 2017   43
Figure 3.21. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country, EU/EEA countries, 2017 . . 43
Figure 3.22. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to carbapenems, by country, EU/EEA countries, 2017  . . . . . 44

Figure 3.23. Acinetobacter spp. Percentage (%) of invasive isolates with combined resistance to fluoroquinolones, aminoglycosides 
and carbapenems, by country, EU/EEA countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Figure 3.24. Streptococcus pneumoniae.  Percentage (%) of invasive isolates non-susceptible to macrolides, by country, EU/EEA 
countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 50

Figure 3.25. Staphylococcus aureus. Percentage (%) of invasive isolates with resistance to meticillin (MRSA), by country, EU/EEA 
countries, 2017  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Figure 3.26. Enterococcus faecalis. Percentage (%) of invasive isolates with high-level resistance to gentamicin, by country, EU/EEA 
countries, 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Figure 3.27. Enterococcus faecium. Percentage (%) of invasive isolates with resistance to vancomycin, by country, EU/EEA countries, 2017 . . . . 58

vi

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Summary

The results presented in this report are based on antimi-
crobial  resistance  data  from  invasive  isolates  reported 
to  the  European  Antimicrobial  Resistance  Surveillance 
Network  (EARS-Net)  by  30  European  Union  (EU)  and 
European  Economic  Area 
in  2018 
(data  referring  to  2017),  and  on  trend  analyses  of  data 
reported  by  the  participating  countries  for  the  period 
2014 to 2017.

(EEA)  countries 

Despite  the  political  prioritisation  of  antimicrobial 
resistance  as  a  threat  to  public  health  and  the  avail-
ability  of  evidence-based  guidance  for  antimicrobial 
stewardship  and  infection  prevention  and  control,  high 
levels  of  resistance  remain  in  the  EU/EEA  for  several 
bacterial  species–antimicrobial  group  combinations. 
Intercountry  variations  also  indicate  that  that  there  is 
scope  for  significant  reductions  in  antimicrobial  resist-
ance in many countries through strengthening of current 
best practice. 

The antimicrobial resistance situation in Europe displays 
wide variations depending on the bacterial species, anti-
microbial  group  and  geographical  region.  For  several 
bacterial  species–antimicrobial  group  combinations,  a 
north-to-south  and  west-to-east  gradient  is  evident.  In 
general, lower resistance percentages were reported by 
countries  in  the  north  while  higher  percentages  were 
reported in the south and east of Europe. 

For  Escherichia  coli  and  Klebsiella  pneumoniae,  com-
bined  resistance  to  several  antimicrobial  groups  was 
frequent, and extended-spectrum beta-lactamase (ESBL) 
production  was  common.  Resistance  percentages  were 
generally  higher  in  K. pneumoniae  than  in  E. coli.  For 
E. coli, there was a small but significant increase in the 
trend of the EU/EEA population-weighted mean percent-
age  for  third-generation  cephalosporin  resistance  from 
14.2%  in  2014  to  14.9%  in  2017,  a  trend  that  remained 
significant  when  only  laboratories  reporting  consist-
ently  during  all  four  years  were  included.  By  contrast, 
no  significant  trends  were  noted  for  the  K. pneumoniae 
EU/ EEA  population-weighted  mean  resistance  percent-
ages  when  restricting  analyses  to  the  laboratories  that 
consistently reported data during the four-year period.

While  carbapenem  resistance  remained  rare  in  E. coli, 
several  countries  reported  carbapenem  resistance  per-
centages  above  10%  for  K. pneumoniae.  Carbapenem 
resistance  was  also  common  in  Pseudomonas  aer-
uginosa  and  Acinetobacter  species,  and  at  higher 
percentages  compared  with  K. pneumoniae.  For  all  four 
gram-negative  bacteria,  the  countries  reporting  the 
highest  carbapenem  resistance  percentages  were  also 
among  the  countries  reporting  the  highest  resistance 
percentages for other antimicrobial groups.

For  Streptococcus  pneumoniae,  the  resistance  situation 
appeared stable between 2014 and 2017, but with large 
inter-country  variations.  Macrolide  non-susceptibility 
was,  for  most  countries,  more  frequent  than  penicillin 
non-susceptibility.

For  Staphylococcus  aureus,  the  decline  in  the  percent-
age  of  meticillin-resistant,  i.e.  MRSA,  isolates  reported 
in  previous  years  continued  in  2017.  The  EU/EEA  pop-
ulation-weighted  mean  MRSA  percentage  decreased 
significantly  from  19.6%  in  2014  to  16.9%  in  2017,  with 
similar  decreasing  trends  reported  from  more  than  one 
fourth  of  the  countries.  Nevertheless,  MRSA  remains 
an  important  pathogen  in  the  EU/EEA,  as  the  levels  of 
MRSA were still high in several countries, and combined 
resistance to other antimicrobial groups was common.

Among enterococci, the increasing trend of Enterococcus 
faecium  resistant  to  vancomycin  is  a  cause  of  concern. 
The  EU/EEA  population-weighted  mean  percentage 
increased  significantly  from  10.4%  in  2014  to  14.9%  in 
2017, and corresponding increasing trends were noted in 
around one third of the countries.

EARS-Net  data  for  2017  show  that  antimicrobial  resist-
ance  remains  a  serious  threat  in  Europe.  For  invasive 
bacterial  infections,  prompt  treatment  with  effective 
antimicrobial  agents  is  especially  important  and  is  one 
of  the  single  most  effective  interventions  to  reduce  the 
risk  of  fatal  outcome.  The  high  percentages  of  resist-
ance  to  key  antimicrobial  groups  reported  from  many 
countries are therefore of great concern and represent a 
serious threat to patient safety in Europe. Prudent anti-
microbial  use  and  comprehensive  infection  prevention 
and  control  strategies  targeting  all  healthcare  sectors 
are the cornerstones of effective interventions aiming to 
prevent selection and transmission of bacteria resistant 
to antimicrobial agents.

1

1 Introduction

Antimicrobial resistance 
is  the  ability  of  a 
Antimicrobial  resistance  (AMR) 
microorganism  to  resist  the  action  of  one  or  more  anti-
microbial  agents.  The  consequences  can  be  severe,  as 
prompt  treatment  with  effective  antimicrobials  is  the 
most  important  intervention  to  reduce  the  risk  of  poor 
outcome of serious infections.

Development of AMR is a natural phenomenon caused by 
mutations in bacterial genes, or acquisition of exogenous 
resistance  genes  carried  by  mobile  genetic  elements 
that can spread horizontally between bacteria. Bacteria 
can  acquire  multiple  resistance  mechanisms  and  hence 
become resistant to several antimicrobial agents, which 
is  particularly  problematic  as  it  may  severely  limit  the 
available treatment alternatives for the infection.

The  major  drivers  behind  the  occurrence  and  spread 
of  AMR  are  the  use  of  antimicrobial  agents  and  the 
transmission  of  antimicrobial-resistant  microorgan-
isms  between  humans;  between  animals;  and  between 
humans,  animals  and  the  environment.  While  antimi-
crobial  use  exerts  ecological  pressure  on  bacteria  and 
contributes  to  the  emergence  and  selection  of  AMR, 
poor  infection  prevention  and  control  practices  favour 
the further spread of these bacteria.

The  problem  of  AMR  calls  for  concerted  efforts  at  the 
country level as well as close international cooperation. 
AMR is listed as a special health issue in the Commission 
Implementing Decision (EU) 2018/945 of 22 June 2018 on 
the  communicable  diseases  and  related  special  health 
issues to be covered by epidemiological surveillance [1].

EARS-Net
The  European  Antimicrobial  Resistance  Surveillance 
Network  (EARS-Net)  is  the  main  EU  surveillance  system 
for  AMR  in  bacteria  that  cause  serious  infections.  Data 
reported from the network serve as important indicators 
on  the  occurrence  and  spread  of  AMR  in  Europe.  All  28 
EU  Member  States  and  two  EEA  countries  (Iceland  and 
Norway)  participate  in  EARS-Net.  The  vast  majority  of 
the  countries  regularly  report  data  for  all  bacteria  and 
antimicrobial groups under surveillance. The number of 
participating  laboratories  continuously  increased  since 
the initiation of the network, indicating a strengthening 
of national AMR surveillance systems in the EU/EEA. The 
widespread and continuing implementation of European 
Committee  on  Antimicrobial  Susceptibility  Testing 
(EUCAST) guidelines for antibacterial susceptibility test-
ing  in  Europe,  and  the  high  proportion  of  laboratories 
that participate in the annual EARS-Net external quality 
assessment (EQA) exercise, contribute to improved data 
quality  and  an  increasing  ability  of  EU/EEA  countries  to 
report comparable AMR data.

is 

EARS-Net 
the  European 
the  continuation  of 
Antimicrobial  Resistance  Surveillance  System  (EARSS), 
which was coordinated by the Dutch National Institute for 
Public  Health  and  the  Environment  (RIVM).  Established 
in  1998,  EARSS  successfully  created  an  international 
network  for  AMR  surveillance  and  demonstrated  how 
international AMR data could inform decisions and raise 
awareness  among  stakeholders  and  policymakers.  On 
1  January  2010,  the  administration  of  EARSS  was  trans-
ferred from RIVM to ECDC and the network was renamed 
EARS-Net.

EARS-Net  is  based  on  a  network  of  representatives 
(National  Focal  Points  for  AMR;  Operational  Contact 
Points for Epidemiology, for Microbiology and for TESSy 
interaction)  from  the  EU/EEA  countries  that  collect 
routine  clinical  antimicrobial  susceptibility  data  from 
national  AMR  surveillance  initiatives.  Scientific  guid-
ance  and  support  is  provided  by  the  EARS-Net  Disease 
Network Coordination Committee, which is composed of 
individual  experts  elected  from  the  appointed  National 
Focal  Points  and  Operational  Contact  Points,  and  com-
pleted  by  observers  from  other  organisations  involved 
in  AMR  surveillance.  EARS-Net  activities  are  coordi-
nated  in  close  collaboration  with  two  other  major  ECDC 
surveillance  networks:  the  European  Surveillance  of 
Antimicrobial Consumption Network (ESAC-Net) and the 
Healthcare-associated  Infections  Surveillance  Network 
(HAI-Net). EARS-Net also collaborates with the European 
Society of Clinical Microbiology and Infectious Diseases 
(ESCMID),  in  particular  with  EUCAST,  which  receives 
support from ECDC and ESCMID.

Through  close  collaboration  and  by  using  compatible 
methodology,  the  Central  Asian  and  Eastern  European 
Surveillance  of  Antimicrobial  Resistance 
(CAESAR) 
Network, coordinated by the World Health Organization 
Regional  Office  for  Europe,  complements  EARS-Net  in 
non-EU/EEA  countries  to  obtain  a  pan-European  over-
view of the AMR situation [2].

The objectives of EARS-Net are to:

•  collect  comparable,  representative  and  accurate  AMR 

data

•  analyse temporal and spatial trends of AMR in Europe

•  provide timely AMR data for policy decisions

•  encourage  the 

implementation,  maintenance  and 
improvement  of  national  AMR  surveillance  pro-
grammes; and

•  support  national  systems  in  their  efforts  to  improve 
diagnostic  accuracy  by  offering  an  annual  external 
quality assessment.

3

2 EARS-Net data collection and analysis

A  total  of  30  countries,  including  all  EU  Member  States 
and  two  EEA  countries  (Iceland  and  Norway)  reported 
AMR data for 2017 to EARS-Net before the end of August 
2018. Only data from invasive (blood and cerebrospinal 
fluid)  isolates  are  included  in  EARS-Net.  The  panels  of 
species-antimicrobial agent combinations under surveil-
lance  are  defined  in  the  EARS-Net  reporting  protocol 
[3].  In  addition,  the  EUCAST  guidelines  for  detection  of 
resistance mechanisms and specific types of resistance 
of  clinical  and/or  epidemiological  importance  describe 
the  mechanisms  of  resistance  and  recommend  meth-
ods of detection for key EARS-Net species-antimicrobial 
group combinations [4].

Routine antimicrobial susceptibility testing (AST) results 
are  collected  from  clinical  laboratories  by  the  national 
network  representatives  in  each  participating  country. 
National  data  are  uploaded  directly  to  The  European 
Surveillance  System  (TESSy)  at  ECDC  on  a  yearly  basis. 
Data presented by EARS-Net might diverge slightly from 
the data presented by the countries themselves as anal-
ysis algorithms and population coverage might differ. 

Data analysis
In  terms  of  analysis,  an  isolate  is  considered  resistant 
to  an  antimicrobial  agent  when  tested  and  interpreted 
as  resistant  (R)  in  accordance  with  the  clinical  break-
point  criteria  used by the local laboratory.  An  isolate is 
considered  non-susceptible  to  an  antimicrobial  agent 
when  tested  and  interpreted  as  either  resistant  (R)  or 
intermediately  susceptible  (I)  with  the  same  local  clini-
cal breakpoint criteria. EARS-Net encourages the use of 
EUCAST  breakpoints,  but  results  based  on  other  inter-
pretive  criteria  used  by  the  reporting  countries  were 
accepted for the analysis.

The  use  of  EUCAST  breakpoints  has  increased  over  the 
years.  In  2017,  approximately  89%  of  the  participat-
ing  laboratories  used  EUCAST,  or  EUCAST-harmonised, 
clinical breakpoints, which is an improvement compared 
with  previous  years  and  increases  comparability  of  the 
reported data [5].

National percentages

As a general rule, results were reported as a resistance 
percentage,  i.e.  the  percentage  of  R  isolates  out  of  all 
isolates  with AST information for  that  specific  species–
antimicrobial  group.  For  some  bacteria,  results  were 
reported as the percentage of non-susceptible (I+R) iso-
lates  out  of  all  isolates  with  the  relevant  information. 
For  selected  analyses,  a  95%  confidence  interval  was 
determined.

If fewer than 10 isolates were reported for a specific spe-
cies–antimicrobial  group  combination  in  a  country,  the 

resistance percentage was not calculated and the results 
were not displayed on the maps presented in this report. 

EU/EEA population-weighted mean percentage

A  population-weighted  EU/EEA  mean  percentage  was 
determined by multiplying the percentage resistance for 
each  country  with  the  corresponding  national  popula-
tion  weight  and  summing  up  the  results;  weights  were 
rescaled  if  resistance  percentages  were  not  available 
for one or more countries. Annual population data were 
retrieved from the Eurostat online database [6].

Country  weightings  were  used  to  adjust  for  imbalances 
in  reporting  propensity  and  population  coverage,  as 
the  total  number  of  reported  isolates  by  country  does 
not,  in  most  cases,  reflect  the  population  size.  As  an 
improvement  compared  to  previous  reports,  the  meth-
odology for calculating the EU/EEA population-weighted 
mean  percentage  has  been  adjusted  to  better  control 
for  increasing  differences  in  the  national  number  of 
reported  isolates.  This  sometimes  resulted  in  differ-
ences  compared  with  the  EU/EEA  population-weighted 
means in previous reports.

Trend analyses

The  statistical  significance  of  temporal  trends  of 
resistance  percentages  by  country  and  for  the  EU/EEA 
population-weighted  mean  was  calculated  based  on 
data from the last four years, i.e. 2014 to 2017. Countries 
reporting fewer than 20 isolates per year, or not provid-
ing data for all years within the considered period, were 
not included in the analysis. The statistical significance 
of  trends  was  assessed  by  the  Cochran–Armitage  test, 
and  a  p-value  of  ≤  0.05  was  considered  significant. 
An  additional  sensitivity  analysis  was  performed  by 
repeating  the  Cochran–Armitage  test,  including  only 
laboratories  that  consistently  reported  data  for  the  full 
four-year  period,  thus  minimising  selection  bias  when 
assessing the significance of the trends. This restriction 
might,  in  some  cases,  have  resulted  in  a  considerably 
lower  number  of  isolates  compared  with  the  analysis 
that included all participating laboratories.

Data validity
The  results,  both  for  inter-country  comparisons  and  in 
some cases national trends, should be interpreted with 
caution. Several factors might influence the results and 
result  in  over-  as  well  as  underestimation  of  resistance 
percentages.

Key  indicators  of  the  population  coverage  and  data 
representativeness  are  presented  in  the  country  sum-
mary  sheets,  available  in  the  Annex.  Some  of  the  most 

5

All  laboratories  providing  data  to  EARS-Net  are  offered 
participation  in  an  annual  EQA  exercise  to  assess  the 
reliability  of  their  laboratory  test  results.  The  level  of 
performance for EQA specimens is generally high [5].

important  potential  sources  of  bias  in  EARS-Net  are 
explained below.

Population coverage 

Population  coverage  varied  among  reporting  countries. 
Some  countries  report  data  from  large  national  surveil-
lance  systems  with  a  high  national  coverage,  whereas 
other  countries  report  data  from  a  smaller  subset  of 
local  laboratories  and  hospitals.  For  an  overview  of  the 
population coverage and the number of reporting labora-
tories, see Annex. For countries reporting data from only 
a small number of hospitals and laboratories located in 
one  specific  geographical  area,  the  sample  may  not  be 
representative  of  the  whole  country.  Likewise,  national 
trends  may  not  be  representative  of  regional  situations 
because pooled data could mask variations at the local 
level.

Sampling 

EARS-Net  data  are  exclusively  based  on  invasive  iso-
lates  from  blood  or  cerebrospinal  fluid.  The  clinical 
relevance of indicator bacteria isolated from these body 
sites  is  undisputable.  This  restriction  prevents  some  of 
the inconsistencies that arise from differences in clinical 
case  definitions,  different  sampling  frames  or  hetero-
geneous  healthcare  utilisation  that  would  otherwise 
confound  the  data  analysis  if  isolates  from  all  anatomi-
cal sites were accepted. However, invasive isolates may 
not  be  representative  of  isolates  of  the  same  bacterial 
species  from  other  type  of  infections,  e.g.  urinary  tract 
infections, pneumonia and wound infections.

Case ascertainment of patients with  bloodstream infec-
tions  is  strongly  linked  to  diagnostic  practices  and 
the  frequency  with  which  blood  cultures  are  taken. 
Therefore,  variations  in  blood  culture  frequency  (non-
differential sampling) result in an increasing uncertainty 
when comparing resistance percentages between hospi-
tals and countries. 

Differential sampling can occur if blood cultures are typ-
ically only performed after empirical treatment does not 
show  an  adequate  therapeutic  response.  Predictably, 
this  will  lead  to  an  overestimation  of  the  resistance 
percentage  by  not  including  susceptible  bloodstream 
infection isolates in the denominator.

Laboratory routines and capacity 

The  use  of  guidelines  for  clinical  breakpoints  varies 
among countries in Europe, and in some instances even 
between  laboratories  in  the  same  country.  As  a  result, 
the  interpretation  of  AST  results  may  vary,  at  least  for 
resistance  mechanisms  resulting  in  minimum  inhibi-
tory  concentrations  (MICs)  close  to  the  breakpoints.  In 
addition, clinical breakpoints may change  over  time, as 
breakpoints  may  be  revised.  As  quantitative  data  (i.e. 
disk  diffusion  zone  diameters  or  MIC  values)  were  not 
always  provided  by  participating  laboratories,  only  the 
reported  local  interpretations  as  S,  I  or  R  were  consid-
ered for the analyses.

6

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 20173 Antimicrobial resistance in Europe  
2014 to 2017

3.1 Escherichia coli
Escherichia  coli  is  part  of  the  normal  intestinal  micro-
biota  in  humans,  but  is  also  a  common  cause  of  severe 
infections. It is the most frequent cause of bloodstream 
infections and urinary tract infections in the EU/EEA and 
involved in infections of both community and healthcare 
origin. In addition, it is associated with intra-abdominal 
infections and causes neonatal meningitis.

Resistance  in  E. coli  readily  develops  either  through 
mutations,  as  often  seen  for  fluoroquinolone  resist-
ance,  or  by  acquisition  of  mobile  genetic  elements 
encoding  resistance  mechanisms,  such  as  the  produc-
tion  of  extended  spectrum  beta-lactamases  (ESBLs) 
and  carbapenemases.  ESBLs  are  enzymes  that  confer 
resistance  to  most  beta-lactam  antibiotics,  including 
third-generation  cephalosporins,  and  are  often  seen  in 
combination  with  other  resistance  mechanisms,  caus-
ing  multidrug-resistance.  Carbapenems  usually  resist 
the  effect  of  ESBLs  and  might  remain  as  one  of  the 
few  treatment  options  for  severe  infections.  A  recently 
emerging  threat  is  carbapenem  resistance  mediated  by 
a  range  of  carbapenemases,  which  may  confer  resist-
ance  to  virtually  all  available  beta-lactam  antibiotics. 
Carbapenamase  genes  are  often  located  on  plasmids 
that  can  be  exchanged  between  Enterobacteriaceae, 
such as E. coli, and other gram-negative bacteria.

Antimicrobial resistance

At the EU/EEA level, more than half (58.2%) of the E. coli 
isolates  reported  to  EARS-Net  for  2017  were  resistant 
to  at  least  one  of  the  antimicrobial  groups  under  regu-
lar surveillance, i.e. aminopenicillins, fluoroquinolones, 
third-generation  cephalosporins,  aminoglycosides  and 
carbapenems  (Table  3.1).  In  2017,  the  highest  EU/EEA 
population-weighted  mean  resistance  percentage  was 
reported for aminopenicillins (58.7%), followed by fluo-
roquinolones  (25.7%),  third-generation  cephalosporins 
(14.9%) and aminoglycosides (11.4%) (Tables 3.2–3.5). In 
2017, resistance to carbapenems remained rare in E. coli 
(Table 3.6).

There  were  small  but  significant  increasing  trends  in 
the  EU/EEA  population-weighted  mean  percentages  of 
fluoroquinolone  resistance  and  third-generation  cepha-
losporin  resistance  between  2014  and  2017  (Tables 
3.3–3.4).  For  carbapenem  resistance,  there  was  a  very 
small  but  significantly  decreasing  trend  at  the  EU/EEA 
level  (Table  3.6).  When  restricting  the  analysis  to  only 
include the laboratories that consistently reported data 
during  all  four  years,  only  the  trend  for  third-genera-
tion  cephalosporin  resistance  remained  statistically 
significant.

Resistance  to  multiple  antimicrobial  groups  was  com-
mon.  Among  the  resistant  phenotypes,  resistance  to 
aminopenicillins,  both  as  single  resistance  or  in  com-
bination  with  other  antimicrobial  groups,  was  the  most 
common at the EU/EEA level (Table 3.1). In 2017, combined 
resistance, measured as resistance to fluoroquinolones, 
third-generation  cephalosporins  and  aminoglycosides 
was  6.3%  (EU/EEA  population-weighted  mean)  and  did 
not  significantly  change  during  the  period  2014–2017 
(Table 3.7).

As in previous years, a majority (87.4%) of the third-gen-
eration cephalosporin-resistant isolates from 2017 were 
extended-spectrum  beta-lactamase 
(ESBL)-positive. 
Only  data  from  laboratories  reporting  ESBL  results  for 
all  isolates  identified  as  resistant  to  third-generation 
cephalosporins (64.9% of the laboratories reporting AST 
data for third-generation cephalosporins in E. coli), and 
only  data  from  countries  reporting  at  least  10  such  iso-
lates were included in the analysis (24 countries).

Except  for  carbapenem  resistance,  large  inter-country 
variations were noted for all antimicrobial groups under 
regular  surveillance,  with  generally  higher  resistance 
percentages  reported  from  the  southern  and  eastern 
parts of Europe than from northern Europe (Figures 3.2–
3.6).  Inter-country  differences  between  the  proportions 
of  isolates  that  were  fully  susceptible  to  the  included 
antimicrobial groups were also present (Figure 3.1).

Discussion

As E. coli is the most common cause of bloodstream infec-
tion  in  Europe,  prompt  access  to  effective  antimicrobial 
treatment  is  essential  to  reduce  the  health-related  and 
economic burden associated with this type of infection. 
The high levels of ESBLs and the increasing frequency of 
resistance to key antimicrobial groups is a serious con-
cern  and  reflects  a  continuous  loss  of  effectiveness  in 
treatment of patients with serious infections.

Use  of  broad-spectrum  antimicrobials 
is  a  known 
risk  factor  for  colonisation  and  spread  of  resistant 
Enterobacteriaceae, 
including  E. coli.  Associations 
between EARS-Net national E. coli resistance levels and 
national antimicrobial consumption in both the hospital 
and  community  sector  have  been  found  [7],  underlining 
the  importance  of  comprehensive  antimicrobial  stew-
ardship  programmes  targeting  both  the  community  and 
healthcare settings [8].

The  high  levels  of  ESBLs  and  increasing  resistance  to 
key antimicrobial groups might also lead to an increased 
consumption of carbapenems, which in turn can increase 
the  selection  pressure  and  facilitated  the  spread  of 
carbapenem-resistant  Enterobacteriaceae  (CRE).  CRE 
infections  are  associated  with  high  mortality,  primarily 

7

due  to  delays  in  effective  treatment  and  the  limited 
availability  of  treatment  options.  In  2017,  the  percent-
age  of  carbapenem  resistance  in  the  invasive  E. coli 
isolates  reported  to  EARS-Net  remained  low.  However, 
continued  and  close  monitoring  remains  essential  as 
carbapenem-resistant  E. coli  are  adapted  to  spread  in 
healthcare  settings  and  in  the  community.  A  recently 
updated  ECDC  rapid  risk  assessment  on  CRE  highlights 
the need for high standards in infection prevention and 
control, combined with adequate microbiological capac-
ity to detected and prevent further spread [9].

CRE can be resistant to carbapenems as a result of vari-
ous mechanisms, including – with increasing frequency 
–  production  of  carbapenemase  enzymes.  The  over-
all  presence  and  spread  of  carbapenemase-producing 
Enterobacteriaceae is not possible to assess by the data 
available  from  EARS-Net  as  some  carbapenemases  do 
not confer a fully carbapenem-resistant phenotype. One 

example  is  the  OXA-48-like  carbapenemase  enzymes 
that  present  a  particular  problem  for  laboratory  detec-
tion  because  of  their  weak  hydrolysing  capacity  of 
carbapenems [10]. To address the need for enhanced CRE 
surveillance  and  to  complement  the  phenotypic-based 
surveillance data available from EARS-Net, the European 
Antimicrobial  Resistance  Genes  Surveillance  Network 
(EURGen-Net),  a  new  ECDC  network  for  genomic-based 
surveillance  of  multidrug-resistant  bacteria,  was  estab-
lished.  As  part  of  this  network,  a  carbapenem-  and/or 
colistin-resistant Enterobacteriaceae (CCRE) project was 
initiated, covering a total of 37 EU/EEA countries and EU 
enlargement  countries.  The  project’s  duration  is  from 
2018 to 2020 [11]. The results of this project will provide 
information  on  the  prevalence  and  distribution  of  car-
bapenemases  and  contribute  to  a  better  understanding 
of  the  dissemination  of  CRE  in  Europe  and  the  risk  fac-
tors associated with CRE infections.

Figure 3.1. Escherichia coli. Distribution of isolates: fully susceptible and resistant to one, two, three, four and 
five antimicrobial groups (among isolates tested against aminopenicillins, fluoroquinolones, third-generation 
cephalosporins, aminoglycosides and carbapenems), EU/EEA countries, 2017

)
s
e
t
a

l

o
s
i

d
e
t
r
o
p
e
r
l

a
t
o
t
/
s
e
t
a

l

o
s
i

d
e
d
u

l
c
n

i
(

y
r
t
n
u
o
C

Finland (2636/5315)

Iceland (119/213)

Norway (3725/3734)

Denmark (4875/5123)

Netherlands (6677/6687)

Estonia (399/788)

Austria (4748/5381)

Germany (19314/21085)

Slovenia (1,383/1,435)

Czech Republic (1,429/3,201)

France (12461/13392)

Luxembourg (433/433)

Portugal (6137/6452)

Belgium (3761/4676)

Lithuania (835/852)

Greece (1,300/1,472)

Croatia (1,091/1,160)

Malta (314/314)

Latvia (192/205)

United Kingdom (24405/31579)

Hungary (1,933/2,061)

Spain (5465/5808)

Slovakia (815/882)

Cyprus (156/156)

Romania (482/518)

Italy (3681/7478)

Ireland (2,979/3,125)

Poland (508/2,881)

Bulgaria (185/247)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of total

Fully 
susceptible

Resistant to one 
antimicrobial group

Resistant to two 
antimicrobial groups

Resistant to three 
antimicrobial groups

Resistant to four 
antimicrobial groups

Resistant to ﬁve 
antimicrobial groups

Only data from isolates tested against all included antimicrobial groups included in analysis.

8

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
and animals. ECDC is working closely with the European 
Food  Safety  Authority  and  the  European  Medicines 
Agency  to  better  understand  the 
interrelationship 
between  antimicrobial  use  and  antimicrobial  resistance 
in humans and animals across Europe.

Trends  in  fluoroquinolone  resistance  might  be  influ-
enced  by  the  fact  that,  in  2016,  EUCAST  lowered  its 
clinical  breakpoints  for  several  fluoroquinolones  in 
Enterobacteriaceae.  As  EARS-Net  bases  its  results  on 
SIR interpretations, it is not possible to assess when or 
to  what  degree  this  change  has  been  implemented  by 
the  participating  laboratories  and  how  this  change  has 
influenced  the  results.  As  a  consequence,  trend  analy-
ses for fluoroquinolone resistance should be interpreted 
with caution.

As high E. coli resistance levels have been reported from 
food-producing  animals  in  Europe,  including  isolates 
with carbapenemase production [12], the need to ensure 
cross-sectoral collaboration between the veterinary and 
food production sectors is essential. This work is under-
pinned  by  the  European  Commission’s  ‘One  Health’ 
approach,  which  addresses  resistance  in  both  humans 

Table 3.1. Escherichia coli. Total number of tested isolates* and resistance combinations among invasive isolates 
tested against aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and 
carbapenems (n=112 327), EU/EEA countries, 2017

Resistance pattern
Fully susceptible
Single resistance (to indicated antimicrobial group)
Total (all single resistance)
Aminopenicillins
Fluoroquinolones
Other antimicrobial groups
Resistance to two antimicrobial groups
Total (all two-group combinations)
Aminopenicillins + fluoroquinolones
Aminopenicillins + third-generation cephalosporins
Aminopenicillins + aminoglycosides
Other antimicrobial group combinations 
Resistance to three antimicrobial groups
Total (all three-group combinations)
Aminopenicillins + third-generation cephalosporins + fluoroquinolones
Aminopenicillins + fluoroquinolones + aminoglycosides
Other antimicrobial group combinations 
Resistance to four antimicrobial groups
Total (all four-group combinations)
Aminopenicillins + third-generation cephalosporins + fluoroquinolones + aminoglycosides
Other antimicrobial group combinations 
Resistance to five antimicrobial groups
Aminopenicillins + third-generation cephalosporins + fluoroquinolones + aminoglycosides + carbapenems

Only resistance combinations >1 % of the total are specified.
* Only data from isolates tested against all five antimicrobial groups were included in the analysis.
** Not adjusted for population differences in the reporting countries.

Number of isolates
46 913

 Percentage (%) of total**
41.8

39 649
36 570
2 868
211

12 340
7 730
2 501
1 933
176

8 205
5 040
2 668
497

5 196
5 174
22

24

35.3
32.6
2.6
0.2

11.0
6.9
2.2
1.7
0.2

7.3
4.5
2.4
0.4

4.6
4.6
<0.1

<0.1

9

Figure 3.2. Escherichia coli. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country,  
EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.3. Escherichia coli. Percentage (%) of invasive isolates with resistance to third-generation cephalosporins, by 
country, EU/EEA countries, 2017 

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

10

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Figure 3.4. Escherichia coli. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country,  
EU/EEA countries, 2017 

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.5. Escherichia coli. Percentage (%) of invasive isolates with resistance to carbapenems, by country, EU/EEA 
countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

11

Figure 3.6. Escherichia coli. Percentage (%) of invasive isolates with combined resistance to third-generation 
cephalosporins, fluoroquinolones and aminoglycosides, by country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

12

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.2. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to 
aminopenicillins (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017 

Country

Finland

Iceland

Norway

Denmark

Netherlands

Estonia

Germany

Austria

Slovenia

Czech Republic

France

Luxembourg

Portugal

Belgium

Greece

Lithuania

EU/EEA  
(population-weighted mean)

Croatia

Malta

Hungary

Latvia

United Kingdom

Spain

Slovakia

Cyprus

Italy

Romania

Poland

Ireland

Bulgaria

Sweden

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

2 365

34.7

(33-37)

151

43.0

(35-51)

3 404

4 490

6 458

261

5 543

4 742

1 216

2 978

41.8

(40-43)

44.9

(43-46)

46.0

(45-47)

47.1

(41-53)

51.7

(50-53)

50.4

(49-52)

52.6

(50-55)

54.4

(53-56)

2472

173

3299

4594

5376

196

8358

4880

1326

3172

36.0

(34-38)

2 690

35.8

(34-38)

2 874

35.2

(33-37)

44.5

(37-52)

45.8

(44-48)

45.3

(44-47)

47.2

(46-49)

192

3 615

4 698

6 394

43.8

(37-51)

213

41.3

(35-48)

42.9

(41-45)

45.0

(44-46)

45.9

(45-47)

3 731

4 885

6 684

42.2

(41-44)

45.6

(44-47)

45.9

(45-47)

47.4

(40-55)

471

46.7

(42-51)

439

47.8

(43-53)

49.4

(48-50)

15 957

49.0

(48-50)

19 786

49.1

(48-50)

49.9

(48-51)

54.8

(52-58)

54.3

(53-56)

5 094

1 420

3 055

50.5

(49-52)

57.1

(54-60)

55.1

(53-57)

5 188

1 435

3 198

49.5

(48-51)

51.6

(49-54)

53.0

(51-55)

10 325

55.9

(55-57)

10946

57.0

(56-58)

11 248

57.2

(56-58)

13 293

55.6

(55-56)

371

59.6

(54-65)

4 899

2 876

1 057

58.9

(57-60)

58.9

(57-61)

55.7

(53-59)

590

57.8

(54-62)

347

5177

2674

1079

582

60.2

(55-65)

419

53.2

(48-58)

433

55.9

(51-61)

57.8

(56-59)

58.0

(56-60)

56.1

(53-59)

59.6

(56-64)

5 772

3 736

1 170

794

59.2

(58-61)

58.0

(56-60)

56.9

(54-60)

6 245

4 669

1 306

56.2

(55-57)

57.5

(56-59)

57.5

(55-60)

59.2

(56-63)

845

57.8

(54-61)

73 881

58.5

(58-59)

77813

58.9

(59-59)

107 383

59.0

(59-59)

122 955

58.7

(58-59)

1 077

268

1 603

182

6 637

5 817

866

153

54.0

(51-57)

53.0

(47-59)

59.1

(57-61)

48.4

(41-56)

62.7

(62-64)

1042

238

1970

192

5117

55.3

(52-58)

55.5

(49-62)

60.6

(58-63)

53.6

(46-61)

1 043

328

1 969

247

57.3

(54-60)

60.1

(55-65)

57.4

(55-60)

55.1

(49-61)

1 135

314

2 021

202

58.8

(56-62)

59.6

(54-65)

60.3

(58-62)

60.4

(53-67)

65.8

(64-67)

21 614

62.7

(62-63)

28 647

62.5

(62-63)

64.9

(64-66)

6427

63.9

(63-65)

6 791

64.1

(63-65)

5 724

62.6

(61-64)

64.5

(61-68)

71.2

(63-78)

878

123

62.8

(59-66)

68.3

(59-76)

2 178

65.4

(63-67)

3385

67.4

(66-69)

253

268

68.0

(62-74)

59.7

(54-66)

259

346

73.0

(67-78)

64.7

(59-70)

2 694

68.7

(67-70)

2646

66.2

(64-68)

159

-

73.0

(65-80)

-

-

143

396

66.4

(58-74)

34.1

(29-39)

817

149

3 114

376

1 034

2 990

186

-

62.3

(59-66)

69.1

(61-76)

853

156

64.9

(62-68)

65.4

(57-73)

66.9

(65-69)

4 078

67.1

(66-69)

72.3

(68-77)

64.5

(62-67)

68.1

(66-70)

78.0

(71-84)

-

-

494

913

2 991

203

-

68.2

(64-72)

69.4

(66-72)

69.8

(68-71)

73.9

(67-80)

-

-

N/A

–: No data
* 
 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

 indicate significant increasing and decreasing trends, respectively.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

13

 
Table 3.3 Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to 
fluoroquinolones (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Finland

Denmark

Norway

Netherlands

France

Sweden

Estonia

United Kingdom

Austria

Germany

Luxembourg

Ireland

Belgium

Czech Republic

Slovenia

Lithuania

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

141

3 987

4 489

3 415

6 444

7.8

(4-14)

11.0

(10-12)

12.3

(11-13)

11.0

(10-12)

13.3

(12-14)

162

4 404

4 570

3 298

5 379

6.8

(3-12)

11.2

(10-12)

11.9

(11-13)

10.2

(9-11)

13.2

(12-14)

10 307

17.6

(17-18)

10 998

17.7

(17-18)

9.6

(6-15)

11.5

(11-12)

11.0

(10-12)

10.9

(10-12)

12.8

(12-14)

199

5 305

5 123

3 731

6 685

11.6

(7-17)

12.0

(11-13)

12.8

(12-14)

13.6

(12-15)

14.2

(13-15)

16.7

(16-17)

13 328

15.0

(14-16)

178

4 808

4 827

3 611

6 398

11 251

6 947

12.6

(12-14)

13.7

(13-14)

15.2

(11-20)

699

13.9

(11-17)

5 762

781

15.8

(15-17)

N/A

17.4

(15-20)

5 142

407

6 921

4 642

6 163

368

2 703

2 599

2 976

1 216

592

11.3

(10-12)

12.3

(9-16)

16.8

(16-18)

19.8

(19-21)

20.6

(20-22)

24.7

(20-29)

24.5

(23-26)

26.7

(25-28)

21.6

(20-23)

23.3

(21-26)

12.8

(10-16)

5 525

256

5 812

4 808

9 019

347

2 631

2 565

3 165

1 325

583

15.6

(15-17)

22 883

16.3

(16-17)

30 185

17.5

(17-18)

20.0

(19-21)

5 278

19.8

(19-21)

5 367

20.5

(19-22)

19.4

(19-20)

17 196

19.4

(19-20)

21 080

20.9

(20-21)

24.2

(20-29)

418

28.9

(25-34)

23.1

(21-25)

26.6

(25-28)

22.6

(21-24)

24.6

(22-27)

20.6

(17-24)

2 990

3 854

3 061

1 420

790

22.9

(21-24)

433

3 119

22.9

(19-27)

23.6

(22-25)

24.5

(23-26)

4 382

23.8

(23-25)

27.6

(26-29)

25.6

(23-28)

19.7

(17-23)

3 199

1 383

849

24.5

(23-26)

24.9

(23-27)

25.2

(22-28)

EU/EEA  
(population-weighted mean)

83 863

25.4

(25-26)

90 137

24.8

(24-25)

124 306

25.2

(25-25)

138 652

25.7

(25-26)

Romania

Portugal

Croatia

Latvia

Hungary

Spain

Greece

Poland

Bulgaria

Cyprus

Slovakia

Malta

Italy

307

5 027

1 072

181

1 614

5 818

1 105

1 057

215

153

887

268

31.3

(26-37)

32.4

(31-34)

20.1

(18-23)

17.7

(12-24)

28.4

(26-31)

34.0

(33-35)

32.8

(30-36)

29.2

(27-32)

38.6

(32-45)

46.4

(38-55)

43.0

(40-46)

28.7

(23-35)

371

5 371

1 038

194

2 021

6 484

1 191

1 571

204

123

894

238

30.7

(26-36)

418

30.6

(26-35)

518

26.4

(23-30)

29.7

(28-31)

24.0

(21-27)

27.8

(22-35)

29.0

(27-31)

31.6

(30-33)

30.6

(28-33)

27.9

(26-30)

35.3

(29-42)

45.5

(37-55)

44.2

(41-48)

37.4

(31-44)

5 783

1 041

245

1 986

6 793

1 304

2 637

237

149

826

328

28.9

(28-30)

6 424

27.3

(26-28)

27.9

(25-31)

27.8

(22-34)

26.8

(25-29)

32.8

(32-34)

32.1

(30-35)

33.1

(31-35)

42.2

(36-49)

47.0

(39-55)

40.4

(37-44)

41.5

(36-47)

1 150

201

2 051

5 557

1 464

1 832

247

156

882

314

28.2

(26-31)

30.3

(24-37)

30.6

(29-33)

32.5

(31-34)

32.9

(31-35)

35.9

(34-38)

42.1

(36-49)

42.9

(35-51)

43.2

(40-47)

43.3

(38-49)

3 647

43.9

(42-46)

5 590

44.4

(43-46)

5 950

43.3

(42-45)

6 945

44.9

(44-46)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

14

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
Table 3.4. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to third-
generation cephalosporins (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Norway

Iceland

Netherlands

Denmark

Finland

Sweden

Estonia

Austria

Belgium

Luxembourg

France

United Kingdom

Ireland

Germany

Slovenia

Spain

Czech Republic

EU/EEA  
(population-weighted mean)

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

3 421

152

6 497

4 410

4 009

6 546

410

4 739

2 802

368

5.8

3.3

5.7

7.0

5.4

5.6

9.3

9.4

9.7

(5-7)

(1-8)

(5-6)

(6-8)

(5-6)

(5-6)

(7-12)

(9-10)

(9-11)

12.0

(9-16)

10 349

9.9

(9-11)

6 221

2 691

6 246

1 216

5 821

2 978

10.3

(10-11)

10.7

(10-12)

10.5

(10-11)

12.7

(11-15)

12.3

(12-13)

14.0

(13-15)

3 301

173

5 378

4 561

4 342

5 995

246

4 900

2 593

347

11 051

5 169

2 638

9 031

1 326

6 428

3 172

6.0

(5-7)

1.7

5.7

7.5

6.1

(0-5)

(5-6)

(7-8)

(5-7)

6.2

(6-7)

11.4

(8-16)

9.7

9.7

(9-11)

(9-11)

12.7

(9-17)

3 617

192

6 397

4 659

4 742

6 958

701

5 267

3 737

418

5.6

4.2

6.4

6.6

6.9

8.3

9.0

(5-6)

(2-8)

(6-7)

(6-7)

(6-8)

(8-9)

(7-11)

10.0

(9-11)

10.5

(10-12)

13.6

(10-17)

3 734

213

6 684

4 883

5 223

5 790

788

5 129

4 672

433

5.9

6.1

6.2

6.9

6.9

7.4

8.8

9.6

9.7

9.7

(5-7)

(3-10)

(6-7)

(6-8)

(6-8)

(7-8)

(7-11)

(9-10)

(9-11)

(7-13)

11.0

(10-12)

11 313

11.2

(11-12)

13 352

10.2

(10-11)

11.3

(10-12)

21 846

9.2

(9-10)

27 925

10.3

(10-11)

11.4

(10-13)

10.3

(10-11)

13.7

(12-16)

11.6

(11-12)

14.5

(13-16)

2 985

17 190

1 420

6 796

3 061

11.4

(10-13)

3 121

12.0

(11-13)

11.1

(11-12)

21 070

12.3

(12-13)

12.5

(11-14)

15.0

(14-16)

15.1

(14-16)

1 435

5 804

3 199

12.5

(11-14)

12.8

(12-14)

14.2

(13-15)

85 092

14.2

(14-14)

90 126

14.6

(14-15)

123 087

14.9

(15-15)

137 677

14.9

(15-15)

N/A

Malta

Portugal

Croatia

Poland

Lithuania

Greece

Romania

Hungary

Latvia

Italy

Cyprus

Slovakia

Bulgaria

268

5 024

1 079

1 085

594

1 122

306

1 619

165

10.8

(7-15)

16.4

(15-17)

10.8

(9-13)

10.5

(9-12)

8.1

(6-11)

21.0

(19-24)

29.4

(24-35)

16.4

(15-18)

10.9

(7-17)

3 694

28.7

(27-30)

153

889

218

28.8

(22-37)

31.8

(29-35)

40.4

(34-47)

238

5 376

1 046

1 610

581

1 215

369

2 026

201

5 592

123

893

205

11.8

(8-17)

16.1

(15-17)

12.5

(11-15)

11.9

(10-14)

16.0

(13-19)

19.8

(18-22)

328

5 784

1 045

2 719

795

1 304

14.6

(11-19)

16.1

(15-17)

14.7

(13-17)

314

6 441

1 148

15.6

(12-20)

15.6

(15-16)

16.5

(14-19)

13.7

(12-15)

2 866

16.7

(15-18)

14.7

(12-17)

17.6

(16-20)

26.8

(22-32)

418

23.4

(19-28)

16.7

(15-18)

17.9

(13-24)

30.1

(29-31)

28.5

(21-37)

30.0

(27-33)

38.5

(32-46)

1 993

253

5 938

149

824

238

16.7

(15-18)

24.1

(19-30)

29.8

(29-31)

30.2

(23-38)

29.7

(27-33)

41.6

(35-48)

852

1 470

518

2 058

205

7 077

156

870

247

16.8

(14-19)

18.3

(16-20)

18.7

(15-22)

20.1

(18-22)

22.0

(16-28)

29.5

(28-31)

30.8

(24-39)

30.9

(28-34)

41.3

(35-48)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

15

 
Table 3.5. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to 
aminoglycosides (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Finland

Iceland

Netherlands

Estonia

Denmark

Sweden

Germany

France

Norway

Austria

Belgium

Lithuania

United Kingdom

Luxembourg

Czech Republic

Malta

EU/EEA  
(population-weighted mean)

Slovenia

Ireland

Portugal

Latvia

Spain

Poland

Hungary

Romania

Croatia

Greece

Italy

Cyprus

Slovakia

Bulgaria

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

3 817

152

6 485

411

4 493

5 606

6 244

10 341

3 419

4 726

2 045

584

7 274

367

2 979

268

4.6

5.3

6.3

6.8

7.3

6.1

6.9

7.7

5.9

7.1

(4-5)

(2-10)

(6-7)

(5-10)

(7-8)

(5-7)

(6-8)

(7-8)

(5-7)

(6-8)

8.9

(8-10)

10.6

(8-13)

8.9

7.9

(8-10)

(5-11)

10.7

(10-12)

9.7

(6-14)

4 135

173

5 378

257

4 591

5 761

9 029

11 055

3 301

4 884

2 286

583

6 052

347

3 172

238

5.4

2.9

6.0

9.3

6.8

6.4

7.1

8.2

6.0

7.0

8.4

(5-6)

(1-7)

(5-7)

(6-14)

(6-8)

(6-7)

(7-8)

(8-9)

(5-7)

(6-8)

(7-10)

10.1

(8-13)

9.9

8.9

(9-11)

(6-12)

11.3

(10-13)

12.2

(8-17)

4 519

192

6 397

702

4 846

6 949

17 023

11 135

3 614

5 248

3 499

791

23 166

418

3 061

328

4.9

3.6

6.2

7.4

6.1

7.2

7.0

7.9

5.5

7.8

8.4

8.0

9.9

9.1

(4-6)

(1-7)

(6-7)

(6-10)

(5-7)

(7-8)

(7-7)

(7-8)

(5-6)

(7-9)

(8-9)

(6-10)

(9-10)

(7-12)

12.2

(11-13)

10.4

(7-14)

Trend 
2014-
2017*

N/A

2017

 %R

5.0

5.6

5.6

5.7

6.0

6.5

6.9

7.0

7.2

7.7

8.1

(95 %CI)

(4-6)

(3-10)

(5-6)

(4-8)

(5-7)

(6-7)

(7-7)

(7-7)

(6-8)

(7-8)

(7-9)

8.3

(6-10)

4 982

213

6 686

786

5 122

5 758

20 623

13 103

3 732

5 318

3 769

848

30 739

10.0

(10-10)

433

3 199

314

10.4

(8-14)

10.7

(10-12)

10.8

(8-15)

84 015

11.3

(11-11)

90 050

11.6

(11-12)

123 625

11.6

(11-12)

138 883

11.4

(11-12)

11.3

(10-13)

12.1

(11-13)

15.1

(14-16)

1 326

2 646

5 372

12.9

(11-15)

11.8

(11-13)

13.8

(13-15)

8.3

(5-13)

191

14.1

(10-20)

1 420

2 991

5 765

244

10.6

(9-12)

11.2

(10-12)

13.1

(12-14)

1 435

3 123

6 387

11.4

(10-13)

11.9

(11-13)

11.9

(11-13)

12.7

(9-18)

201

13.4

(9-19)

1 216

2 705

4 991

181

5 820

1 068

1 610

303

1 077

1 110

15.1

(14-16)

9.8

(8-12)

14.7

(13-17)

17.2

(13-22)

10.9

(9-13)

15.6

(14-18)

3 493

19.4

(18-21)

153

888

189

17.6

(12-25)

22.7

(20-26)

29.1

(23-36)

6 489

1 581

2 020

366

1 008

1 200

5 408

123

896

182

14.7

(14-16)

6 796

14.5

(14-15)

11.2

(10-13)

13.6

(12-15)

18.3

(14-23)

12.7

(11-15)

16.1

(14-18)

2 521

1 992

414

1 027

1 301

13.3

(12-15)

13.3

(12-15)

15.0

(12-19)

15.7

(14-18)

16.8

(15-19)

20.2

(19-21)

6 079

19.0

(18-20)

13.8

(8-21)

24.2

(21-27)

19.8

(14-26)

149

828

210

16.1

(11-23)

20.2

(17-23)

34.8

(28-42)

5 805

2 719

2 060

513

1 154

1 467

7 134

156

875

229

13.8

(13-15)

14.0

(13-15)

15.1

(14-17)

15.2

(12-19)

16.6

(15-19)

17.0

(15-19)

18.4

(18-19)

21.8

(16-29)

22.5

(20-25)

36.2

(30-43)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

16

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
Table 3.6. Escherichia coli. Total number of invasive isolates tested (N) and percentage with resistance to carbapenems 
(%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Bulgaria

Croatia

Czech Republic

Estonia

Finland

Iceland

Lithuania

Luxembourg

Latvia

Malta

Slovenia

Slovakia

Germany

Denmark

Austria

Belgium

Spain

France

Sweden

United Kingdom

Ireland

Netherlands

Poland

Hungary

Norway

EU/EEA  
(population-weighted mean)

Italy

Portugal

Romania

Cyprus

Greece

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

197

1 079

1 702

254

4 013

140

593

368

182

268

1 216

820

6 247

3 946

4 600

2 614

5 817

9 693

6 298

6 367

2 697

6 475

979

1 517

3 420

81 776

3 696

4 998

305

153

1 122

0.5

0.0

0.0

0.0

0.0

0.0

0.0

0.3

0.0

0.0

0.0

0.0

0.1

<0.1

<0.1

<0.1

(0-3)

(0-0)

(0-0)

(0-1)

(0-0)

(0-3)

(0-1)

(0-2)

(0-2)

(0-1)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

0.1

(0-0)

182

1 046

1 471

219

4 425

162

579

347

192

238

1 326

830

9 032

4 046

4 760

2 588

6 399

<0.1

(0-0)

10 481

0.0

0.1

(0-0)

(0-0)

<0.1

(0-0)

0.0

0.2

0.0

0.0

0.1

0.2

(0-0)

(0-1)

(0-0)

(0-0)

(0-0)

(0-0)

<0.1

(0-0)

0.7

0.0

1.2

(0-2)

(0-2)

(1-2)

5 307

5 497

2 615

5 375

1 499

1 922

3 297

86 487

5 592

5 354

368

123

1 215

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

<0.1

<0.1

<0.1

0.0

<0.1

<0.1

0.1

0.3

<0.1

<0.1

0.1

0.0

(0-2)

(0-0)

(0-0)

(0-2)

(0-0)

(0-0)

(0-1)

(0-1)

(0-2)

(0-2)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

<0.1

(0-0)

0.2

0.2

0.1

1.9

0.0

1.2

(0-0)

(0-0)

(0-0)

(1-4)

(0-3)

(1-2)

224

1 045

1 483

602

4 832

192

793

418

246

328

1 420

751

17 196

4 671

5 134

3 845

6 790

10 929

6 927

22 762

2 989

6 394

2 553

1 905

3 616

121 774

6 106

5 760

411

149

1 303

0.9

0.0

0.0

0.0

(0-3)

(0-0)

(0-0)

(0-1)

<0.1

(0-0)

0.0

0.0

0.0

0.0

0.0

0.0

0.0

<0.1

0.0

<0.1

0.1

0.1

(0-0)

(0-0)

(0-1)

(0-1)

(0-1)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

247

1 132

1 431

687

5 315

198

849

433

203

314

1 435

844

21 080

5 117

5 227

4 672

5 802

<0.1

(0-0)

12 843

0.1

(0-0)

<0.1

<0.1

0.0

<0.1

0.0

0.1

0.1

0.3

<0.1

1.0

0.0

0.9

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-2)

(0-2)

(0-2)

5 769

30 074

3 116

6 682

2 741

1 987

3 733

137 728

7 280

6 384

510

156

1 467

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

<0.1

<0.1

<0.1

<0.1

<0.1

<0.1

<0.1

<0.1

<0.1

<0.1

<0.1

0.1

0.1

0.1

0.3

0.3

0.4

1.3

1.6

(0-1)

(0-0)

(0-0)

(0-1)

(0-0)

(0-0)

(0-0)

(0-1)

(0-2)

(0-1)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-0)

(0-1)

(0-1)

(0-5)

(1-2)

N/A

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

17

 
Table 3.7. Escherichia coli. Total number of isolates tested (N) and percentage with combined resistance to 
fluoroquinolones, third-generation cephalosporins and aminoglycosides (%R), including 95 % confidence intervals 
(95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Denmark

Netherlands

Sweden

Finland

Norway

France

Austria

Belgium

Luxembourg

Germany

Estonia

United Kingdom

Lithuania

Spain

Ireland

Czech Republic

Slovenia

Malta

Portugal

Hungary

Poland

Croatia

Romania

Greece

Latvia

Italy

Cyprus

Slovakia

Bulgaria

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

141

4 406

6 425

4 203

3 787

3 413

10 299

4 609

2 045

367

6 158

404

6 191

582

5 814

2 689

2 976

1 216

268

4 989

1 599

1 026

1 070

298

1 102

163

1.4

1.9

2.1

2.0

2.2

2.0

3.5

2.6

3.9

3.8

3.0

3.5

4.4

2.6

5.3

4.7

6.4

7.1

6.2

6.7

8.2

8.2

5.6

6.0

(0-5)

(1-2)

(2-3)

(2-2)

(2-3)

(2-2)

(3-4)

(2-3)

(3-5)

(2-6)

(3-3)

(2-6)

(4-5)

(1-4)

(5-6)

(4-6)

(6-7)

(6-9)

(6-6)

(4-10)

(7-9)

(7-10)

(4-7)

(5-8)

14.4

(11-19)

10.7

(9-13)

2.5

(1-6)

162

4 531

5 377

5 257

4 103

3 298

10 988

4 785

2 285

347

9 013

233

5 119

581

6 416

2 621

3 165

1 325

88 084

238

5 366

2 015

1 532

1 000

364

1 187

191

0.0

2.5

2.0

2.5

2.6

1.9

3.9

2.9

3.5

5.2

3.0

5.2

4.5

4.3

5.5

5.4

6.9

8.1

6.3

7.1

7.6

6.7

6.1

6.9

(0-2)

(2-3)

(2-2)

(2-3)

(2-3)

(1-2)

(4-4)

(2-3)

(3-4)

(3-8)

(3-3)

(3-9)

(4-5)

(3-6)

(5-6)

(5-6)

(6-8)

(7-10)

(6-6)

(4-11)

(7-8)

(6-8)

(5-7)

(5-9)

13.5

(10-17)

10.7

(9-13)

10.5

(7-16)

3 428

13.7

(13-15)

5 389

14.6

(14-16)

153

887

188

13.1

(8-19)

17.0

(15-20)

20.2

(15-27)

123

891

182

9.8

(5-16)

17.1

(15-20)

12.6

(8-18)

N/A

178

4 640

6 396

6 939

4 492

3 609

11 082

5 235

3 496

418

17 013

698

21 101

783

6 787

2 984

3 061

1 420

120 727

328

5 762

1 981

2 411

1 023

410

1 300

242

5 763

149

822

204

1.1

1.8

2.3

3.1

2.4

1.9

3.8

3.5

3.8

3.8

3.4

4.0

4.0

2.6

6.2

5.3

7.9

6.9

6.4

5.5

7.7

6.4

8.5

9.4

(0-4)

(1-2)

(2-3)

(3-4)

(2-3)

(2-2)

(3-4)

(3-4)

(3-4)

(2-6)

(3-4)

(3-6)

(4-4)

(2-4)

(6-7)

(5-6)

(7-9)

(6-8)

(6-7)

(3-9)

(7-8)

(5-8)

(7-10)

(8-11)

11.7

(9-15)

10.4

(9-12)

10.3

(7-15)

199

4 883

6 681

5 746

4 971

3 729

13 038

5 071

3 765

433

20 610

780

26 808

845

5 551

3 116

3 199

1 383

132 208

314

6 365

2 047

1 666

1 133

513

1 463

197

1.5

1.8

1.9

2.0

2.4

2.4

3.0

3.3

3.5

3.5

3.7

3.7

4.1

4.4

5.5

5.7

6.3

6.3

6.3

6.4

6.6

8.2

8.2

9.4

9.7

9.8

(0-4)

(1-2)

(2-2)

(2-2)

(2-3)

(2-3)

(3-3)

(3-4)

(3-4)

(2-6)

(3-4)

(3-5)

(4-4)

(3-6)

(5-6)

(5-7)

(5-7)

(5-8)

(6-6)

(4-10)

(6-7)

(7-9)

(7-10)

(8-11)

(7-13)

(8-11)

11.2

(7-16)

12.9

(12-14)

6 454

13.7

(13-15)

11.4

(7-18)

14.8

(12-17)

22.1

(17-28)

156

863

229

15.4

(10-22)

17.7

(15-20)

24.9

(19-31)

EU/EEA  
(population-weighted mean)

80 896

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

18

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
3.2 Klebsiella pneumoniae
Klebsiella  pneumoniae  predominantly  colonises  hos-
pitalised  individuals,  where  it  is  mainly  found  in  the 
gastrointestinal  tract,  skin  and  the  respiratory  tract. 
The majority of infections caused by K. pneumoniae are 
healthcare-associated  and  can  spread  rapidly  between 
patients  and  via  the  hands  of  hospital  personnel,  lead-
ing  to  nosocomial  outbreaks.  Infections  include  urinary 
tract infections, lower respiratory tract infections, intra-
abdominal infections and bloodstream infections.

Similar  to  E. coli,  K. pneumoniae  can  be  resistant  to 
multiple  antimicrobial  agents,  and  resistance  traits  are 
frequently  acquired  through  plasmids.  In  contrast  to 
E. coli,  K. pneumoniae  has  a  chromosomally  encoded 
class  A  beta-lactamase  and  is  thus  intrinsically  resist-
ant  to  aminopenicillins.  Many  novel  ESBL  variants  were 
initially  identified  in  K. pneumoniae  and  were  only  sub-
sequently  found  in  E. coli.  Carbapenems  frequently 
resist  the  effect  of  ESBLs  and  might  remain  as  one  of 
the  few  treatment  options  for  severe  K. pneumoniae 
infections.  A  recently  emerging  threat  is  carbapenem 
resistance  mediated  by  a  range  of  carbapenemases, 
which  may  confer  resistance  to  virtually  all  available 
beta-lactam  antibacterial  drugs.  Carbapenamase  genes 
are  often  located  on  plasmids  that  can  be  exchanged 
between  Enterobacteriaceae,  including  K. pneumoniae, 
and other gram-negative bacteria.

Antimicrobial resistance
At  the  EU/EEA  level,  more  than  a  third  (34.1%)  of  the 
K. pneumoniae  isolates  reported  to  EARS-Net  for  2017 
were  resistant  to  at  least  one  of  the  antimicrobial 
groups  under  regular  surveillance,  i.e.  fluoroquinolo-
nes,  third-generation  cephalosporins,  aminoglycosides 
and  carbapenems  (Table  3.8).  In  2017,  the  highest  EU/
EEA  population-weighted  mean  resistance  percentage 
was  reported  for  fluoroquinolones  (31.5%),  followed 
by  third-generation  cephalosporins  (31.2%),  amino-
glycosides  (24.1%)  and  carbapenems  (7.2%)  (Tables 
3.9–3.12).  There  was  a  small  but  significant  increase 
in  the  EU/ EEA  population-weighted  mean  percentage 
for  fluoroquinolone  resistance,  however  the  trend  did 
not  remain  significant  when  the  analysis  was  limited 
to  the  laboratories  that  consistently  reported  data  dur-
ing  the  period.  No  significant  trend  was  noted  for  any 
of  the  other  antimicrobial  groups,  including  combined 
resistance  to  fluoroquinolones,  third-generation  cepha-
losporins and aminoglycosides (Tables 3.9–3.13).

Single  resistance  was  less  commonly  reported  than 
resistance to two or more antimicrobial groups, with the 
most  common  resistance  phenotype  being  combined 
resistance  to  fluoroquinolones,  third-generation  cepha-
losporins and aminoglycosides (Table 3.8).

the 

A  majority  of 
third-generation  cephalosporin-
resistant  isolates  were  ESBL  positive.  Only  data  from 
laboratories reporting ESBL results for all isolates iden-
tified  as  resistant  to  third-generation  cephalosporins 
(76%  of  the  laboratories  reporting  AST  data  for  third-
generation  cephalosporins  in  K. pneumoniae),  and  only 

data  from  countries  reporting  at  least  10  such  isolates 
were  included  (23  countries).  Among  the  K. pneumo-
niae isolates meeting the inclusion criteria, 87.8% were 
ascertained  as  ESBL-positive  by  the  participating  labo-
ratories in 2017.

resistance  percentages 

Large  inter-country  variations  could  be  noted  for  all 
antimicrobial  groups  under  regular  surveillance,  with 
reported 
generally  higher 
from  the  southern  and  eastern  parts  of  Europe  than 
from  northern  Europe  (Figures  3.8–3.12).  The  coun-
tries  reporting  the  highest  percentages  of  carbapenem 
resistance were also among the countries reporting the 
highest  resistance  percentages  for  the  other  antimicro-
bial groups. Similar distinct variations could be seen in 
the country-specific distributions between fully suscep-
tible  isolates  and  isolates  with  resistance  to  one,  two, 
three or four antimicrobial groups (Figure 3.7).

Discussion 

Despite  the  stabilising  EU/EEA  resistance  levels  in 
K. pneumoniae  reported  during  the  last  four  years,  the 
K. pneumoniae resistance situation remains problematic 
in the EU/EEA. The high levels of carbapenem resistance 
reported in several countries in the southern and south-
eastern  parts  of  Europe,  almost  always  combined  with 
resistance  to  several  other  key  antimicrobial  groups, 
have  serious  public  health  implications  and  represent 
an increasing threat to European healthcare delivery and 
patient  safety.  Multidrug-resistance  and  carbapenem 
resistance  have  been  associated  with  higher  health-
care costs, prolonged hospital stays, treatment failures 
and  mortality.  Remaining  treatment  alternatives  for 
these  infections  are  very  limited.  The  World  Health 
Organization (WHO) sees a critical need for research and 
the  development  of  new  antibiotics  which  target  third-
generation cephalosporin and carbapenem resistance in 
Enterobacteriaceae, including K. pneumoniae and E. coli 
[13].

As  highlighted  in  the  recent  updated  ECDC  rapid  risk 
assessment on CRE, options for action include timely and 
appropriate  diagnosis,  high  standards  of  infection  pre-
vention  and  control  and  antimicrobial  stewardship  [9]. 
In recent years, many EU/EEA countries have also devel-
oped  and  implemented  recommendations  and  guidance 
documents  on  multidrug-resistant  Enterobacteriaceae 
and/or  CRE  [14],  indicating  a  trend  towards  nationally 
coordinated  responses  to  this  public  health  threat.  In 
2017,  to  support  countries,  ECDC  published  a  guidance 
document  on  how  to  prevent  the  entry  and  spread  of 
CRE  into  healthcare  settings.  The  guidance  outlines 
evidence-based best practices for the prevention of CRE, 
including measures for intervention that can be adopted 
or adapted to local needs depending on the availability 
of financial and structural resources [15].

As  for  E. coli,  the  frequency  of  carbapenem-resistant 
isolates  determined  by  phenotypic  methods  might 
underestimate the distribution and spread of carbapene-
mase-producing  K. pneumoniae,  especially  in  countries 
where  carbapenemases  such  as  OXA-48  are  common. 

19

This  is  partly  reflected  by  the  substantially  higher  per-
centages of carbapenem non-susceptible K. pneumoniae 
compared  to  carbapenem-resistant  K. pneumoniae  in 
some countries [16]. The recently launched carbapenem- 
and/or  colistin-resistant  Enterobacteriaceae 
(CCRE) 
project as part of the European Antimicrobial Resistance 
Genes  Surveillance  Network  (EURGen-Net)  will  provide 
updated  and  more  detailed  information  on  the  distri-
bution  of  carbapenemase-producing  K. pneumoniae  in 
Europe [11].

Colistin  is  frequently  being  used  to  treat  CRE  infec-
tions,  but  colistin  resistance  may  develop  in  patients 
treated  with  colistin.  The  recent  discovery  of  transfer-
able  plasmid-mediated  colistin  resistance  genes  that 
can  transmit  colistin  resistance  more  easily  between 
bacteria further increased the risk for spread of colistin 
resistance  [17].  Colistin  resistance  poses  a  substantial 

public health risk to the EU/EEA because it further limits 
treatment options in patients with infections caused by 
multidrug-resistant  gram-negative  bacteria,  including 
CRE. The distribution of colistin resistance is difficult to 
assess through EARS-Net, as colistin susceptibility test-
ing is generally not part of the initial routine AST panel 
for Enterobacteriaceae, but rather performed at national 
level  after  referral  of  multidrug-resistant  isolates  to  a 
reference  laboratory.  In  addition,  colistin  susceptibility 
testing  is  methodologically  challenging,  substantially 
reducing  the  quality  of  results  from  agar  dilution,  disk 
diffusion  and  gradient  diffusion.  A  joint  EUCAST  and 
CLSI  subcommittee  has  issued  recommendations  con-
firming  that  broth  microdilution  is  so  far  the  only  valid 
method  for  colistin  susceptibility  testing  [18].  A  sur-
vey  among  EARS-Net  participating  laboratories  in  2017 
showed that a majority of the responding local laborato-
ries did not test for colistin susceptibility locally or used 

Figure 3.7. Klebsiella pneumoniae. Distribution of isolates: fully susceptible and resistant to one, two, three and 
four antimicrobial groups (among isolates tested against fluoroquinolones, third-generation cephalosporins, 
aminoglycosides and carbapenems), EU/EEA countries, 2017 

)
s
e
t
a

l

o
s
i

d
e
t
r
o
p
e
r
l

a
t
o
t
/
s
e
t
a

l

o
s
i

d
e
d
u

l
c
n

i
(

y
r
t
n
u
o
C

Finland (716/758)

Sweden (1032/1034)

Norway (781/781)

Denmark (1122/1186)

United Kingdom (4654/5519)

Netherlands (1189/1190)

Austria (1022/1152)

Iceland (16/17)

Germany (3466/3549)

Ireland (476/479)

Spain (1414/1446)

Estonia (143/161)

Belgium (621/803)

Slovenia (306/312)

Luxembourg (99/99)

France (2754/2904)

Latvia (115/116)

Malta (117/117)

Hungary (673/693)

Cyprus (71/17)

Portugal (2694/2743)

Croatia (294/313)

Czech Republic (1050/1330)

Italy (2320/2720)

Slovakia (446/468)

Romania (332/339)

Lithuania (322/326)

Poland (667/1,203)

Greece (1345/1363)

Bulgaria (168/169)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of total

Fully 
susceptible

Resistant to one 
antimicrobial group

Resistant to two 
antimicrobial groups

Resistant to three 
antimicrobial groups

Resistant to four 
antimicrobial groups

Only data from isolates tested against all included antimicrobial groups included in analysis.

20

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
implemented  by  participating  laboratories  and  how 
these  changes  have  influenced  the  results.  As  a  conse-
quence,  trend  analyses  for  fluoroquinolone  resistance 
should be interpreted with caution.

methods that are not recommended by EUCAST (unpub-
lished data, ECDC/UK NEQAS), leading to the conclusion 
that  data  sources  other  than  EARS-Net  are  needed  for 
colistin susceptibility surveillance until local laboratory 
capacity has improved. To better understand the capac-
ity for colistin susceptibility testing and the distribution 
of colistin-resistant Enterobacteriaceae in Europe, ECDC 
included  colistin  in  the  surveillance  panel  of  the  CCRE 
project. This project includes a capacity building compo-
nent fro reference laboratories, which hopefully will also 
improve diagnostic capacity at the local level. 

Similar  to  E. coli,  the  trends  in  fluoroquinolone  resist-
ance may be influenced by the fact that in 2016, EUCAST 
lowered  its  clinical  breakpoints  for  several  fluoroqui-
nolones  in  Enterobacteriaceae.  As  EARS-Net  bases 
its  results  on  SIR  interpretations,  it  is  not  possible  to 
assess  when  or  to  what  degree  this  change  has  been 

Table 3.8. Klebsiella pneumoniae. Total number of invasive isolates tested* and resistance combinations among 
isolates tested against fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems 
(n=30 409). EU/EEA countries, 2017

Resistance pattern
Fully susceptible
Single resistance (to indicated antimicrobial group)
Total (all single resistance)
Third-generation cephalosporins
Fluoroquinolones
Other antimicrobial groups
Resistance to two antimicrobial groups
Total (all two-group combinations)
Third-generation cephalosporins + fluoroquinolones
Third-generation cephalosporins + aminoglycosides
Fluoroquinolones + aminoglycosides
Other antimicrobial group combinations 
Resistance to three antimicrobial groups
Total (all three-group combinations)
Third-generation cephalosporins + fluoroquinolones + aminoglycosides
Third-generation cephalosporins + fluoroquinolones + carbapenems
Other antimicrobial group combinations 
Resistance to four antimicrobial groups
Third-generation cephalosporins + fluoroquinolones + aminoglycosides + carbapenems

Only resistance combinations >1 % of the total are specified.
* Only data from isolates tested against all four antimicrobials groups were included in the analysis.
** Not adjusted for population differences in the reporting countries.

Number of isolates
20 045

Percentage (%) of total**
65.9

2 287
1 215
842
230

1 993
1 127
468
333
65

4 719
4 114
524
81

1 365

7.5
4.0
2.8
0.8

6.6
3.7
1.5
1.1
0.2

15.5
13.5
1.7
0.3

4.5

21

Figure 3.8. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country, 
EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.9. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to third-generation 
cephalosporins, by country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

22

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Figure 3.10. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to aminoglycosides, by 
country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.11. Klebsiella pneumoniae. Percentage (%) of invasive isolates with resistance to carbapenems, by country, 
EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

23

Figure 3.12. Klebsiella pneumoniae. Percentage (%) of invasive isolates with combined resistance to fluoroquinolones, 
third-generation cephalosporins and aminoglycosides, by country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

24

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.9. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to 
fluoroquinolones (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Finland

Denmark

United Kingdom

Sweden

Norway

Netherlands

Austria

Ireland

Germany

Spain

Belgium

Estonia

France

Luxembourg

Slovenia

EU/EEA  
(population-weighted mean)

Latvia

Cyprus

Malta

Croatia

Hungary

Portugal

Czech Republic

Italy

Bulgaria

Romania

Lithuania

Poland

Slovakia

Greece

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

28

581

943

1 130

763

746

886

971

355

980

3.6

4.6

6.9

7.7

4.1

6.2

4.7

(0-18)

(3-7)

(5-9)

(6-9)

(3-6)

(5-8)

(3-6)

10.4

(9-12)

13.5

(10-18)

12.7

(11-15)

1 266

18.6

(17-21)

506

133

18.2

(15-22)

21.8

(15-30)

35

658

935

1 011

907

700

908

1 029

388

1 580

1 508

379

62

2.9

3.3

5.3

(0-15)

(2-5)

(4-7)

13.3

(11-16)

4.5

5.0

6.8

(3-6)

(4-7)

(5-9)

11.7

(10-14)

17.0

(13-21)

9.6

(8-11)

21.6

(20-24)

22.7

(19-27)

33.9

(22-47)

21

769

1 152

4 065

1 533

808

1 134

1 246

453

3 068

1 676

669

183

0.0

(0-16)

2.7

5.3

7.5

5.4

4.3

6.9

9.8

(2-4)

(4-7)

(7-8)

(4-7)

(3-6)

(5-9)

(8-12)

11.3

(8-15)

12.6

(11-14)

22.7

(21-25)

23.6

(20-27)

29.5

(23-37)

16

756

1 183

5 293

1 034

781

1 190

1 147

478

3 549

1 419

803

161

2017

 %R

Trend 
2014-
2017*

(95 %CI)

6.3

(0-30)

N/A

N/A

7.9

9.1

9.3

9.8

(6-10)

(8-11)

(9-10)

(8-12)

10.2

(8-13)

11.9

(10-14)

14.2

(12-16)

14.9

(12-18)

15.6

(14-17)

22.6

(20-25)

23.7

(21-27)

24.8

(18-32)

2 175

31.0

(29-33)

2 332

30.7

(29-33)

2 589

27.7

(26-29)

2 886

26.8

(25-28)

66

233

31.8

(21-44)

32.6

(27-39)

60

237

20.0

(11-32)

24.5

(19-30)

78

267

35.9

(25-48)

29.6

(24-35)

99

306

28.3

(20-38)

30.4

(25-36)

19 990

30.4

(30-31)

22 417

30.1

(30-31)

30 583

30.3

(30-31)

32 409

31.5

(31-32)

116

80

99

330

641

1 712

1 382

1 295

151

257

154

455

493

44.8

(36-54)

26.3

(17-37)

32.3

(23-42)

44.8

(39-50)

34.9

(31-39)

36.5

(34-39)

48.0

(45-51)

55.7

(53-58)

50.3

(42-59)

66.5

(60-72)

45.5

(37-54)

67.9

(63-72)

70.8

(67-75)

112

62

88

380

700

2 094

1 416

2 000

96

267

179

659

474

42.0

(33-52)

37.1

(25-50)

26.1

(17-37)

48.7

(44-54)

36.7

(33-40)

38.6

(36-41)

48.9

(46-52)

53.7

(51-56)

37.5

(28-48)

61.4

(55-67)

45.8

(38-53)

63.9

(60-68)

70.0

(66-74)

1 063

67.6

(65-70)

1 161

66.4

(64-69)

91

75

102

318

713

2 350

1 384

2 248

160

342

324

1 119

466

1 180

41.8

(32-53)

32.0

(22-44)

33.3

(24-43)

43.4

(38-49)

35.2

(32-39)

41.7

(40-44)

50.5

(48-53)

56.0

(54-58)

55.6

(48-63)

60.8

(55-66)

54.6

(49-60)

66.8

(64-70)

66.3

(62-71)

116

71

117

309

685

2 736

1 329

2 562

169

337

326

739

466

32.8

(24-42)

35.2

(24-47)

39.3

(30-49)

40.8

(35-46)

41.5

(38-45)

45.7

(44-48)

49.2

(46-52)

55.7

(54-58)

59.8

(52-67)

64.1

(59-69)

64.7

(59-70)

66.3

(63-70)

66.7

(62-71)

68.6

(66-71)

1 346

66.9

(64-69)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

25

 
Table 3.10. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to 
third-generation cephalosporins (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Finland

Sweden

Norway

Iceland

Denmark

Austria

Netherlands

United Kingdom

Ireland

Germany

Belgium

Estonia

Spain

Slovenia

Luxembourg

France

EU/EEA  
(population-weighted mean)

Latvia

Malta

Hungary

Croatia

Portugal

Cyprus

Czech Republic

Italy

Romania

Poland

Lithuania

Slovakia

Greece

Bulgaria

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

582

1 000

746

28

925

996

911

978

354

2.4

4.5

5.9

0.0

7.6

8.2

5.5

9.3

(1-4)

(3-6)

(4-8)

(0-12)

(6-9)

(7-10)

(4-7)

(8-11)

11.6

(8-15)

1 006

12.7

(11-15)

485

135

16.3

(13-20)

20.7

(14-29)

1 265

18.0

(16-20)

233

66

26.6

(21-33)

34.8

(24-48)

644

1 001

701

36

929

1 050

908

916

387

1 581

406

93

1 491

237

60

3.0

3.3

5.0

0.0

7.8

8.4

8.6

(2-5)

(2-5)

(4-7)

(0-10)

(6-10)

(7-10)

(7-11)

10.5

(9-13)

14.7

(11-19)

760

1 537

811

25

1 118

1 245

1 134

3 914

452

4.1

4.9

5.8

0.0

7.5

9.6

(3-6)

(4-6)

(4-8)

(0-14)

(6-9)

(8-11)

10.3

(9-12)

8.9

(8-10)

13.5

(10-17)

10.2

(9-12)

3 068

13.6

(12-15)

19.7

(16-24)

23.7

(15-34)

669

183

22.9

(20-26)

32.8

(26-40)

744

1 034

781

17

1 125

1 072

1 189

4 973

478

3 546

803

161

2017

 %R

4.6

5.6

5.8

5.9

7.3

Trend 
2014-
2017*

N/A

(95 %CI)

(3-6)

(4-7)

(4-8)

(0-29)

N/A

(6-9)

8.6

(7-10)

10.9

(9-13)

11.4

(10-12)

14.6

(12-18)

14.7

(14-16)

19.3

(17-22)

21.1

(15-28)

20.3

(18-22)

1 677

22.4

(20-24)

1 445

21.4

(19-24)

22.8

(18-29)

28.3

(17-41)

267

78

22.8

(18-28)

35.9

(25-48)

312

99

23.7

(19-29)

27.3

(19-37)

2 192

29.6

(28-32)

2 338

30.5

(29-32)

2 597

28.9

(27-31)

2 892

28.8

(27-31)

20 188

31.4

(31-32)

22 511

31.0

(31-32)

30 447

31.4

(31-32)

32 453

31.2

(31-32)

104

99

644

334

1 712

80

1 383

1 319

256

465

154

493

52.9

(43-63)

28.3

(20-38)

35.6

(32-39)

47.9

(42-53)

115

88

704

380

47.0

(38-56)

15.9

(9-25)

37.2

(34-41)

46.8

(42-52)

95

102

722

321

47.4

(37-58)

21.6

(14-31)

37.5

(34-41)

48.6

(43-54)

116

117

693

309

33.6

(25-43)

35.0

(26-44)

41.1

(37-45)

41.7

(36-47)

40.9

(39-43)

2 094

40.4

(38-43)

2 349

46.7

(45-49)

2 743

44.9

(43-47)

32.5

(22-44)

62

43.5

(31-57)

75

30.7

(21-42)

71

46.5

(35-59)

52.9

(50-56)

56.5

(54-59)

73.8

(68-79)

68.2

(64-72)

52.6

(44-61)

69.4

(65-73)

1 092

72.5

(70-75)

151

74.8

(67-82)

1 417

1 999

270

676

178

469

1 185

96

54.1

(51-57)

55.9

(54-58)

70.7

(65-76)

64.2

(60-68)

51.7

(44-59)

67.2

(63-71)

69.5

(67-72)

75.0

(65-83)

1 384

2 246

344

1 142

326

465

1 181

160

51.8

(49-54)

55.8

(54-58)

68.0

(63-73)

64.4

(62-67)

56.7

(51-62)

61.3

(57-66)

72.5

(70-75)

72.5

(65-79)

1 329

2 546

339

1 203

326

459

1 362

169

53.2

(50-56)

54.6

(53-57)

62.5

(57-68)

63.0

(60-66)

63.2

(58-68)

63.2

(59-68)

69.2

(67-72)

76.3

(69-83)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

26

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
Table 3.11. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to 
aminoglycosides (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Finland

Denmark

Norway

Sweden

Austria

Netherlands

United Kingdom

Germany

Iceland

Ireland

Estonia

Belgium

Slovenia

Spain

Luxembourg

France

EU/EEA  
(population-weighted mean)

Cyprus

Latvia

Croatia

Malta

Portugal

Italy

Hungary

Czech Republic

Greece

Lithuania

Poland

Romania

Slovakia

Bulgaria

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

N/A

N/A

559

943

744

860

925

898

1 174

1 006

28

354

135

341

233

2.3

4.9

4.8

3.3

5.5

3.9

5.5

7.1

(1-4)

(4-6)

(3-7)

(2-5)

(4-7)

(3-5)

(4-7)

(6-9)

3.6

(0-18)

12.1

(9-16)

18.5

(12-26)

10.9

(8-15)

20.2

(15-26)

625

938

700

943

959

908

1 070

1 582

36

389

61

354

237

1.9

2.6

3.6

3.2

4.8

5.7

9.3

5.6

(1-3)

(2-4)

(2-5)

(2-5)

(4-6)

(4-7)

(8-11)

(5-7)

0.0

(0-10)

15.9

(12-20)

21.3

(12-34)

11.6

(8-15)

19.0

(14-25)

727

1 154

809

1 141

1 157

1 134

4 135

3 042

25

453

183

637

267

2.3

3.2

3.3

3.4

4.8

6.1

6.7

7.7

0.0

(1-4)

(2-4)

(2-5)

(2-5)

(4-6)

(5-8)

(6-7)

(7-9)

(0-14)

11.5

(9-15)

21.3

(16-28)

13.8

(11-17)

16.5

(12-21)

721

1 186

781

1 033

1 141

1 190

5 363

3 468

17

479

161

633

312

2.9

3.2

4.2

4.7

4.8

7.6

7.9

8.0

(2-4)

(2-4)

(3-6)

(4-6)

(4-6)

(6-9)

(7-9)

(7-9)

11.8

11.9

(1-36)

(9-15)

12.4

(8-19)

12.5

(10-15)

16.0

(12-21)

1 264

13.8

(12-16)

1 509

16.0

(14-18)

1 678

15.5

(14-17)

1 445

17.6

(16-20)

66

19.7

(11-31)

60

15.0

(7-27)

78

26.9

(18-38)

99

18.2

(11-27)

2 188

27.7

(26-30)

2 337

26.3

(25-28)

2 569

26.2

(25-28)

2 857

23.8

(22-25)

19 828

25.0

(24-26)

22 360

24.2

(24-25)

30 023

24.4

(24-25)

32 620

24.1

(24-25)

80

118

334

99

1 706

1 190

639

1 383

1 067

152

455

250

494

143

28.7

(19-40)

43.2

(34-53)

48.8

(43-54)

28.3

(20-38)

30.5

(28-33)

36.2

(33-39)

31.8

(28-36)

50.7

(48-53)

59.3

(56-62)

49.3

(41-58)

59.1

(54-64)

67.6

(61-73)

68.2

(64-72)

65.7

(57-73)

62

113

380

88

2 090

1 956

706

1 417

1 170

179

666

266

475

84

37.1

(25-50)

43.4

(34-53)

43.2

(38-48)

22.7

(14-33)

32.6

(31-35)

34.0

(32-36)

34.6

(31-38)

51.9

(49-55)

50.7

(48-54)

46.4

(39-54)

58.6

(55-62)

54.1

(48-60)

66.5

(62-71)

59.5

(48-70)

75

91

316

102

2 337

2 300

720

1 385

1 171

325

1 075

336

466

135

22.7

(14-34)

38.5

(28-49)

36.1

(31-42)

22.5

(15-32)

35.0

(33-37)

36.1

(34-38)

34.7

(31-38)

47.1

(44-50)

52.9

(50-56)

49.2

(44-55)

56.7

(54-60)

61.9

(56-67)

62.4

(58-67)

64.4

(56-72)

71

115

311

117

2 717

2 571

693

1 330

1 348

322

1 165

338

468

168

26.8

(17-39)

29.6

(21-39)

30.9

(26-36)

31.6

(23-41)

33.5

(32-35)

34.5

(33-36)

37.8

(34-42)

49.6

(47-52)

53.2

(50-56)

53.7

(48-59)

55.5

(53-58)

58.6

(53-64)

61.1

(57-66)

63.1

(55-70)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

27

 
Table 3.12. Klebsiella pneumoniae. Total number of invasive isolates tested (N) and percentage with resistance to 
carbapenems (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Estonia

Croatia

Iceland

Luxembourg

Norway

Slovenia

Hungary

Sweden

Ireland

Denmark

Finland

Czech Republic

Germany

Netherlands

Lithuania

United Kingdom

France

Austria

Belgium

Latvia

Spain

Slovakia

Poland

EU/EEA  
(population-weighted mean)

Portugal

Malta

Bulgaria

Cyprus

Romania

Italy

Greece

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

92

334

28

66

746

233

621

978

353

830

583

1 148

1 006

903

154

1 069

2 103

971

429

118

1 266

456

451

19 617

1 701

99

139

80

257

1 315

1 088

0.0

0.9

0.0

1.5

0.0

0.9

1.1

0.0

0.6

0.2

0.0

0.1

0.7

0.2

1.3

0.8

0.5

0.6

0.5

1.7

2.3

2.6

1.3

7.3

1.8

9.1

7.2

(0-4)

(0-3)

(0-12)

(0-8)

(0-0)

(0-3)

(0-2)

(0-0)

(0-2)

(0-1)

(0-1)

(0-0)

(0-1)

(0-1)

(0-5)

(0-2)

(0-1)

(0-1)

(0-2)

(0-6)

(2-3)

(1-5)

(0-3)

(7-8)

(1-3)

(4-17)

(4-13)

5.0

(1-12)

31.5

(26-38)

32.9

(30-36)

62.3

(59-65)

56

380

35

60

700

237

687

900

389

846

658

1 100

1 583

907

177

962

2 244

1 022

389

112

1 483

436

660

21 808

2 085

88

95

62

271

1 999

1 185

0.0

2.4

0.0

0.0

0.1

1.3

0.1

0.0

0.5

0.0

0.0

0.3

0.1

0.1

0.0

0.4

0.5

0.8

0.5

0.0

2.2

0.9

0.5

6.8

3.4

4.5

3.2

(0-6)

(1-4)

(0-12)

(0-6)

(0-1)

(0-4)

(0-1)

(0-0)

(0-2)

(0-0)

(0-1)

(0-1)

(0-0)

(0-1)

(0-2)

(0-1)

(0-1)

(0-2)

(0-2)

(0-3)

(1-3)

(0-2)

(0-1)

(6-7)

(3-4)

(1-11)

(1-9)

12.9

(6-24)

24.7

(20-30)

33.5

(31-36)

61.9

(59-65)

168

323

21

78

810

267

703

1 531

453

1 119

770

1 096

3 068

1 131

325

4 068

2 528

1 198

669

90

1 677

435

1 123

30 148

2 340

102

159

75

334

2 307

1 180

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.1

0.7

0.3

0.3

0.0

0.5

0.1

0.0

0.3

0.4

0.7

2.4

2.2

2.1

2.5

2.1

7.4

5.2

5.9

(0-2)

(0-1)

(0-12)

(0-5)

(0-0)

(0-1)

(0-1)

(0-0)

(0-2)

(0-1)

(0-1)

(0-0)

(0-1)

(0-0)

(0-1)

(0-0)

(0-1)

(0-1)

(1-4)

(0-8)

(1-3)

(1-4)

(1-3)

(7-8)

(4-6)

(2-12)

4.4

(2-9)

10.7

(5-20)

31.4

(26-37)

33.9

(32-36)

66.9

(64-70)

143

302

16

99

781

312

681

1 033

478

1 185

758

1 051

3 549

1 190

325

5 274

2 807

1 109

791

116

1 442

450

1 161

32 461

2 720

117

169

71

334

2 634

1 363

Trend 
2014-
2017*

(95 %CI)

(0-3)

(0-1)

(0-13)

N/A

N/A

(0-4)

(0-0)

(0-1)

(0-1)

(0-1)

(0-1)

(0-1)

(0-1)

(0-1)

(0-1)

(0-1)

(0-2)

(0-1)

(0-1)

(0-2)

(1-2)

(0-6)

(2-4)

(3-7)

(5-8)

(7-7)

(8-10)

0.0

0.0

0.0

0.0

0.0

0.0

0.1

0.1

0.2

0.3

0.3

0.4

0.5

0.5

0.6

0.6

0.7

1.0

1.1

1.7

2.7

4.4

6.4

7.2

8.6

10.3

(5-17)

12.4

(8-18)

15.5

(8-26)

22.5

(18-27)

29.7

(28-31)

64.7

(62-67)

 and 

* 
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

 indicate significant increasing and decreasing trends, respectively.

year during the period.

28

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.13. Klebsiella pneumoniae. Total number of isolates tested (N) and percentage with combined resistance to 
fluoroquinolones, third-generation cephalosporins and aminoglycosides (%R), including 95 % confidence intervals 
(95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Denmark

Finland

Austria

Norway

Sweden

United Kingdom

Netherlands

Ireland

Germany

Belgium

Estonia

Spain

Slovenia

Luxembourg

France

EU/EEA  
(population-weighted mean)

Croatia

Latvia

Cyprus

Malta

Portugal

Italy

Hungary

Czech Republic

Greece

Lithuania

Bulgaria

Poland

Romania

Slovakia

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

28

925

556

900

744

623

975

865

353

979

341

131

1 263

233

66

0.0

(0-12)

3.1

1.4

3.2

3.9

1.4

3.1

2.0

7.4

5.3

7.9

11.5

10.1

(2-4)

(1-3)

(2-5)

(3-6)

(1-3)

(2-4)

(1-3)

(5-11)

(4-7)

(5-11)

(7-18)

(8-12)

35

924

623

936

699

860

906

908

387

1 578

353

36

0.0

(0-10)

1.1

1.1

3.3

2.3

1.9

4.2

3.0

7.2

3.2

9.3

(1-2)

(0-2)

(2-5)

(1-4)

(1-3)

(3-6)

(2-4)

(5-10)

(2-4)

(7-13)

22.2

(10-39)

21

1 112

726

1 156

807

1 141

3 764

1 134

452

3 038

637

183

0.0

(0-16)

1.4

1.2

3.5

2.6

2.1

3.7

3.5

5.8

5.3

9.3

(1-2)

(1-2)

(3-5)

(2-4)

(1-3)

(3-4)

(3-5)

(4-8)

(5-6)

(7-12)

16.9

(12-23)

1 488

11.7

(10-13)

1 674

12.4

(11-14)

18.9

(14-25)

16.7

(9-28)

237

60

16.9

(12-22)

13.3

(6-25)

267

78

13.1

(9-18)

24.4

(15-35)

16

1 122

716

1 062

781

1 033

4 760

1 189

477

3 466

633

161

1 417

306

99

0.0

2.4

2.4

3.0

3.2

3.3

4.2

5.0

5.9

6.3

8.5

(0-21)

N/A

N/A

(2-3)

(1-4)

(2-4)

(2-5)

(2-5)

(4-5)

(4-6)

(4-8)

(5-7)

(6-11)

11.8

(7-18)

13.0

(11-15)

16.0

(12-21)

17.2

(10-26)

2 172

23.7

(22-26)

2 324

22.5

(21-24)

2 556

21.3

(20-23)

2 844

19.4

(18-21)

19 193

20.8

(20-21)

21 930

19.7

(19-20)

29 403

20.6

(20-21)

31 098

20.5

(20-21)

30.6

(26-36)

380

32.4

(28-37)

27.5

(23-33)

305

23.0

(18-28)

330

104

80

99

1 705

1 164

636

1 382

1 061

152

143

443

247

493

41.3

(32-51)

15.0

(8-25)

25.3

(17-35)

22.8

(21-25)

32.0

(29-35)

28.6

(25-32)

38.7

(36-41)

55.1

(52-58)

35.5

(28-44)

44.1

(36-53)

54.6

(50-59)

56.3

(50-63)

63.3

(59-68)

112

62

88

2 084

1 940

698

1 416

1 160

178

84

645

261

468

36.6

(28-46)

17.7

(9-30)

14.8

(8-24)

25.0

(23-27)

29.7

(28-32)

309

91

75

102

2 332

2 174

31.9

(22-42)

18.7

(11-29)

14.7

(8-23)

27.2

(25-29)

32.7

(31-35)

30.2

(27-34)

711

30.1

(27-34)

41.5

(39-44)

1 384

40.8

(38-43)

46.7

(44-50)

39.9

(33-47)

28.6

(19-39)

1 171

323

133

48.4

(46-51)

42.1

(37-48)

45.9

(37-55)

54.0

(50-58)

1 052

53.6

(51-57)

49.8

(44-56)

59.6

(55-64)

335

465

55.2

(50-61)

55.7

(51-60)

115

71

117

2 711

2 352

685

1 329

1 345

322

168

703

336

457

24.3

(17-33)

25.4

(16-37)

28.2

(20-37)

28.4

(27-30)

31.6

(30-34)

33.1

(30-37)

41.8

(39-44)

47.9

(45-51)

48.1

(43-54)

50.0

(42-58)

52.6

(49-56)

55.4

(50-61)

57.1

(52-62)

 and 

* 
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

 indicate significant increasing and decreasing trends, respectively.

year during the period.

29

Discussion and conclusion

EARS-Net data showed that at the EU/EEA level, small but 
significantly decreasing trends in resistance were noted 
for P. aeruginosa for all antimicrobial groups under sur-
veillance during the period 2014 to 2017, although these 
trends  did  not  always  remain  statistically  significant 
when  only  the  laboratories  that  consistently  reported 
data  during  the  period  were  included.  Nevertheless, 
high  resistance  percentages  and  combined  resistance 
persisted  in  many  countries,  especially  in  the  eastern 
and  south-eastern  parts  of  Europe.  As  P. aeruginosa 
is  intrinsically  resistant  to  many  antimicrobial  agents, 
additional  acquired  resistance  is  further  complicating 
treatment  of  serious  infections  in  already  vulnerable 
patient groups.

The public health implications of resistant P. aeruginosa 
should  not  be  neglected,  as  the  bacterium  remains  one 
of the major causes of healthcare-associated infection in 
Europe [19–20]. Due to its ubiquitous nature and poten-
tial  virulence,  P. aeruginosa  is  a  challenging  pathogen 
to  control  in  healthcare  settings.  Prudent  antimicrobial 
use and high standards of infection prevention and con-
trol  are  essential  to  prevent  the  situation  from  further 
deteriorating.

3.3 Pseudomonas aeruginosa
Pseudomonas  aeruginosa  is  a  non-fermenting  gram-
in  aquatic 
negative  bacterium  that 
environments in nature. It is an opportunistic pathogen 
and  a  major  cause  of  infection  in  hospitalised  patients 
with 
immune 
defences.  It  commonly  causes  healthcare-associated 
pneumonia (including ventilator-associated pneumonia), 
bloodstream infections and urinary tract infections.

localised  or  systemic 

impairment  of 

is  ubiquitous 

P. aeruginosa is intrinsically resistant to the majority of 
antimicrobial  agents  due  to  its  selective  ability  to  pre-
vent  various  antibiotic  molecules  from  penetrating  its 
outer  membrane  or  to  extrude  them  if  they  enter  the 
cell. The antimicrobial groups that remain active include 
some fluoroquinolones (e.g. ciprofloxacin and levofloxa-
cin),  aminoglycosides  (e.g.  gentamicin,  tobramycin  and 
amikacin), some beta-lactams (e.g. piperacillin-tazobac-
tam,  ceftazidime,  cefepime,  ceftolozane-tazobactam, 
ceftazidime-avibactam,  imipenem,  meropenem,  dorip-
enem)  and  polymyxins.  Resistance  of  P. aeruginosa  to 
these  agents  can  be  acquired  through  one  or  more  of 
several  mechanisms,  including  modified  antimicrobial 
targets,  efflux,  reduced  permeability  and  degrading 
enzymes.

Antimicrobial resistance

In  the  EU/EEA,  30.8%  of  the  P. aeruginosa  isolates 
reported  to  EARS-Net  for  2017  were  resistant  to  at 
least  one  of  the  antimicrobial  groups  under  regular 
surveillance  (piperacillin  ±  tazobactam,  fluoroquinolo-
nes,  ceftazidime,  aminoglycosides  and  carbapenems) 
(Table  3.14).  The  highest  EU/EEA  population-weighted 
mean  resistance  percentage  in  2017  was  reported  for 
fluoroquinolones  (20.3%),  followed  by  piperacillin  ± 
tazobactam  (18.3%),  carbapenems  (17.4%),  ceftazidime 
(14.7%) and aminoglycosides (13.2%) (Tables 3.15–3.19). 
For  all  antimicrobial  groups  under  regular  surveillance, 
the  EU/EEA  population-weighted  mean  percentage 
decreased  significantly  between  2014  and  2017  (Tables 
3.15–3.19).  When  only  considering  the  laboratories  that 
consistently  reported  data  during  all  four  years,  only 
the  decreasing  trends  for  piperacillin  ±  tazobactam 
resistance,  aminoglycoside  resistance  and  carbapenem 
resistance  remained  statistically  significant  (Tables 
3.15–3.19).

Resistance  to  two  or  more  antimicrobial  groups  was 
common  and  seen  in  18.3%  of  all  tested  isolates. 
(Table  3.14).  The  EU/EEA  population-weighted  mean 
percentage  of  combined  resistance,  defined  as  resist-
ance to at least three of the antimicrobial groups under 
surveillance, significantly decreased between 2014 and 
2017 (Table 3.20).

Large  inter-country  variations  could  be  noted  for  all 
antimicrobial  groups,  with  generally  higher  resistance 
percentages  reported  from  southern  and  eastern  parts 
of Europe than northern Europe (Figures 3.13–3.18).

30

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.14. Pseudomonas aeruginosa. Total number of tested isolates and resistance combinations among 
invasive isolates tested against at least three antimicrobial groups among piperacillin ± tazobactam, ceftazidime, 
fluoroquinolones, aminoglycosides and carbapenems (n = 16 885), EU/EEA countries, 2017

Number of isolates
11 691

Percentage (%) of total*
69.2

Resistance pattern
Fully susceptible (to tested antibiotics)
Single resistance (to indicated antimicrobial group)
Total (all single resistance types)
Carbapenems
Fluoroquinolones
[Piperacillin ± tazobactam]
Aminoglycosides
Ceftazidime
Resistance to two antimicrobial groups
Total (all two groups combinations) 
[Piperacillin ± tazobactam] + ceftazidime
Fluoroquinolones + aminoglycosides
Fluoroquinolones + carbapenems
Other antimicrobial group combinations
Resistance to three antimicrobial groups
Total (all three group combinations) 
Fluoroquinolones + aminoglycosides + carbapenems
Other antimicrobial group combinations
Resistance to four antimicrobial groups
Total (all four group combinations)
[Piperacillin ± tazobactam] + fluoroquinolones + aminoglycosides + carbapenems
Fluoroquinolones + ceftazidime + aminoglycosides + carbapenems
Other antimicrobial group combinations
Resistance to five antimicrobial groups 
[Piperacillin ± tazobactam] + fluoroquinolones + ceftazidime +  
aminoglycosides + carbapenems

Only resistance combinations >1 % of the total are specified
* Not adjusted for population differences in the reporting countries

2 104
775
696
339
185
109

1 185
444
173
232
336

669
163
506

577
185
174
218

659

Figure 3.13. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to piperacillin ± 
tazobactam, by country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

12.5
4.6
4.1
2.0
1.1
0.6

7.0
2.6
1.0
1.4
2.0

4.0
1.0
3.0

3.4
1.1
1.0
1.3

3.9

31

Figure 3.14. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by 
country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.15. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to ceftazidime, by country, 
EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

32

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Figure 3.16. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to aminoglycosides, by 
country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.17. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with resistance to carbapenems, by country, 
EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

33

Figure 3.18. Pseudomonas aeruginosa. Percentage (%) of invasive isolates with combined resistance (resistance to 
three or more antimicrobial groups among piperacillin ± tazobactam, ceftazidime, fluoroquinolones, aminoglycosides 
and carbapenems), by country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

34

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.15. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to 
piperacillin ± tazobactam (%R), including 95 % confidence intervals (95 %CI), EU/EEA countries, 2014 to 2017

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

11

388

610

254

337

306

530

870

294

37

112

636

178

39

642

216

42

31

11 525

1 783

36

429

686

Country

Iceland

Denmark

United Kingdom

Norway

Sweden

Finland

Netherlands

Spain

Belgium

Luxembourg

Slovenia

Austria

Ireland

Estonia

Germany

Croatia

Cyprus

Lithuania

EU/EEA  
(population-weighted mean)

France

Malta

Czech Republic

Italy

Portugal

Hungary

Greece

Poland

Bulgaria

Latvia

Slovakia

Romania

0.0

4.1

(0-28)

(2-6)

17

460

10.3

(8-13)

2 039

9.1

(0-41)

4.4

4.8

7.9

4.7

6.9

8.1

7.8

9.5

(3-7)

(3-7)

(5-12)

(3-8)

(4-10)

(6-11)

(6-10)

(6-13)

10.8

(3-25)

25.9

(18-35)

11.8

11.2

(9-15)

(7-17)

10.3

(3-24)

17.4

(15-21)

24.5

(19-31)

16.7

(7-31)

32.3

(17-51)

11

441

493

227

399

333

494

871

251

27

141

675

195

16

972

249

43

41

5.7

5.8

7.2

6.5

9.1

8.0

0.0

9.9

(3-10)

(4-9)

(5-11)

(4-9)

(7-11)

(5-12)

(0-13)

(6-16)

11.9

(10-15)

9.2

6.3

(6-14)

(0-30)

17.5

(15-20)

24.5

(19-30)

4.7

(1-16)

29.3

(16-46)

19.5

(19-20)

12 569

19.9

(19-21)

17.0

(15-19)

8.3

(2-22)

23.1

(19-27)

31.5

(28-35)

1 061

28.5

(26-31)

736

666

185

48

3

269

90

23.5

(20-27)

31.4

(28-35)

32.4

(26-40)

31.3

(19-46)

**

(**)

36.1

(30-42)

62.2

(51-72)

1 915

25

463

1 074

1 176

747

638

249

55

13

257

78

16.1

(15-18)

16.0

(5-36)

25.3

(21-29)

29.5

(27-32)

24.5

(22-27)

26.9

(24-30)

22.3

(19-26)

37.8

(32-44)

27.3

(16-41)

23.1

(5-54)

42.4

(36-49)

59.0

(47-70)

2017

 %R

Trend 
2014-
2017*

(95 %CI)

0.0

2.9

5.3

6.0

6.3

6.4

7.1

(0-20)

N/A

(2-5)

(4-6)

(3-11)

(4-9)

(4-9)

(5-9)

N/A

8.2

(6-10)

10.5

(8-14)

11.1

(4-23)

13.0

(8-20)

13.5

(11-16)

14.0

(10-19)

14.5

(6-27)

N/A

16.2

(14-18)

16.2

(12-22)

17.0

(8-30)

18.0

(11-28)

0.0

3.5

6.0

7.4

7.4

9.4

4.0

9.4

9.7

(0-20)

(2-6)

(5-7)

(4-12)

(5-10)

(7-13)

(3-6)

(8-12)

(7-14)

12.5

(4-27)

19.6

(13-27)

13.8

(11-17)

12.8

(9-18)

17.0

(8-30)

17.2

(15-19)

18.7

(14-24)

12.5

(6-23)

13.5

(7-23)

17

484

2 697

183

446

377

620

788

439

54

138

721

286

55

1 755

234

53

89

18.8

(18-19)

16 414

18.3

(18-19)

17.4

(16-19)

1 690

19.2

(17-21)

12.5

(4-27)

37

21.6

(10-38)

25.3

(21-30)

30.7

(28-33)

22.7

(20-25)

23.6

(21-27)

28.3

(25-32)

30.0

(26-35)

40.0

(27-54)

26.7

(8-55)

36.9

(30-45)

48.8

(38-60)

409

1 312

1 206

721

813

389

69

14

187

131

23.0

(19-27)

24.2

(22-27)

24.2

(22-27)

24.3

(21-28)

29.6

(27-33)

32.1

(28-37)

33.3

22-46)

35.7

(13-65)

N/A

42.8

(36-50)

53.4

(45-62)

215

472

351

520

817

318

40

143

689

243

53

1 423

252

64

74

15 152

1 958

40

458

1 147

1 230

720

692

393

55

15

168

86

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

** Less than 10 isolates reported, no percentage calculated

35

 
Table 3.16. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to 
fluoroquinolones (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Norway

Denmark

Cyprus

United Kingdom

Sweden

Netherlands

Belgium

Malta

Finland

Iceland

Austria

Estonia

Luxembourg

Ireland

Germany

France

Spain

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

257

388

42

629

338

541

309

36

289

11

599

39

41

178

623

1 779

873

3.1

3.6

(1-6)

(2-6)

16.7

(7-31)

5.4

7.7

6.7

(4-7)

(5-11)

(5-9)

12.6

(9-17)

2.8

(0-15)

10.0

(7-14)

0.0

(0-28)

10.9

(8-14)

10.3

(3-24)

9.8

8.4

(3-23)

(5-14)

13.0

(10-16)

20.6

(19-23)

24.6

(22-28)

230

420

43

522

382

502

261

25

302

12

659

18

28

194

970

1 939

881

5.2

5.0

(3-9)

(3-8)

11.6

(4-25)

8.8

4.7

5.8

11.1

(7-12)

(3-7)

(4-8)

(8-16)

12.0

(3-31)

8.9

8.3

(6-13)

(0-38)

10.3

(8-13)

0.0

(0-19)

17.9

(6-37)

9.8

(6-15)

14.3

(12-17)

19.1

(17-21)

23.0

(20-26)

227

460

64

2 119

469

543

366

40

292

17

694

56

40

243

1 423

1 971

843

5.7

3.7

(3-10)

(2-6)

20.3

(11-32)

6.9

6.0

6.1

(6-8)

(4-9)

(4-8)

14.5

(11-19)

10.0

(3-24)

7.9

(5-12)

17.6

(4-43)

7.2

3.6

(5-9)

(0-12)

12.5

(4-27)

11.9

(8-17)

12.4

(11-14)

13.6

(12-15)

23.0

(20-26)

205

484

53

2 802

445

657

430

37

356

17

721

56

56

287

1 755

1 709

842

4.9

(2-9)

5.0

5.7

7.7

9.0

9.9

(3-7)

(1-16)

(7-9)

(6-12)

(8-12)

10.5

(8-14)

10.8

(3-25)

11.2

11.8

(8-15)

(1-36)

12.3

(10-15)

N/A

N/A

12.5

(5-24)

N/A

12.5

(5-24)

13.9

(10-18)

14.2

(13-16)

15.1

(13-17)

20.1

(17-23)

EU/EEA  
(population-weighted mean)

11 629

20.8

(20-22)

12 681

20.9

(20-22)

15 388

18.8

(18-19)

16 704

20.3

(20-21)

Slovenia

Lithuania

Hungary

Portugal

Italy

Bulgaria

Czech Republic

Croatia

Greece

Poland

Slovakia

Romania

Latvia

112

31

743

22.3

(15-31)

25.8

(12-45)

24.6

(22-28)

1 062

26.3

(24-29)

141

41

769

1 185

14.2

(9-21)

26.8

(14-43)

24.7

(22-28)

22.7

(20-25)

739

48

447

230

676

184

275

92

18

28.3

(25-32)

1 080

24.6

(22-27)

27.1

(15-42)

32.7

(28-37)

30.0

(24-36)

37.7

(34-41)

35.3

(28-43)

45.5

(39-52)

55.4

(45-66)

16.7

(4-41)

55

464

256

662

257

278

92

13

36.4

(24-50)

30.0

(26-34)

35.2

(29-41)

34.1

(31-38)

36.2

(30-42)

52.2

(46-58)

62.0

(51-72)

23.1

(5-54)

143

73

736

1 227

1 166

56

464

259

702

400

190

89

16

20.3

(14-28)

15.1

(8-25)

24.3

(21-28)

20.1

(18-22)

24.7

(22-27)

35.7

(23-50)

34.7

(30-39)

37.5

(32-44)

34.6

(31-38)

31.0

(26-36)

47.4

(40-55)

51.7

(41-62)

31.3

(11-59)

123

89

732

1 208

1 390

71

411

237

816

358

211

132

14

20.3

(14-29)

21.3

(13-31)

23.4

(20-27)

23.7

(21-26)

25.1

(23-27)

28.2

(18-40)

30.2

(26-35)

32.9

(27-39)

35.3

(32-39)

37.2

(32-42)

46.9

(40-54)

62.1

(53-70)

64.3

(35-87)

N/A

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in 

any year during the period.

36

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
Table 3.17. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to 
ceftazidime (% R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Denmark

Netherlands

Sweden

United Kingdom

Norway

Finland

Belgium

Estonia

Austria

Spain

Ireland

Germany

France

Luxembourg

Slovenia

Cyprus

Czech Republic

Malta

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

11

386

534

433

588

251

307

316

28

631

864

175

638

9.1

(0-41)

3.9

4.9

5.5

4.6

5.2

6.2

8.9

(2-6)

(3-7)

(4-8)

(3-7)

(3-9)

(4-9)

(6-13)

7.1

(1-24)

8.7

9.6

8.0

9.9

(7-11)

(8-12)

(4-13)

(8-12)

1 778

12.0

(11-14)

41

112

42

446

36

2.4

(0-13)

20.5

(13-29)

23.8

(12-39)

21.5

(18-26)

2.8

(0-15)

11

439

502

379

472

216

334

226

7

577

816

195

968

1 919

28

141

43

464

25

0.0

3.6

4.4

4.5

6.1

5.6

6.9

6.2

**

(0-28)

(2-6)

(3-7)

(3-7)

(4-9)

(3-10)

(4-10)

(3-10)

(**)

9.9

(8-13)

10.4

(8-13)

7.2

8.9

(4-12)

(7-11)

11.6

(10-13)

7.1

9.9

4.7

(1-24)

(6-16)

(1-16)

19.6

(16-24)

8.0

(1-26)

17

447

543

473

2 021

224

352

320

17

628

836

243

1 421

1 956

40

143

64

464

40

0.0

4.5

3.3

7.4

4.3

7.1

5.4

7.8

(0-20)

(3-7)

(2-5)

(5-10)

(3-5)

(4-11)

(3-8)

(5-11)

17.6

(4-43)

11.3

(9-14)

10.2

(8-12)

10.7

(7-15)

10.1

(9-12)

11.3

(10-13)

5.0

(1-17)

17.5

(12-25)

10.9

(5-21)

19.2

(16-23)

7.5

(2-20)

17

461

657

446

2 680

197

378

431

47

620

836

272

1 744

1 568

56

138

53

411

37

2017

 %R

Trend 
2014-
2017*

(95 %CI)

0.0

(0-20)

N/A

N/A

N/A

3.5

3.5

4.5

4.7

5.1

6.1

7.2

8.5

8.7

9.6

9.6

(2-6)

(2-5)

(3-7)

(4-6)

(2-9)

(4-9)

(5-10)

(2-20)

(7-11)

(8-12)

(6-14)

10.1

(9-12)

12.2

(11-14)

12.5

(5-24)

13.0

(8-20)

13.2

(5-25)

13.4

(10-17)

13.5

(5-29)

EU/EEA  
(population-weighted mean)

11 588

15.4

(15-16)

12 383

15.4

(15-16)

15 102

14.4

(14-15)

16 266

14.7

(14-15)

Lithuania

Portugal

Croatia

Italy

Hungary

Poland

Greece

Slovakia

Bulgaria

Latvia

Romania

30

16.7

(6-35)

1 061

22.0

(20-25)

24.2

(19-30)

41

1 185

248

19.2

(17-22)

18.5

(14-24)

19.5

(9-35)

74

10.8

(5-20)

227

683

739

183

649

261

47

3

88

24.9

(22-28)

1 068

21.7

(19-24)

24.1

(21-27)

21.9

(16-29)

26.7

(23-30)

29.5

(24-35)

29.8

(17-45)

**

(**)

59.1

(48-69)

763

259

660

247

52

13

85

24.2

(21-27)

27.8

(22-34)

19.4

(16-23)

34.8

(29-41)

26.9

(16-41)

23.1

(5-54)

65.9

(55-76)

1 228

240

1 160

735

401

696

164

54

15

86

18.0

(16-20)

20.8

(16-27)

23.0

(21-26)

20.7

(18-24)

19.5

(16-24)

33.6

(30-37)

31.1

(24-39)

38.9

(26-53)

26.7

(8-55)

44.2

(33-55)

88

1 216

231

1 332

729

415

814

180

71

14

127

14.8

(8-24)

18.6

(16-21)

19.5

(15-25)

20.0

(18-22)

23.9

(21-27)

24.6

(21-29)

24.9

(22-28)

35.6

(29-43)

38.0

(27-50)

42.9

(18-71)

N/A

55.9

(47-65)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

** Less than 10 isolates reported, no percentage calculated

37

 
Table 3.18. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to 
aminoglycosides (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Norway

Sweden

Denmark

Cyprus

Finland

United Kingdom

Netherlands

Germany

Austria

Estonia

Luxembourg

Belgium

Ireland

Slovenia

Malta

France

Portugal

Spain

EU/EEA  
(population-weighted mean)

Lithuania

Czech Republic

Hungary

Italy

Poland

Croatia

Bulgaria

Greece

Slovakia

Latvia

Romania

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

11

240

313

388

42

305

641

544

643

638

40

39

258

178

112

36

0.0

1.3

0.6

2.3

9.5

2.3

1.7

2.9

5.9

6.6

7.5

7.7

8.5

5.6

8.9

11.1

(0-28)

(0-4)

(0-2)

(1-4)

(3-23)

(1-5)

(1-3)

(2-5)

(4-8)

(5-9)

(2-20)

(2-21)

(5-13)

(3-10)

(4-16)

(3-26)

1 767

1 064

873

15.7

(14-18)

17.6

(15-20)

16.5

(14-19)

12

219

387

441

43

341

539

502

966

678

17

28

218

195

141

25

1 950

1 191

883

0.0

0.9

1.3

2.3

0.0

1.8

5.2

2.8

7.1

6.3

5.9

3.6

6.0

4.1

9.2

(0-26)

(0-3)

(0-3)

(1-4)

(0-8)

(1-4)

(3-7)

(2-5)

(6-9)

(5-8)

(0-29)

(0-18)

(3-10)

(2-8)

(5-15)

16.0

(5-36)

14.1

(13-16)

13.5

(12-16)

16.4

(14-19)

17

213

471

460

64

352

2 140

541

1 421

692

54

40

327

243

143

40

1 976

1 230

843

0.0

0.9

0.8

1.7

4.7

2.3

3.6

2.8

6.8

6.1

7.4

(0-20)

(0-3)

(0-2)

(1-3)

(1-13)

(1-4)

(3-4)

(2-5)

(6-8)

(4-8)

(2-18)

15.0

(6-30)

11.0

(8-15)

10.3

(7-15)

13.3

(8-20)

7.5

(2-20)

10.7

(9-12)

11.6

(10-14)

15.3

(13-18)

17

183

444

484

53

378

2 831

657

1 729

717

56

56

377

288

138

37

1 713

1 210

838

0.0

0.5

0.9

1.0

1.9

1.9

3.9

4.0

4.8

5.0

5.4

5.4

7.7

8.7

8.7

(0-20)

N/A

N/A

N/A

(0-3)

(0-2)

(0-2)

(0-10)

(1-4)

(3-5)

(3-6)

(4-6)

(4-7)

(1-15)

(1-15)

(5-11)

(6-13)

(5-15)

10.8

(3-25)

10.9

(9-12)

12.1

(10-14)

12.5

(10-15)

11 576

16.1

(15-17)

12 703

15.3

(15-16)

15 408

14.1

(14-15)

16 732

13.2

(13-14)

30

446

741

704

185

231

44

676

276

18

93

26.7

(12-46)

20.6

(17-25)

21.1

(18-24)

41

464

766

24.4

(12-40)

21.3

(18-25)

20.5

(18-24)

74

464

740

14.9

(8-25)

18.8

(15-23)

17.6

(15-21)

89

411

734

13.5

(7-22)

14.4

(11-18)

14.6

(12-17)

23.2

(20-26)

1 050

17.2

(15-20)

1 203

19.1

(17-21)

1 428

18.0

(16-20)

31.9

(25-39)

35.1

(29-42)

31.8

(19-48)

35.8

(32-40)

37.0

(31-43)

5.6

(0-27)

63.4

(53-73)

258

256

47

667

277

11

90

30.6

(25-37)

34.0

(28-40)

27.7

(16-43)

26.4

(23-30)

41.9

(36-48)

9.1

(0-41)

63.3

(53-73)

367

260

39

701

191

15

87

25.6

(21-30)

33.5

(28-40)

48.7

(32-65)

28.0

(25-31)

33.0

(26-40)

20.0

(4-48)

50.6

(40-61)

384

237

71

815

211

14

132

25.5

(21-30)

26.6

(21-33)

28.2

(18-40)

30.2

(27-33)

36.0

(30-43)

42.9

(18-71)

N/A

57.6

(49-66)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

38

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
Table 3.19 Pseudomonas aeruginosa. Total number of invasive isolates tested (N) and percentage with resistance to 
carbapenems (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Denmark

Norway

Netherlands

United Kingdom

Finland

Belgium

Ireland

Sweden

Estonia

Luxembourg

Malta

Germany

Austria

France

Czech Republic

Cyprus

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

(0-20)

N/A

11

386

256

543

590

307

344

177

408

39

42

36

642

636

9.1

4.7

5.9

4.4

6.3

7.2

(0-41)

(3-7)

(3-9)

(3-7)

(4-9)

(5-11)

10.2

(7-14)

8.5

7.1

(5-14)

(5-10)

15.4

(6-31)

4.8

(1-16)

13.9

(5-29)

17.0

(14-20)

12.7

(10-16)

12

437

228

500

499

341

256

195

398

16

24

25

971

680

0.0

4.6

5.7

4.0

2.4

4.7

3.9

9.2

6.5

(0-26)

(3-7)

(3-10)

(2-6)

(1-4)

(3-8)

(2-7)

(6-14)

(4-9)

12.5

(2-38)

8.3

(1-27)

16.0

(5-36)

14.7

(13-17)

12.2

(10-15)

1 780

18.7

(17-21)

1 925

16.4

(15-18)

448

42

14.1

(11-18)

33.3

(20-50)

464

43

10.6

(8-14)

20.9

(10-36)

17

458

225

543

2 108

352

365

243

472

54

31

40

1 422

696

1 968

464

64

5.9

2.4

6.7

3.7

5.1

6.0

9.6

6.2

(0-29)

(1-4)

(4-11)

(2-6)

(4-6)

(4-9)

(7-13)

(3-10)

11.0

(8-14)

20.4

(11-34)

6.5

(1-21)

12.5

(4-27)

14.5

(13-16)

12.9

(11-16)

15.6

(14-17)

8.8

(6-12)

18.8

(10-30)

17

484

205

655

2 804

377

474

288

446

55

56

37

1 753

725

1 710

411

53

0.0

2.5

3.4

4.4

5.7

6.1

8.2

9.0

9.0

(1-4)

(1-7)

(3-6)

(5-7)

(4-9)

(6-11)

(6-13)

(6-12)

9.1

(3-20)

10.7

(4-22)

10.8

(3-25)

12.7

(11-14)

13.9

(11-17)

13.9

(12-16)

14.8

(12-19)

17.0

(8-30)

N/A

N/A

EU/EEA  
(population-weighted mean)

11 789

19.7

(19-20)

12 719

19.4

(19-20)

15 456

18.2

(18-19)

16 864

17.4

(17-18)

Slovenia

Portugal

Spain

Italy

Poland

Lithuania

Bulgaria

Croatia

Hungary

Greece

Slovakia

Latvia

Romania

112

31.3

(23-41)

1 064

22.5

(20-25)

872

753

185

31

48

232

744

699

250

18

94

18.5

(16-21)

25.1

(22-28)

27.6

(21-35)

29.0

(14-48)

29.2

(17-44)

35.3

(29-42)

33.5

(30-37)

42.9

(39-47)

38.4

(32-45)

16.7

(4-41)

58.5

(48-69)

141

1 191

872

1 082

254

41

55

257

770

675

262

13

92

15.6

(10-23)

19.8

(18-22)

22.7

(20-26)

23.0

(21-26)

37.0

(31-43)

26.8

(14-43)

25.5

(15-39)

38.5

(33-45)

35.8

(32-39)

40.4

(37-44)

51.9

(46-58)

15.4

(2-45)

66.3

(56-76)

143

1 227

842

1 206

397

74

56

260

739

699

182

16

93

19.6

(13-27)

19.2

(17-21)

21.4

(19-24)

23.5

(21-26)

26.2

(22-31)

16.2

(9-27)

30.4

(19-44)

42.3

(36-49)

33.3

(30-37)

42.1

(38-46)

42.3

(35-50)

31.3

(11-59)

51.6

(41-62)

138

1 215

835

1 434

393

89

71

238

733

821

202

14

131

17.4

(11-25)

18.3

(16-21)

18.4

(16-21)

19.9

(18-22)

24.2

(20-29)

24.7

(16-35)

25.4

(16-37)

30.7

(25-37)

36.6

(33-40)

39.3

(36-43)

47.0

(40-54)

57.1

(29-82)

N/A

63.4

(54-72)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in 

any year during the period.

39

 
Table 3.20. Pseudomonas aeruginosa. Total number of invasive isolates tested (N) with combined resistance (resistance 
to three or more antimicrobial groups among piperacillin ± tazobactam, ceftazidime, fluoroquinolones, aminoglycosides 
and carbapenems) including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017 

Country

Iceland

Denmark

Norway

Netherlands

United Kingdom

Sweden

Finland

Luxembourg

Belgium

Austria

Germany

Ireland

Malta

Estonia

Cyprus

France

Slovenia

Spain

EU/EEA  
(population-weighted mean)

Portugal

Lithuania

Czech Republic

Italy

Hungary

Croatia

Poland

Bulgaria

Greece

Slovakia

Latvia

Romania

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

11

388

257

542

627

436

306

41

297

638

643

178

36

40

42

0.0

(0-28)

1.5

1.6

2.8

1.6

1.6

3.9

4.9

8.4

7.1

8.9

5.6

5.6

0.0

(1-3)

(0-4)

(2-5)

(1-3)

(1-3)

(2-7)

(1-17)

(6-12)

(5-9)

(7-11)

(3-10)

(2-18)

(0-9)

14.3

(5-29)

12

441

230

502

501

386

341

28

260

680

941

195

25

15

43

0.0

2.3

1.3

2.8

3.8

2.6

4.7

3.6

4.6

6.8

8.2

5.1

(0-26)

(1-4)

(0-4)

(2-5)

(2-6)

(1-5)

(3-8)

(0-18)

(2-8)

(5-9)

(7-10)

(2-9)

12.0

(3-31)

0.0

2.3

(0-22)

(0-12)

17

460

227

543

2 131

472

352

40

366

697

1 320

243

40

56

64

0.0

1.3

2.6

2.6

2.5

5.3

3.4

2.5

6.3

6.7

7.9

8.6

5.0

3.6

4.7

(0-18)

(1-3)

(1-6)

(2-4)

(2-3)

(4-8)

(2-6)

(0-13)

(4-9)

(5-9)

(7-9)

(6-13)

(1-17)

(1-12)

(2-13)

17

484

205

657

2 830

446

378

56

439

724

1 755

288

37

57

53

0.0

0.4

1.5

2.1

2.4

3.1

3.4

5.4

6.6

7.0

7.2

7.6

8.1

8.8

9.4

(0-18)

N/A

(0-1)

(0-4)

(1-4)

(2-3)

(2-5)

(2-6)

(2-15)

(5-9)

(5-9)

(6-9)

(5-11)

(3-21)

(4-19)

(4-20)

N/A

1 784

13.2

(12-15)

1 940

12.0

(11-14)

1 972

10.7

(9-12)

1 709

10.6

(9-12)

112

873

11 810

1 064

31

446

746

746

232

187

48

679

268

18

94

18.8

(12-27)

12.4

(10-15)

15.4

(15-16)

20.6

(18-23)

25.8

(12-45)

20.2

(17-24)

141

874

12 711

1 186

41

464

7.1

(3-13)

14.2

(12-17)

143

843

15.4

(10-22)

14.5

(12-17)

138

837

10.9

(7-17)

10.9

(9-13)

15.1

(14-16)

15 410

13.7

(13-14)

16 885

13.3

(13-14)

16.9

(14-18)

1 230

14.8

(13-17)

1 214

16.1

(14-18)

24.4

(12-40)

19.0

(15-23)

74

464

10.8

(6-20)

19.6

(16-23)

89

411

16.9

(10-26)

17.3

(14-21)

22.9

(20-26)

1 082

20.0

(18-22)

1 206

20.1

(18-23)

1 436

17.5

(16-20)

21.7

(19-25)

31.5

(26-38)

26.7

(21-34)

29.2

(17-44)

36.1

(32-40)

37.3

(32-43)

11.1

(1-35)

59.6

(49-70)

770

257

260

55

666

270

13

92

20.9

(18-24)

28.0

(23-34)

29.6

(24-36)

29.1

(18-43)

28.4

(25-32)

40.7

(35-47)

15.4

(2-45)

63.0

(52-73)

740

260

403

56

702

183

16

90

19.1

(16-22)

31.9

(27-38)

20.6

(17-25)

35.7

(24-59)

31.6

(28-35)

33.9

(27-41)

18.8

(7-43)

42.9

(39-59)

735

238

417

71

816

202

14

132

18.1

(15-21)

21.4

(17-27)

22.8

(19-27)

26.8

(18-38)

32.4

(29-36)

39.1

(33-46)

42.9

(20-66)

N/A

59.1

(51-67)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in 

any year during the period.

40

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
3.4 Acinetobacter species
The  Acinetobacter  genus  consists  of  a  large  number  of 
species  which  can  be  divided  into  two  complexes:  the 
Acinetobacter  baumannii  complex  –  the  group  includ-
ing most of the disease-causing species (A. baumannii, 
A.  pittii  and  A.  nosocomialis)  –  and  the  generally  less 
pathogenic  Acinetobacter  non-baumannii  group.  The 
correct  identification  of  Acinetobacter  isolates  to  spe-
cies  level  is  difficult,  although  possible  with  mass 
spectrometry and genotypic methods.

Species  belonging  to  the  Acinetobacter  baumannii 
group are opportunistic pathogens primarily associated 
with  healthcare-associated  infections  including  ven-
tilator-associated  pneumonia,  central-line-associated 
bloodstream  infections,  urinary  tract  infections  and 
wound  infections.  Risk  factors  for  infection  include 
advanced  age,  presence  of  serious  underlying  disease, 
immune  suppression,  major  trauma  or  burn  injuries, 
invasive  procedures,  presence  of  indwelling  catheters, 
mechanical ventilation, extended hospital stay and pre-
vious administration of antibiotics.

Acinetobacter  spp.,  particularly  those  belonging  to  the 
A. baumannii  complex,  are  intrinsically  resistant  to 
most  antimicrobial  agents  due  to  their  selective  abil-
ity  to  prevent  various  molecules  from  penetrating  their 
outer  membrane.  The  antimicrobial  groups  that  remain 
active  include  some  fluoroquinolones  (e.g.  ciprofloxa-
cin and levofloxacin), aminoglycosides (e.g. gentamicin, 
tobramycin and amikacin), carbapenems (imipenem and 
meropenem), polymyxins (polymyxin B and colistin) and 
possibly sulbactam and tigecycline. Acquired resistance 
results from mutational changes in the chromosome and 
acquisition of plasmid-mediated resistance genes.

Antimicrobial resistance
More than half of the Acinetobacter spp. isolates reported 
by  EU/EEA  countries  to  EARS-Net  for  2017  (55.0%)  were 
resistant  to  at  least  one  of  the  antimicrobial  groups 

under  regular  surveillance,  i.e.  fluoroquinolones,  ami-
noglycosides and carbapenems (Table 3.21). In 2017, the 
EU/EEA  population-weighted  mean  percentage  showed 
little  variation  between  the  antimicrobial  groups  and 
varied  between  32.4%  and  37.6%  (Tables  3.22–3.24). 
Trend analyses were not performed for the EU/EEA popu-
lation-weighted means as the proportion of laboratories 
that  consistently  reported  data  for  the  full  four-year 
period remained low.

Resistance to one or two antimicrobial groups was con-
siderably  less  common  than  combined  resistance  to  all 
three groups under surveillance (Table 3.21). In 2017, the 
population-weighted  EU/EEA  mean  percentage  for  com-
bined  resistance  to  fluoroquinolones,  aminoglycosides 
and carbapenems was 28.4% (Table 3.25).

Large inter-country variations were noted for all antimi-
crobial groups under regular surveillance, with generally 
higher  resistance  percentages  reported  from  southern 
and  eastern  parts  of  Europe  than  from  northern  Europe 
(Figures  3.20–3.23).  Single  resistance  to  one  antimi-
crobial  group  was  less  common  in  countries  reporting 
comparatively  low  proportions  of  fully  susceptible  iso-
lates (Figure 3.19).

Discussion and conclusion

in 
in  previous  years,  antimicrobial  resistance 
As 
Acinetobacter  spp.  varied  largely  across  Europe,  with 
generally  high  resistance  percentages  reported  from 
the  Baltic  countries  and  from  southern  and  south-east-
ern  Europe.  More  than  half  of  the  Acinetobacter  spp. 
isolates  reported  to  EARS-Net  for  2017  were  resistant 
to  at  least  one  antimicrobial  group  under  surveillance. 
Combined  resistance  to  multiple  antimicrobial  groups 
was  common.  The  most  frequently  reported  resistance 
phenotype  was  resistance  to  all  three  groups  under 
regular  surveillance,  i.e.  fluoroquinolones,  aminoglyco-
sides and carbapenems. This is a public health concern 
because  it  not  only  severely  limits  options  for  patient 
treatment  but  also  constitutes  an  infection  prevention 

Table 3.21. Acinetobacter spp. Overall resistance and resistance combinations among invasive isolates tested to 
fluoroquinolones, aminoglycosides and carbapenems (n=5 853)*, EU/EEA countries, 2017

Resistance pattern
Fully susceptible
Single resistance (to indicated antimicrobial group)
Total (any single resistance)
Fluoroquinolones
Aminoglycosides
Carbapenems
Resistance to two antimicrobial groups
Total (any two-group combinations)
Fluoroquinolones + carbapenems
Fluoroquinolones + aminoglycosides
Aminoglycosides + carbapenems
Resistance to three antimicrobial groups
Fluoroquinolones + aminoglycosides + carbapenems

* Only data from isolates tested against all three antimicrobial groups were included in the analysis.
** Not adjusted for population differences in the reporting countries.

Number of isolates
2 633

 % of total**
45.0

249
158
56
35

441
283
145
13

2 530

4.3
2.7
1.0
0.6

7.5
4.8
2.5
0.2

43.2

41

timely  laboratory  reporting,  screening  and  pre-emptive 
isolation  of  high-risk  patients,  high-standard  infection 
control and antimicrobial stewardship programmes [21].

and control challenge. The presence of multidrug-resist-
ant  Acinetobacter  spp.  in  the  healthcare  environment 
is  problematic:  the  bacterium  can  persist  in  the  envi-
ronment  for  long  periods  and  is  notoriously  difficult  to 
eradicate once established.

ECDC’s 
risk  assessment  on  carbapenem-resistant 
Acinetobacter  baumannii  in  healthcare  highlights  the 
need  of  increased  efforts  to  face  this  significant  threat 
to  patients  and  healthcare  systems  in  all  EU/EEA  coun-
tries.  The  document  outlines  options  to  reduce  risks 
through  clinical  management,  prevention  of  trans-
mission  in  hospitals  and  other  healthcare  settings, 
prevention  of  cross-border  transmission,  and  improve-
ment  of  preparedness  of  EU/EEA  countries.  Options  for 
response  presented  in  the  risk  assessment  included 

Figure 3.19. Acinetobacter spp. Distribution of isolates: fully susceptible and resistant to one, two and three 
antimicrobial groups (among isolates tested against fluoroquinolones, aminoglycosides and carbapenems),  
EU/EEA countries, 2017

)
s
e
t
a

l

o
s
i

d
e
t
r
o
p
e
r
l

a
t
o
t
/
s
e
t
a

l

o
s
i

d
e
d
u

l
c
n

i
(

y
r
t
n
u
o
C

Sweden (51/54)

Norway (31/31)

Malta (9/9)

Iceland (6/6)

Finland (36/37)

Denmark (66/68)

Netherlands (120/122)

United Kingdom (746/818)

Germany (457/505)

Austria (74/75)

Ireland (59/66)

Luxembourg (8/8)

France (468/475)

Belgium (98/131)

Czech Republic (55/55)

Estonia (9/16)

Portugal (166/174)

Slovenia (36/36)

Slovakia (119/126)

Hungary (352/358)

Spain (88/88)

Cyprus (50/50)

Italy (763/878)

Latvia (32/34)

Poland (333/352)

Romania (182/183)

Lithuania (85/87)

Bulgaria (92/92)

Greece (1,059/1,096)

Croatia (203/208)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of total

Fully 
susceptible

Resistant to one 
antimicrobial group

Resistant to two 
antimicrobial groups

Resistant to three 
antimicrobial groups

Only data from isolates tested against all included antimicrobial groups included in analysis.

42

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
Figure 3.20. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to fluoroquinolones, by country,  
EU/EEA countries, 2017 

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.21. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to aminoglycosides, by country, 
EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

43

Figure 3.22. Acinetobacter spp. Percentage (%) of invasive isolates with resistance to carbapenems, by country,  
EU/EEA countries, 2017 

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.23. Acinetobacter spp. Percentage (%) of invasive isolates with combined resistance to fluoroquinolones, 
aminoglycosides and carbapenems, by country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

44

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.22. Acinetobacter spp. Total number of invasive isolates tested (N) and percentage with resistance to 
fluoroquinolones (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Norway

Sweden

Denmark

Finland

Netherlands

United Kingdom

Germany

Ireland

Austria

Belgium

France

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

34

52

69

31

72

123

199

86

75

4

5.9

(1-20)

11.5

(4-23)

2.9

6.5

4.2

(0-10)

(1-21)

(1-12)

11.4

(6-18)

6.0

4.7

5.3

**

(3-10)

(1-11)

(1-13)

(**)

32

26

68

43

74

139

339

83

61

26

9.4

3.8

5.9

2.3

6.8

7.2

8.6

4.8

(2-25)

(0-20)

(2-14)

(0-12)

(2-15)

(4-13)

(6-12)

(1-12)

16.4

(8-28)

0.0

(0-13)

33

86

72

28

106

589

460

68

81

78

3.0

4.7

2.8

0.0

2.8

4.4

5.7

1.5

(0-16)

(1-11)

(0-10)

(0-12)

(1-8)

(3-6)

(4-8)

(0-8)

16.0

(9-26)

7.7

(3-16)

395

11.9

(9-16)

430

13.5

(10-17)

452

15.0

(12-19)

Trend 
2014-
2017*

N/A

2017

 %R

(95 %CI)

0.0

0.0

1.5

2.7

3.3

6.3

6.8

7.6

9.5

(0-11)

(0-7)

(0-8)

(0-14)

(1-8)

(5-8)

(5-9)

(3-17)

(4-19)

10.8

(6-17)

N/A

12.3

(9-16)

20.0

(10-33)

36.4

(11-69)

31

54

68

37

122

793

498

66

74

130

473

55

11

Czech Republic

Estonia

EU/EEA  
(population-weighted mean)

59

-

15.3

(7-27)

-

(-)

60

4

18.3

(10-30)

**

(**)

4 244

40.2

(39-42)

5 028

38.6

(37-40)

Portugal

Slovenia

Slovakia

Hungary

Spain

Cyprus

Italy

Latvia

Poland

Romania

Lithuania

Bulgaria

Greece

Croatia

Iceland

Luxembourg

Malta

264

34

170

441

79

58

52.7

(46-59)

41.2

(25-59)

51.8

(44-59)

66.4

(62-71)

67.1

(56-77)

77.6

(65-87)

469

92.1

(89-94)

52

185

123

66

115

806

164

3

6

10

88.5

(77-96)

82.7

(76-88)

83.7

(76-90)

84.8

(74-92)

73.9

(65-82)

95.3

(94-97)

92.1

(87-96)

**

**

(**)

(**)

30.0

(7-65)

308

31

154

464

95

60

664

60

243

189

73

131

946

196

6

8

15

55.8

(50-61)

58.1

(39-75)

51.9

(44-60)

68.1

(64-72)

64.2

(54-74)

83.3

(71-92)

81.6

(78-85)

78.3

(66-88)

88.1

(83-92)

82.5

(76-88)

93.2

(85-98)

78.6

(71-85)

94.9

(93-96)

92.3

(88-96)

**

**

(**)

(**)

13.3

(2-40)

57

5

5 591

206

60

115

397

106

28

697

68

393

157

87

106

862

176

3

8

7

17.5

(9-30)

**

(**)

37.5

(36-39)

6 069

37.6

(36-39)

50.5

(43-58)

55.0

(42-68)

46.1

(37-56)

68.0

(63-73)

68.9

(59-78)

71.4

(51-87)

79.9

(77-83)

85.3

(75-93)

83.0

(79-87)

91.1

(85-95)

87.4

(79-94)

67.9

(58-77)

94.9

(93-96)

94.9

(91-98)

**

**

**

(**)

(**)

(**)

172

36

126

352

88

50

804

33

348

183

86

92

1 060

204

6

8

9

38.4

(31-46)

47.2

(30-65)

52.4

(43-61)

67.0

(62-72)

70.5

(60-80)

76.0

(62-87)

79.2

(76-82)

81.8

(65-93)

83.0

(79-87)

89.1

(84-93)

91.9

(84-97)

95.7

(89-99)

96.0

(95-97)

98.0

(95-99)

**

**

**

(**)

(**)

(**)

N/A

N/A

N/A

N/A

N/A

–: No data
* 
 and 
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in 

 indicate significant increasing and decreasing trends, respectively.

any year during the period.

** Less than 10 isolates reported, no percentage calculated

45

Table 3.23. Acinetobacter spp. Total number of invasive isolates tested (N) and percentage with resistance to 
aminoglycosides (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Denmark

Finland

Norway

Sweden

Netherlands

Ireland

Germany

United Kingdom

France

Austria

Czech Republic

Belgium

Portugal

EU/EEA  
(population-weighted mean)

Slovakia

Slovenia

Spain

Hungary

Poland

Cyprus

Italy

Latvia

Lithuania

Romania

Croatia

Greece

Bulgaria

Estonia

Iceland

Luxembourg

Malta

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

60

31

33

36

73

89

197

129

409

79

59

2

265

4 190

170

34

80

444

188

57

444

52

65

122

166

800

87

-

3

6

1.7

3.2

3.0

2.8

5.5

2.2

4.1

(0-9)

(0-17)

(0-16)

(0-15)

(2-13)

(0-8)

(2-8)

10.1

(5-17)

8.3

8.9

(6-11)

(4-17)

10.2

(4-21)

**

(**)

63

42

32

26

74

80

331

153

431

63

60

15

4.8

2.4

9.4

3.8

(1-13)

(0-13)

(2-25)

(0-20)

10.8

(5-20)

3.8

5.4

2.0

11.1

6.3

(1-11)

(3-8)

(0-6)

(8-14)

(2-15)

15.0

(7-27)

0.0

(0-22)

42.3

(36-48)

310

46.5

(41-52)

34.5

(33-36)

4 997

32.4

(31-34)

40.6

(33-48)

32.4

(17-51)

58.8

(47-70)

59.5

(55-64)

58.5

(51-66)

73.7

(60-84)

88.3

(85-91)

69.2

(55-81)

80.0

(68-89)

77.0

(69-84)

82.5

(76-88)

83.9

(81-86)

60.9

(50-71)

-

**

**

(-)

(**)

(**)

10

30.0

(7-65)

154

31

96

465

245

59

656

61

73

188

197

945

116

2

6

8

15

42.9

(35-51)

41.9

(25-61)

49.0

(39-59)

60.6

(56-65)

70.2

(64-76)

74.6

(62-85)

74.7

(71-78)

59.0

(46-71)

90.4

(81-96)

80.9

(74-86)

88.3

(83-92)

83.7

(81-86)

74.1

(65-82)

**

**

**

(**)

(**)

(**)

13.3

(2-40)

70

28

32

85

103

63

436

598

449

81

57

66

206

5 557

115

60

106

401

387

28

704

81

87

152

182

878

79

5

3

8

7

0.0

3.6

3.1

5.9

3.9

1.6

3.0

3.3

(0-5)

(0-18)

(0-16)

(2-13)

(1-10)

(0-9)

(2-5)

(2-5)

12.2

(9-16)

16.0

(9-26)

8.8

1.5

(3-19)

(0-8)

68

36

31

51

120

62

460

790

474

75

55

99

N/A

0.0

0.0

0.0

0.0

2.5

3.2

3.5

4.6

9.1

9.3

(0-5)

(0-10)

(0-11)

(0-7)

(1-7)

(0-11)

(2-6)

(3-6)

(7-12)

(4-18)

12.7

(5-24)

13.1

(7-21)

N/A

39.3

(33-46)

168

28.6

(22-36)

32.8

(32-34)

6 022

32.4

(31-34)

N/A

40.9

(32-50)

43.3

(31-57)

50.9

(41-61)

59.1

(54-64)

72.6

(68-77)

57.1

(37-76)

76.4

(73-80)

77.8

(67-86)

82.8

(73-90)

89.5

(83-94)

83.0

(77-88)

125

36

88

358

344

50

836

33

86

183

206

40.0

(31-49)

41.7

(26-59)

54.5

(44-65)

56.1

(51-61)

72.7

(68-77)

76.0

(62-87)

76.1

(73-79)

78.8

(61-91)

81.4

(72-89)

83.6

(77-89)

84.0

(78-89)

85.0

(82-87)

1 064

85.6

(83-88)

81.0

(71-89)

92

89.1

(81-95)

**

**

(**)

(**)

12.5

(0-53)

**

(**)

9

6

8

9

**

**

**

**

(**)

(**)

(**)

(**)

N/A

N/A

N/A

N/A

–: No data
* 
 and 
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

 indicate significant increasing and decreasing trends, respectively.

year during the period.

** Less than 10 isolates reported, no percentage calculated

46

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.24. Acinetobacter spp. Total number of invasive isolates tested (N) and percentage with resistance to 
carbapenems (%R), including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Denmark

Norway

Sweden

Netherlands

Finland

United Kingdom

Germany

France

Ireland

Austria

Belgium

Czech Republic

Slovakia

Estonia

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

62

34

52

74

32

120

201

401

79

78

4

59

161

-

1.6

2.9

3.8

0.0

3.1

1.7

5.5

2.5

1.3

(0-9)

(0-15)

(0-13)

(0-5)

(0-16)

(0-6)

(3-10)

(1-5)

(0-7)

6.4

(2-14)

**

5.1

(**)

(1-14)

32.9

(26-41)

-

(-)

65

32

34

73

43

132

337

428

84

64

24

60

142

3

4.6

9.4

2.9

4.1

2.3

0.8

6.5

5.6

6.0

9.4

0.0

6.7

(1-13)

(2-25)

(0-15)

(1-12)

(0-12)

(0-4)

(4-10)

(4-8)

(2-13)

(4-19)

(0-14)

(2-16)

28.2

(21-36)

**

(**)

69

33

84

104

28

584

452

450

65

81

78

57

109

8

0.0

0.0

1.2

0.0

0.0

1.5

4.9

(0-5)

(0-11)

(0-6)

(0-3)

(0-12)

(1-3)

(3-7)

7.1

(5-10)

0.0

(0-6)

12.3

(6-22)

2.6

1.8

(0-9)

(0-9)

28.4

(20-38)

**

(**)

66

31

54

121

37

782

502

469

63

75

131

55

120

15

0.0

0.0

0.0

0.8

2.7

2.8

4.4

6.2

6.3

6.7

6.9

(0-5)

(0-11)

(0-7)

(0-5)

(0-14)

(2-4)

(3-7)

(4-9)

(2-15)

(2-15)

(3-13)

12.7

(5-24)

31.7

(23-41)

33.3

(12-62)

EU/EEA  
(population-weighted mean)

4 275

33.2

(32-35)

5 052

32.1

(31-33)

5 588

32.6

(31-34)

6 158

33.4

(32-35)

57.7

(52-63)

206

51.9

(45-59)

Portugal

Slovenia

Hungary

Poland

Spain

Cyprus

Italy

Latvia

Bulgaria

Romania

Lithuania

Greece

Croatia

Iceland

Luxembourg

Malta

262

34

443

189

78

58

477

52

110

123

66

841

166

3

6

10

53.1

(47-59)

26.5

(13-44)

44.5

(40-49)

53.4

(46-61)

65.4

(54-76)

77.6

(65-87)

89.9

(87-92)

78.8

(65-89)

59.1

(49-68)

81.3

(73-88)

69.7

(57-80)

93.2

(91-95)

87.3

(81-92)

**

**

(**)

(**)

10.0

(0-45)

307

31

467

244

95

59

664

61

130

189

73

983

200

6

7

15

38.7

(22-58)

55.2

(51-60)

65.6

(59-72)

53.7

(43-64)

83.1

(71-92)

78.3

(75-81)

68.9

(56-80)

73.8

(65-81)

81.5

(75-87)

80.8

(70-89)

93.5

(92-95)

89.0

(84-93)

**

**

(**)

(**)

13.3

(2-40)

60

401

391

106

28

702

82

103

160

87

861

181

3

8

7

43.3

(31-57)

58.6

(54-63)

66.0

(61-71)

62.3

(52-71)

71.4

(51-87)

172

36

358

344

88

50

40.7

(33-48)

41.7

(26-59)

52.5

(47-58)

67.4

(62-72)

68.2

(57-78)

76.0

(62-87)

78.5

(75-81)

868

78.7

(76-81)

73.2

(62-82)

74.8

(65-83)

85.0

(79-90)

81.6

(72-89)

95.4

(94-97)

94.5

(90-97)

**

**

**

(**)

(**)

(**)

34

92

182

87

1 095

208

6

8

9

79.4

(62-91)

80.4

(71-88)

87.4

(82-92)

88.5

(80-94)

94.8

(93-96)

96.2

(93-98)

**

**

**

(**)

(**)

(**)

N/A

N/A

N/A

N/A

N/A

N/A

N/A

–: No data
* 
 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

 indicate significant increasing and decreasing trends, respectively.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

** Less than 10 isolates reported, no percentage calculated

47

 
Table 3.25. Acinetobacter spp. Total number of isolates tested (N) and percentage with combined resistance to 
fluoroquinolones, aminoglycosides and carbapenems (%R), including 95 % confidence intervals (95 % CI), by country, 
EU/EEA countries, 2014 to 2017

Country

Denmark

Finland

Norway

Sweden

Netherlands

Germany

Ireland

United Kingdom

France

Czech Republic

Austria

Belgium

Portugal

Slovakia

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

49

30

33

36

69

188

79

119

391

59

74

2

260

160

0.0

0.0

3.0

2.8

0.0

2.1

1.3

1.7

1.5

5.1

2.7

**

(0-7)

(0-12)

(0-16)

(0-15)

(0-5)

(1-5)

(0-7)

(0-6)

(1-3)

(1-14)

(0-9)

(**)

39.2

(33-45)

24.4

(18-32)

60

42

32

26

73

328

75

131

424

60

61

13

302

142

3.3

2.4

9.4

3.8

4.1

3.7

1.3

0.0

5.2

5.0

4.9

0.0

(0-12)

(0-13)

(2-25)

(0-20)

(1-12)

(2-6)

(0-7)

(0-3)

(3-8)

(1-14)

(1-14)

(0-25)

45.0

(39-51)

23.2

(17-31)

67

28

32

84

100

435

61

558

447

57

81

64

206

109

0.0

0.0

0.0

1.2

0.0

2.3

0.0

0.9

6.7

0.0

8.6

0.0

(0-5)

(0-12)

(0-11)

(0-6)

(0-4)

(1-4)

(0-6)

(0-2)

(5-9)

(0-6)

(4-17)

(0-6)

37.9

(31-45)

24.8

(17-34)

66

36

31

51

120

457

59

746

468

55

74

98

166

119

N/A

0.0

0.0

0.0

0.0

0.8

1.3

1.7

1.7

5.3

5.5

(0-5)

(0-10)

(0-11)

(0-7)

(0-5)

(0-3)

(0-9)

(1-3)

(3-8)

(1-15)

6.8

(2-15)

7.1

(3-14)

N/A

24.1

(18-31)

25.2

(18-34)

EU/EEA  
(population-weighted mean)

4 074

28.5

(27-30)

4 901

27.7

(26-29)

5 413

28.3

(27-30)

5 853

28.4

(27-30)

N/A

Slovenia

Hungary

Spain

Poland

Italy

Latvia

Cyprus

Lithuania

Bulgaria

Romania

Croatia

Greece

Estonia

Iceland

Luxembourg

Malta

34

438

78

184

437

52

57

65

85

121

162

793

-

3

6

10

20.6

(9-38)

38.4

(34-43)

55.1

(43-66)

38.0

(31-45)

86.3

(83-89)

61.5

(47-75)

73.7

(60-84)

60.0

(47-72)

47.1

(36-58)

76.9

(68-84)

80.9

(74-87)

82.6

(80-85)

-

**

**

(-)

(**)

(**)

10.0

(0-45)

31

462

94

240

650

60

59

73

112

186

193

943

1

6

7

15

35.5

(19-55)

51.7

(47-56)

41.5

(31-52)

54.6

(48-61)

72.6

(69-76)

46.7

(34-60)

72.9

(60-84)

76.7

(65-86)

66.1

(57-75)

76.9

(70-83)

87.0

(81-91)

82.2

(80-85)

**

**

**

(**)

(**)

(**)

6.7

(0-32)

60

397

106

383

692

67

28

87

76

152

175

838

5

3

8

7

38.3

(26-52)

52.4

(47-57)

44.3

(35-54)

59.3

(54-64)

74.7

(71-78)

67.2

(55-78)

57.1

(37-76)

75.9

(65-84)

72.4

(61-82)

82.9

(76-89)

81.1

(75-87)

36

352

88

333

763

32

50

85

92

182

203

41.7

(26-59)

48.9

(44-54)

51.1

(40-62)

59.5

(54-65)

72.6

(69-76)

75.0

(57-89)

76.0

(62-87)

77.6

(67-86)

78.3

(68-86)

81.3

(75-87)

83.7

(78-89)

84.0

(81-86)

1 059

84.3

(82-86)

**

**

**

**

(**)

(**)

(**)

(**)

9

6

8

9

**

**

**

**

(**)

(**)

(**)

(**)

N/A

N/A

N/A

N/A

–: No data
* 
 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

 indicate significant increasing and decreasing trends, respectively.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

** Less than 10 isolates reported, no percentage calculated

48

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
3.5 Streptococcus pneumoniae
Streptococcus  pneumoniae  is  a  common  cause  of  dis-
ease,  especially  among  young  children,  elderly  people 
and  patients  with  compromised  immune  functions.  The 
clinical  spectrum  ranges  from  upper  airway  and  middle 
ear  infection  to  pneumonia,  bloodstream  infection  and 
meningitis.

The  mechanism  of  penicillin  resistance  in  S. pneu-
moniae  consists  of  alterations  in  penicillin-binding 
proteins  (PBPs),  which  may  result  in  reduced  affinity 
to  penicillin  G  and  a  variable  spectrum  of  other  beta-
lactams.  Alterations  in  PBPs  are  due  to  homologous 
DNA  recombination  with  PBP  gene  sequences  originat-
ing from commensal streptococci. Acquisition of mosaic 
PBP  results  in  different  degrees  of  resistance,  ranging 
from low-level clinical resistance, conventionally termed 
intermediate  (I),  to  full  clinical  resistance  (R).  In  the 
absence of meningitis, infections with intermediate iso-
lates  are  often  successfully  treated  with  high  doses  of 
benzylpenicillin or of an aminopenicillin.

Macrolide  resistance  is  mainly  due  to  acquisition  of 
either an erythromycin ribosomal methylation gene or a 
macrolide efflux system gene.

Antimicrobial resistance

In  2017,  as  in  previous  years,  wide  inter-country  varia-
tions  could  be  noted  in  S. pneumoniae  susceptibility. 
The national percentages of isolates with penicillin non-
susceptibility  ranged  from  0.2%  to  45.5%  (Table  3.26) 
and from 3.6% to 36.8% for macrolide non-susceptibility 
(Table  3.27,  Figure  3.24).  Macrolide  non-susceptibility 
was,  for  most  countries,  higher  than  penicillin  non-
susceptibility.  Combined  non-susceptibility  to  both 
penicillins  and  macrolides  was  less  common,  with  a 
majority  of  the  countries  reporting  this  phenotype  for 
less than 10% of the tested isolates (Table 3.28).

Data  might  not  be  comparable  across  all  countries  and 
years as the clinical breakpoints used to determine peni-
cillin susceptibility in S. pneumoniae differ depending on 
the  sites  of  infection  and  the  guidelines  used  for  inter-
pretation. Consequently, a population-weighted EU/EEA 
mean percentage was not calculated for S. pneumoniae.

Discussion and conclusion

Based  on  EARS-Net  data,  the  resistance  situation  in 
S. pneumoniae  appears  stable  in  the  EU/EEA,  with  few 
countries reporting increasing or decreasing trends dur-
ing  the  period  2014–2017.  As  in  previous  years,  large 
inter-country  variations  could  be  noted  for  penicillin 
susceptibility.  Differences  in  the  clinical  breakpoints 
used for determining penicillin susceptibility in S. pneu-
moniae  with  regard  to  guidelines  used  and  the  sites  of 
infection  introduce  bias  when  comparing  national  data 
reported to EARS-Net. Limited information on the guide-
lines used for interpretation and incomplete quantitative 
susceptibility  data  hamper  any  assessment  of  inter-
country differences.

In  parallel  to  EARS-Net,  the  invasive  pneumococcal 
disease  (IPD)  enhanced  surveillance  initiative,  which  is 
also  coordinated  by  ECDC,  collects  additional  data  on 
IPD  cases  from  reference  laboratories  throughout  the 
EU/EEA  [22].  Data  from  this  surveillance  initiative  show 
that  the  prevalence  of  non-susceptibility  increased  for 
penicillin and erythromycin in all countries that consist-
ently reported antimicrobial susceptibility data between 
2014 and 2016. It is, however, difficult to compare data 
from the two surveillance systems due to differences in 
data  sources  and  completeness  of  reporting.  The  two 
surveillance  systems  within  ECDC  are  currently  being 
harmonised to make best use of available data.

Most EU/EEA countries have implemented routine immu-
nisation  for  children  with  multivalent  pneumococcal 
conjugated  vaccines  (PCVs).  In  some  countries,  adult 
high-risk  groups  such  as  the  elderly  and  immunocom-
promised  are  also  targeted  with  the  polysaccharide 
vaccine  or  with  PCVs  [23].  Increased  immunisation  and 
better serotype coverage of the available PCVs are likely 
to impact the epidemiology of non-susceptible S. pneu-
moniae  in  the  EU/EEA,  both  in  terms  of  changes  in  the 
age-specific  incidence  and  potential  serotype  replace-
ment.  Continued  long-term  monitoring  of  antimicrobial 
non-susceptibility  is  crucial  to  detect  the  emergence  of 
non-vaccine, non-susceptible serotypes.

49

Figure 3.24. Streptococcus pneumoniae.  Percentage (%) of invasive isolates non-susceptible to macrolides, by 
country, EU/EEA countries, 2017 

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

50

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.26. Streptococcus pneumoniae. Total number of tested isolates (N) and percentages non-susceptible to 
penicillin (%IR), including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017

Country

Belgium

Estonia

Netherlands

Denmark

Germany

Norway

Czech Republic

United Kingdom

Austria

Sweden

Luxembourg

Hungary

Slovenia

Finland

Italy

Portugal

Lithuania

Ireland

Poland

Latvia

Iceland

Spain

Croatia

Slovakia

France

Bulgaria

Romania

Malta

Cyprus

Greece

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

1 110

72

1 139

709

499

534

274

1 288

361

696

32

128

300

593

183

610

67

328

130

48

25

551

129

29

656

32

45

8

12

-

1.3

4.2

2.1

5.6

4.4

5.1

5.8

5.1

5.3

7.9

6.3

(1-2)

(1-12)

(1-3)

(4-8)

(3-7)

(3-7)

(3-9)

(4-6)

(3-8)

(6-10)

(1-21)

11.7

(7-19)

9.7

(7-14)

12.5

(10-15)

15.3

(10-21)

10.2

(8-13)

16.4

(8-27)

17.7

(14-22)

29.2

(22-38)

4.2

8.0

(1-14)

(1-26)

27.9

(24-32)

26.4

(19-35)

20.7

(8-40)

1 361

72

1 163

747

761

429

284

1 095

444

420

27

181

323

677

389

797

87

303

217

59

25

665

126

27

0.6

2.8

1.8

4.7

6.2

5.4

3.2

7.8

5.6

9.8

3.7

7.2

9.0

(0-1)

(0-10)

(1-3)

(3-6)

(5-8)

(3-8)

(1-6)

(6-10)

(4-8)

(7-13)

(0-19)

(4-12)

(6-13)

12.7

(10-15)

12.3

(9-16)

11.2

(9-14)

16.1

(9-26)

17.5

(13-22)

24.4

(19-31)

8.5

(3-19)

24.0

(9-45)

23.5

(20-27)

19.0

(13-27)

22.2

(9-42)

1 327

112

1 391

707

1 359

500

266

3 201

440

882

51

174

269

706

399

884

99

363

337

61

19

643

155

13

0.4

3.6

2.2

6.1

4.6

4.4

4.5

4.9

3.4

7.1

(0-1)

(1-9)

(2-3)

(4-8)

(4-6)

(3-7)

(2-8)

(4-6)

(2-6)

(6-9)

13.7

(6-26)

15.5

(10-22)

6.7

(4-10)

10.3

(8-13)

6.5

(4-9)

12.2

(10-15)

16.2

(10-25)

16.5

(13-21)

19.3

(15-24)

11.5

(5-22)

10.5

(1-33)

25.0

(22-29)

21.9

(16-29)

7.7

(0-36)

22.3

(19-26)

1 068

22.9

(20-26)

1 046

25.3

(23-28)

25.0

(11-43)

46.7

(32-62)

**

0

-

(**)

(0-26)

(-)

35

41

20

7

-

22.9

(10-40)

39.0

(24-55)

35

**

-

(15-59)

(**)

(-)

33

56

10

10

-

27.3

(13-46)

41.1

(28-55)

10

40

-

(0-45)

(12-74)

(-)

1 472

141

1 401

727

1 823

480

366

3 963

463

750

45

204

319

698

522

997

109

412

290

51

27

706

129

39

614

29

79

19

11

-

0.2

2.1

3.4

3.9

4.8

4.8

4.9

5.3

6.0

6.1

6.7

6.9

(0-1)

(0-6)

(3-5)

(3-6)

(4-6)

(3-7)

(3-8)

(5-6)

(4-9)

(5-8)

(1-18)

(4-11)

10.0

(7-14)

10.5

(8-13)

10.5

(8-13)

12.8

(11-15)

15.6

(9-24)

15.8

(12-20)

16.6

(12-21)

17.6

(8-31)

18.5

(6-38)

N/A

22.5

(19-26)

22.5

(16-31)

25.6

(13-42)

N/A

25.9

(22-30)

27.6

(13-47)

29.1

(19-40)

31.6

(13-57)

45.5

(17-77)

-

(-)

N/A

N/A

N/A

–: No data
* 
 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

 indicate significant increasing and decreasing trends, respectively.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

** Less than 10 isolates reported, no percentage calculated

51

 
Table 3.27. Streptococcus pneumoniae. Total number of tested isolates (N) and percentages non-susceptible to 
macrolides (%IR), including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 2017 

Country

Denmark

Estonia

Sweden

Netherlands

Norway

United Kingdom

Germany

Latvia

Luxembourg

Czech Republic

Austria

Hungary

Ireland

Finland

Portugal

Belgium

Slovenia

Lithuania

Iceland

Spain

France

Italy

Poland

Cyprus

Bulgaria

Romania

Slovakia

Croatia

Malta

Greece

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

709

54

788

1 287

492

1 260

494

49

35

274

400

123

317

636

658

1 108

300

62

24

544

656

252

121

11

30

50

29

6.6

5.6

6.7

4.3

7.5

7.1

7.1

4.1

(5-9)

(1-15)

(5-9)

(3-6)

(5-10)

(6-9)

(5-10)

(0-14)

14.3

(5-30)

7.7

(5-11)

10.5

(8-14)

14.6

(9-22)

13.9

(10-18)

14.5

(12-17)

16.0

(13-19)

17.9

(16-20)

19.3

(15-24)

22.6

(13-35)

12.5

(3-32)

20.0

(17-24)

747

54

850

1 168

403

1 077

758

58

29

284

439

170

296

765

822

1 361

323

72

25

631

5.2

7.4

6.9

3.9

(4-7)

(2-18)

(5-9)

(3-5)

10.7

(8-14)

7.2

8.4

6.9

0.0

6.7

8.7

(6-9)

(7-11)

(2-17)

(0-12)

(4-10)

(6-12)

11.2

(7-17)

15.5

(12-20)

14.4

(12-17)

17.0

(15-20)

18.7

(17-21)

18.9

(15-24)

12.5

(6-22)

12.0

(3-31)

23.5

(20-27)

23.0

(20-26)

1 068

24.4

(22-27)

28.6

(23-35)

29.8

(22-39)

0.0

(0-28)

26.7

(12-46)

48.0

(34-63)

41.4

(24-61)

24.5

(21-29)

31.1

(25-38)

**

(**)

21.2

(9-39)

30.0

(12-54)

35.3

(20-54)

428

206

7

33

20

34

126

20

-

707

100

899

1 389

473

3 423

1 386

52

51

263

455

166

354

791

912

1 327

269

94

19

630

1 046

464

277

10

32

59

12

4.8

8.0

5.8

3.1

9.5

6.5

8.2

5.8

(3-7)

(4-15)

(4-8)

(2-4)

(7-13)

(6-7)

(7-10)

(1-16)

15.7

(7-29)

7.2

8.8

(4-11)

(6-12)

13.3

(8-19)

14.4

(11-19)

12.0

(10-14)

15.1

(13-18)

15.9

(14-18)

13.8

(10-18)

18.1

(11-27)

0.0

(0-18)

25.9

(22-29)

26.4

(24-29)

23.1

(19-27)

30.7

(25-36)

60.0

(26-88)

21.9

(9-40)

39.0

(27-53)

8.3

(0-38)

727

127

750

1 406

439

4 273

1 852

28

49

366

507

187

396

808

1 024

1 472

216

107

27

691

614

599

253

19

29

76

31

127

19

-

N/A

3.6

3.9

4.8

5.7

5.9

6.0

7.1

7.1

8.2

9.3

(2-5)

(1-9)

(3-7)

(5-7)

(4-9)

(5-7)

(6-8)

(1-24)

(2-20)

(7-13)

11.2

(9-14)

11.8

(8-17)

13.1

(10-17)

15.5

(13-18)

15.5

(13-18)

15.6

(14-18)

15.7

(11-21)

15.9

(10-24)

18.5

(6-38)

N/A

21.6

(19-25)

23.3

(20-27)

23.4

(20-27)

24.9

(20-31)

26.3

(9-51)

N/A

27.6

(13-47)

27.6

(18-39)

35.5

(19-55)

N/A

36.2

(28-45)

36.8

(16-62)

-

(-)

N/A

N/A

116

21.6

(14-30)

8

-

**

-

(**)

(-)

19.8

(13-28)

154

35.1

(28-43)

40.0

(19-64)

-

(-)

9

-

**

-

(**)

(-)

–: No data
* 
 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

 indicate significant increasing and decreasing trends, respectively.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

** Less than 10 isolates reported, no percentage calculated

52

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
Table 3.28. Streptococcus pneumoniae. Total number of tested isolates (N) and percentages non-susceptible to 
penicillins and macrolides (%IR), including 95 % confidence intervals (95 % CI), by country, EU/EEA countries, 2014 to 
2017

Country

Belgium

Netherlands

Estonia

Denmark

United Kingdom

Germany

Norway

Czech Republic

Sweden

Austria

Latvia

Luxembourg

Italy

Hungary

Slovenia

Finland

Portugal

Ireland

Lithuania

Spain

Poland

Iceland

Croatia

Bulgaria

France

Slovakia

Romania

Malta

Cyprus

Greece

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

Trend 
2014-
2017*

(95 %CI)

1 069

1 025

54

709

1 190

491

490

274

693

351

46

32

163

123

300

570

601

317

62

526

119

24

116

30

0.7

1.2

1.9

3.9

2.9

1.4

2.2

3.3

4.2

2.8

4.3

6.3

(0-1)

(1-2)

(0-10)

(3-6)

(2-4)

(1-3)

(1-4)

(2-6)

(3-6)

(1-5)

(1-15)

(1-21)

11.0

(7-17)

7.3

4.7

6.5

5.8

(3-13)

(3-8)

(5-9)

(4-8)

11.4

(8-15)

16.1

(8-28)

12.2

(9-15)

24.4

(17-33)

8.3

(1-27)

10.3

(5-17)

10.0

(2-27)

1 361

1 030

27

747

1 060

748

403

284

409

433

53

27

347

170

323

654

776

296

72

624

195

25

126

32

0.4

0.9

3.7

2.4

2.7

2.7

2.5

1.8

5.6

2.5

1.9

(0-1)

(0-2)

(0-19)

(1-4)

(2-4)

(2-4)

(1-5)

(1-4)

(4-8)

(1-4)

(0-10)

0.0

(0-13)

5.8

1.8

5.0

7.0

6.6

(4-9)

(0-5)

(3-8)

(5-9)

(5-9)

10.8

(8-15)

11.1

(5-21)

12.0

(10-15)

19.5

(14-26)

8.0

7.9

(1-26)

(4-14)

12.5

(4-29)

1 327

1 263

100

707

3 136

1 342

469

263

877

438

51

51

361

166

269

687

868

354

94

612

271

19

154

32

0.3

0.4

1.0

2.3

2.6

2.2

2.8

1.1

4.0

1.4

3.9

7.8

4.4

7.8

3.7

6.1

6.7

9.9

(0-1)

(0-1)

(0-5)

(1-4)

(2-3)

(1-3)

(1-5)

(0-3)

(3-6)

(1-3)

(0-13)

(2-19)

(3-7)

(4-13)

(2-7)

(4-8)

(5-9)

(7-13)

12.8

(7-21)

14.4

(12-17)

16.6

(12-22)

0.0

(0-18)

15.6

(10-22)

9.4

(2-25)

656

15.9

(13-19)

1 068

17.4

(15-20)

1 046

18.3

(16-21)

26

45

8

11

-

19.2

(7-39)

37.8

(24-53)

**

(**)

0.0

(0-28)

-

(-)

27

20

20

7

-

22.2

(9-42)

25.0

(9-49)

25.0

(9-49)

**

-

(**)

(-)

12

56

9

10

-

0.0

(0-26)

30.4

(19-44)

**

(**)

40.0

(12-74)

-

(-)

1 472

1 297

127

727

3 885

1 803

439

366

745

457

28

45

474

187

216

671

978

396

107

676

241

27

126

29

614

30

75

19

11

-

0.1

1.1

1.6

1.8

2.0

2.4

2.5

3.0

3.0

3.3

3.6

4.4

5.3

6.4

6.5

6.7

7.2

9.6

(0-0)

(1-2)

(0-6)

(1-3)

(2-2)

(2-3)

(1-4)

(2-5)

(2-4)

(2-5)

(0-18)

(1-15)

(3-8)

(3-11)

(4-11)

(5-9)

(6-9)

(7-13)

N/A

11.2

(6-19)

12.4

(10-15)

14.1

(10-19)

14.8

(4-34)

N/A

15.9

(10-23)

17.2

(6-36)

17.8

(15-21)

23.3

(10-42)

N/A

24.0

(15-35)

26.3

(9-51)

45.5

(17-77)

-

(-)

N/A

N/A

N/A

–: No data
* 
 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

 indicate significant increasing and decreasing trends, respectively.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

** Less than 10 isolates reported, no percentage calculated

53

 
MRSA,  focusing  on  both  improved  infection  prevention 
and control and prudent antimicrobial use [14].

Despite  this  positive  development,  MRSA  remains  an 
important  pathogen  in  Europe.  S. aureus  is  one  of  the 
most  common  causes  of  serious  bacterial  infections, 
exhibiting high rates of morbidity and mortality. The high 
percentages of MRSA in some countries, often combined 
with  resistance  to  other  antimicrobials,  are  a  concern 
and  contributing  to  the  burden  of  AMR.  Carriage  and 
infection  with  MRSA  is  only  associated  with  healthcare 
exposure,  and  community-associated  MRSA  (CA-MRSA) 
are  increasingly  being  reported  from  many  parts  of  the 
world.  The  proportion  of  community-onset  infections 
caused by MRSA clones that are usually associated with 
healthcare  (HA-MRSA)  has  also  increased,  indicating 
transfer  of  HA-MRSA  clones  into  the  community  [24]. 
In  order  to  further  slow  the  spread  of  MRSA  in  Europe, 
comprehensive MRSA strategies targeting all healthcare 
sectors remain essential.

in  a 

The  monitoring  of  MRSA  in  animals  and  food  is  cur-
limited 
rently  voluntary  and  only  performed 
number  of  countries,  but  shows  a  constantly  evolving 
situation  including  detection  of  livestock-associated 
MRSA  (LA-MRSA),  HA-MRSA  and  CA-MRSA  from  com-
panion animals and/or livestock [12]. Recently, LA-MRSA 
has  gained  increasing  attention,  as  it  poses  a  zoonotic 
risk,  particularly  for  those  working  in  close  contact 
with  livestock.  An  ECDC  survey  documents  the  increas-
ing  detection  and  geographical  dispersion  of  LA-MRSA 
in  humans  in  the  EU/EEA  between  2007  and  2013  and 
highlights  the  public  health  and  veterinary  importance 
of LA-MRSA as a One Health issue [25].

3.6 Staphylococcus aureus
Staphylococcus  aureus  is  a  gram-positive  bacterium 
that  frequently  colonises  the  skin  of  healthy  humans. 
However,  S. aureus  is  also  an  opportunistic  microor-
ganism  involved  in  infections  of  both  community  and 
healthcare  origin.  Besides  being  a  common  cause  of 
skin,  soft  tissue  and  bone  infections,  it  is  one  of  the 
leading  causes  of  bloodstream  infections  in  Europe. 
S. aureus  acquires  resistance  to  meticillin  and  some 
other  beta-lactam  agents  through  expression  of  the 
exogenous  mecA,  or  less  frequently,  the  mecC  gene. 
These genes code for a variant penicillin-binding protein 
PBP2’  (PBP2a)  with  low  affinity  for  beta-lactams  and 
able to substitute for the function of the other penicillin-
binding  proteins,  thus  preventing  the  inhibition  of  cell 
wall synthesis by beta-lactams.

Antimicrobial resistance
The  EU/EEA  population-weighted  mean  MRSA  percent-
age was 16.9% in 2017. This is a result of a significantly 
decreasing trend between 2014 and 2017 (Table 3.30).

In  2017,  large  differences  in  national  MRSA  percent-
ages  could  be  noted,  ranging  from  1.0%  to  44.4% 
(Figure  3.30).  Close  to  a  third  of  the  countries  reported 
significantly  decreasing 
the  period 
2014–2017,  including  countries  with  both  low  and  high 
percentages of MRSA (Table 3.30).

trends  during 

Among  MRSA,  combined  resistance  to  other  anti-
microbial  groups  was  common.  The  most  common 
resistance  combination  was  MRSA  and  resistance  to 
fluoroquinolones.  Rifampicin  resistance  was  less  com-
mon (Table 3.29).

Discussion and conclusion

MRSA  percentages  seem  to  be  stabilising  or  still 
decreasing  in  a  majority  of  EU/EEA  countries,  which  is 
also  reflected  in  the  continuously  decreasing  EU/EEA 
population-weighted  mean.  Many  countries  have  devel-
oped  and  implemented  national  recommendations  and 
guidance  documents  on  the  prevention  of  spread  of 

Table 3.29. Staphylococcus aureus. Total number of tested isolates* and resistance combinations among invasive 
isolates tested against meticillin, fluoroquinolones and rifampicin (n=49 424), EU/EEA countries, 2017 

Resistance pattern
Fully susceptible
Single resistance (to indicated antimicrobial group)
Total (any single resistance)
MRSA
Fluoroquinolones 
Rifampicin
Resistance to two antimicrobial groups
Total (any two-group combinations)
MRSA + fluoroquinolones 
Other resistance combinations
Resistance to three antimicrobial groups
MRSA + fluoroquinolones + rifampicin

Number of isolates
40 088

 Percentage (%) of total**
81.1

3 940
1 094
2 665
181

5 187
5 133
54

209

8.0
2.2
5.4
0.4

10.5
10.4
0.1

0.4

Only resistance combinations >1 % of the total are specified.
* Only data from isolates tested against all three antimicrobial groups were included in the analysis.
** Not adjusted for population differences in the reporting countries.

54

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Figure 3.25. Staphylococcus aureus. Percentage (%) of invasive isolates with resistance to meticillin (MRSA), by 
country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

55

Table 3.30. Staphylococcus aureus. Total number of invasive isolates tested (N) and percentage with resistance to 
meticillin (MRSA) including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Norway

Sweden

Iceland

Netherlands

Finland

Estonia

Denmark

Latvia

Austria

Belgium

Lithuania

Slovenia

Germany

Luxembourg

France

Czech Republic

Bulgaria

Poland

Ireland

Trend 
2014-
2017*

N/A

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

2017

 %R

(95 %CI)

1 544

2 745

61

2 524

1 831

223

1 874

220

2 651

1.0

1.0

3.3

1.0

2.6

3.1

2.5

8.2

7.8

(1-2)

(1-1)

(0-11)

(1-1)

(2-3)

(1-6)

(2-3)

(5-13)

(7-9)

988

383

495

3 146

125

5 484

1 695

216

490

13.5

(11-16)

7.8

(5-11)

13.1

(10-16)

12.9

(12-14)

12.0

(7-19)

17.4

(16-18)

13.0

(11-15)

20.8

(16-27)

20.6

(17-24)

1 453

3 124

88

2 107

2 070

151

1 876

251

2 785

2 757

913

376

513

5 020

135

5 535

1 806

222

958

1.2

0.8

0.0

1.3

1.9

4.0

1.6

5.6

7.5

(1-2)

(1-1)

(0-4)

(1-2)

(1-3)

(1-8)

(1-2)

(3-9)

(7-9)

10.8

(10-12)

12.3

(10-15)

8.5

9.2

(6-12)

(7-12)

1 448

3 450

76

2 699

1 890

314

1 963

284

3 053

6 717

1 364

503

534

1.2

2.3

1.3

1.2

2.2

3.5

2.0

4.2

7.1

6.7

(1-2)

(2-3)

(0-7)

(1-2)

(2-3)

(2-6)

(1-3)

(2-7)

(6-8)

(6-7)

12.2

(10-14)

11.3

11.0

(9-14)

(9-14)

1 462

3 787

69

2 694

2 439

290

1 996

210

3 158

8 883

1 511

514

576

11.3

(10-12)

9 866

10.2

(10-11)

12 021

8.9

(5-15)

15.7

(15-17)

13.7

(12-15)

13.1

(9-18)

15.8

(14-18)

187

5 578

1 887

231

1 772

1 143

10.2

(6-15)

13.8

(13-15)

13.9

(12-16)

14.3

(10-19)

16.4

(15-18)

14.3

(12-17)

200

6 472

1 944

227

1 805

1 140

1.0

1.2

1.4

1.5

2.0

2.1

2.5

5.7

5.9

6.9

8.5

8.8

9.0

9.1

9.5

(1-2)

(1-2)

(0-8)

(1-2)

(1-3)

(1-4)

(2-3)

(3-10)

(5-7)

(6-7)

(7-10)

(6-12)

(7-12)

(9-10)

(6-14)

12.9

(12-14)

13.2

(12-15)

13.7

(9-19)

15.2

(14-17)

16.3

(14-19)

United Kingdom

2 400

11.3

(10-13)

1 075

19.4

(17-22)

1 057

18.1

(16-21)

EU/EEA  
(population-weighted mean)

40 906

19.6

(19-20)

45 509

19.0

(19-19)

57 387

17.7

(17-18)

64 769

16.9

(17-17)

Hungary

Spain

Croatia

Slovakia

Cyprus

Italy

Greece

Portugal

Malta

Romania

1 279

1 920

484

640

136

2 134

556

3 193

78

316

23.1

(21-25)

22.1

(20-24)

21.3

(18-25)

28.0

(25-32)

36.0

(28-45)

1 517

1 968

486

583

143

24.7

(23-27)

25.3

(23-27)

24.5

(21-29)

28.1

(25-32)

43.4

(35-52)

33.6

(32-36)

3 000

34.1

(32-36)

37.1

(33-41)

612

39.4

(35-43)

47.4

(46-49)

3 619

46.8

(45-48)

43.6

(32-55)

56.0

(50-62)

87

297

49.4

(39-60)

57.2

(51-63)

1 668

1 944

458

571

139

2 981

639

3 454

97

477

25.2

(23-27)

25.8

(24-28)

25.3

(21-30)

27.1

(24-31)

38.8

(31-47)

33.6

(32-35)

38.8

(35-43)

43.6

(42-45)

37.1

(28-48)

50.5

(46-55)

1 566

1 804

520

613

125

3 591

822

3 728

95

507

23.6

(22-26)

25.3

(23-27)

28.5

(25-33)

29.2

(26-33)

31.2

(23-40)

33.9

(32-35)

38.4

(35-42)

39.2

(38-41)

42.1

(32-53)

44.4

(40-49)

* 

 indicate significant increasing and decreasing trends, respectively.

 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.

  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in any 

year during the period.

56

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
3.7 Enterococci
Enterococci belong to the normal bacterial microbiota of 
the gastrointestinal tract of humans. They are regarded 
commensals  but  can  cause  invasive  diseases  when 
the  commensal  relationship  with  the  host  is  disrupted. 
Enterococci  can  cause  a  variety  of  infections,  includ-
ing  urinary  tract  infections,  bloodstream  infections 
and  endocarditis,  and  are  associated  with  peritonitis 
and  intra-abdominal  abscesses.  The  vast  majority  of 
clinical enterococcal infections in humans are caused by 
Enterococcus faecalis and E. faecium.

Enterococci are intrinsically resistant to a broad range of 
antimicrobial agents including cephalosporins, sulphon-
amides  and  low  concentrations  of  aminoglycosides.  By 
nature, enterococci also have low susceptibility to many 
beta-lactam agents as a consequence of their low-affinity 
penicillin-binding proteins. However, there is commonly 
synergy  between  aminoglycosides  and  penicillins  or 
glycopeptides  against  enterococci  without  acquired 
high-level  glycopeptide  resistance.  Some  enterococci 
have acquired genes conferring high-level resistance to 
aminoglycosides,  causing  loss  of  any  synergistic  effect 
between beta-lactams and aminoglycosides.

Glycopeptide  resistance  of  clinical  relevance  is  mostly 
mediated  through  two  phenotypes:  VanA,  with  high-
level  resistance  to  vancomycin  and  a  variable  level  of 
resistance to teicoplanin, and VanB, with a variable level 
of resistance, in most cases to vancomycin only.

Antimicrobial resistance

Enterococcus faecalis: high-level gentamicin resistance

In 2017, the EU/EEA population-weighted mean percent-
age  for  high-level  gentamicin  resistance  in  E. faecalis 
was 30.0%, with national percentages ranging from 7.1% 
to  45.9%  (Figure  3.26).  The  EU/EEA  trend  decreased 
significantly between 2014 and 2017, with similar signif-
icantly decreasing national trends reported from almost 
one fourth of the countries (Table 3.31).

Enterococcus faecalis: vancomycin resistance 

Vancomycin  resistance  in  E. faecalis  remained  low  in 
most  countries.  For  more  information,  please  refer  to 
the online ECDC Surveillance Atlas of Infectious Diseases 
[16].

Enterococcus faecium: vancomycin resistance

The  EU/EEA  population-weighted  mean  percentage  for 
vancomycin resistance in E. faecium was 14.9% in 2017, 
which represents a significant increase from 2014 when 
the percentage was 10.4%.

In  2017,  national  percentages  ranged  from  0.0%  to 
43.9%. Eleven out of the 30 reporting countries reported 
resistance  percentages  below  5%  (Figure  3.27).  Several 
of  the  countries  reporting  comparatively  high  per-
centages  of  resistance  to  vancomycin  also  reported 
significantly  increasing  trends  for  the  last  four  years 

(Table  3.32).  For  several  countries,  the  increase  during 
the four-year period was considerable.

Enterococcus faecium: high-level gentamicin resistance 

With few exceptions, national percentages for high-level 
aminoglycoside  resistance  in  E. faecium  were  higher 
than  for  E. faecalis.  For  more  information,  please  refer 
to ECDC’s Surveillance Atlas of Infectious Diseases [16].

Discussion and conclusion

Data  from  EARS-Net  indicate  that  vancomycin-resistant 
E. faecium is becoming a cause for concern in Europe. The 
significantly  increasing  trend,  observed  at  the  EU/ EEA 
level and in many of the individual countries, highlights 
the  need  for  close  monitoring.  Enterococci  have  intrin-
sic  resistance  to  several  antimicrobial  classes,  and 
any  additional  acquired  resistance  severely  limits  the 
number of treatment options. WHO has listed vancomy-
cin-resistant E. faecium as a pathogen with high priority 
in  its  global  priority  list  of  antibiotic-resistant  bacteria, 
emphasising the paucity of available and effective treat-
ment options [13]. High levels of antimicrobial-resistant 
enterococci  remain  a  major  infection  control  challenge 
and  an  important  cause  of  healthcare-associated  infec-
tions in Europe. Besides the fact that infections caused 
by  resistant  strains  are  difficult  to  treat,  enterococci 
easily disseminate in healthcare settings. 

The  reason  behind  the  increase  of  vancomycin-resist-
ant  E. faecium 
in  Europe  remains  unclear.  Studies 
performed  in  individual  EU/EEA  countries  show  highly 
regional  spread  with  multiple  hospital  outbreaks  [26–
28].  Contrary  to  many  other  bacterium–antimicrobial 
group  combinations  under  surveillance  by  EARS-Net, 
no  distinct  geographical  pattern  could  be  seen  for  van-
comycin-resistant  E. faecium,  as  high  resistance  levels 
were reported from countries in both southern, eastern 
and  northern  Europe.  Better  knowledge  of  the  epidemi-
ology  of  vancomycin-resistant  enterococci  is  needed  to 
guide prevention and control strategies.

57

Figure 3.26. Enterococcus faecalis. Percentage (%) of invasive isolates with high-level resistance to gentamicin,  
by country, EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

Figure 3.27. Enterococcus faecium. Percentage (%) of invasive isolates with resistance to vancomycin, by country,  
EU/EEA countries, 2017

< 1%
1% to < 5%
5% to < 10%
10% to < 25%
25% to < 50%
≥ 50% 
No data reported or fewer than 10 isolates
Not included

Non-visible countries

Liechtenstein
Luxembourg
Malta

58

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Table 3.31. Enterococcus faecalis. Total number of invasive isolates tested (N) and percentage with high-level 
resistance to gentamicin including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Denmark

Cyprus

Greece

France

Sweden

Norway

Belgium

Iceland

Estonia

Luxembourg

Netherlands

Germany

Portugal

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

60

80

407

1 741

723

270

170

12

19

39

403

903

607

30.0

(19-43)

17.5

(10-28)

20.1

(16-24)

13.7

(12-15)

15.8

(13-19)

20.7

(16-26)

22.9

(17-30)

8.3

(0-38)

36.8

(16-62)

30.8

(17-48)

28.8

(24-33)

33.6

(30-37)

32.6

(29-37)

63

58

460

1 097

579

163

249

21

26

56

343

1 295

872

25.4

(15-38)

8.6

(3-19)

13.3

(10-17)

12.2

(10-14)

12.6

(10-16)

9.8

(6-15)

13.3

(9-18)

14.3

(3-36)

26.9

(12-48)

14.3

(6-26)

23.0

(19-28)

30.7

(28-33)

33.3

(30-36)

56

39

540

1 057

722

221

328

24

56

48

451

2 341

851

2017

 %R

Trend 
2014-
2017*

(95 %CI)

7.1

(2-17)

8.6

(3-18)

12.2

(10-15)

12.7

(10-15)

13.3

(11-16)

N/A

14.4

(10-20)

16.4

(12-21)

18.2

(7-35)

19.7

(11-31)

22.0

(14-32)

N/A

N/A

19.6

(10-32)

20.5

(9-36)

15.9

(13-19)

15.0

(13-17)

13.4

(11-16)

15.8

(11-21)

19.8

(16-25)

16.7

(5-37)

32.1

(20-46)

12.5

(5-25)

56

70

621

795

945

216

304

33

71

82

24.4

(20-29)

537

24.4

(21-28)

25.2

(23-27)

2 658

25.7

(24-27)

33.8

(31-37)

931

25.8

(23-29)

EU/EEA  
(population-weighted mean)

9 737

36.3

(35-37)

10 711

31.9

(31-33)

12 698

31.8

(31-33)

13 459

30.0

(29-31)

Slovakia

Ireland

Austria

Croatia

Slovenia

Czech Republic

Malta

Spain

Lithuania

Poland

Hungary

Bulgaria

Romania

Latvia

Italy

Finland

United Kingdom

261

290

421

149

119

525

28

970

65

148

659

105

34

13

516

-

-

41.0

(35-47)

31.4

(26-37)

37.1

(32-42)

32.9

(25-41)

36.1

(28-45)

38.7

(34-43)

25.0

(11-45)

38.9

(36-42)

29.2

(19-42)

43.9

(36-52)

49.8

(46-54)

40.0

(31-50)

76.5

(59-89)

46.2

(19-75)

234

261

501

203

133

544

29

936

63

388

730

100

-

58

49.1

(43-56)

28.0

(23-34)

33.7

(30-38)

35.5

(29-42)

32.3

(24-41)

38.8

(35-43)

27.6

(13-47)

40.0

(37-43)

44.4

(32-58)

46.4

(41-51)

45.5

(42-49)

42.0

(32-52)

-

(-)

36.2

(24-50)

213

265

447

179

152

515

33

950

45

666

786

98

87

87

45.1

(38-52)

29.4

(24-35)

33.3

(29-38)

33.0

(26-40)

43.4

(35-52)

37.1

(33-41)

39.4

(23-58)

37.5

(34-41)

35.6

(22-51)

43.1

(39-47)

42.2

(39-46)

46.9

(37-57)

56.3

(45-67)

46.0

(35-57)

213

302

474

171

167

526

29

845

60

660

769

133

89

72

25.8

(20-32)

30.8

(26-36)

33.1

(29-38)

33.3

(26-41)

33.5

(26-41)

34.0

(30-38)

34.5

(18-54)

36.7

(33-40)

36.7

(25-50)

41.2

(37-45)

41.5

(38-45)

43.6

(35-52)

44.9

(34-56)

45.8

(34-58)

55.2

(51-60)

1 249

47.8

(45-51)

1 441

45.3

(43-48)

1 630

45.9

(43-48)

-

-

(-)

(-)

-

-

-

-

(-)

(-)

-

-

-

-

(-)

(-)

-

-

-

-

(-)

(-)

N/A

N/A

N/A

N/A

–: No data
* 
 and 
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in 

 indicate significant increasing and decreasing trends, respectively.

any year during the period.

59

Table 3.32. Enterococcus faecium. Total number of invasive isolates tested (N) and percentage with resistance to 
vancomycin, including 95 % confidence intervals (95 % CI), EU/EEA countries, 2014 to 2017

Country

Iceland

Luxembourg

Malta

Sweden

Finland

Slovenia

France

Netherlands

Spain

Austria

Norway

Belgium

Estonia

Denmark

Portugal

Czech Republic

Italy

EU/EEA  
(population-weighted mean)

Germany

Bulgaria

Croatia

Latvia

United Kingdom

Hungary

Greece

Poland

Slovakia

Romania

Lithuania

Ireland

Cyprus

2014

2015

2016

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

 %R

(95 %CI)

N

11

31

11

452

368

115

737

532

546

480

227

195

48

715

363

250

472

8 324

882

60

67

15

423

224

264

182

129

56

44

390

35

0.0

3.2

0.0

0.4

0.0

1.7

0.5

1.1

2.4

4.4

1.8

3.1

0.0

4.5

(0-28)

(0-17)

(0-28)

(0-2)

(0-1)

(0-6)

(0-1)

(0-2)

(1-4)

(3-7)

(0-4)

(1-7)

(0-7)

(3-6)

20.1

(16-25)

4.4

8.5

(2-8)

(6-11)

10.4

(10-11)

9.1

(7-11)

13.3

(6-25)

10.4

(4-20)

13.3

(2-40)

21.3

(17-25)

8.5

(5-13)

26.9

(22-33)

21.4

(16-28)

10.1

(5-17)

25.0

(14-38)

4.5

(1-15)

45.1

(40-50)

40.0

(24-58)

20

23

6

408

298

124

849

572

571

483

185

163

27

690

459

322

756

9 152

1 347

41

93

34

218

240

315

215

143

72

52

404

28

Trend 
2014-
2017*

N/A

N/A

N/A

2017

 %R

0.0

0.0

0.0

0.0

0.7

0.7

0.8

1.4

1.8

3.2

4.5

5.5

5.8

7.0

7.2

(95 %CI)

(0-20)

(0-10)

(0-25)

(0-1)

(0-2)

(0-4)

(0-2)

(1-2)

(1-3)

(2-5)

(2-8)

(4-8)

(1-16)

(5-9)

(5-10)

13.3

(9-18)

0.0

0.0

8.3

0.4

0.0

0.0

0.6

0.9

2.1

4.3

1.9

1.7

0.0

7.5

7.5

7.8

(0-21)

(0-11)

(0-38)

(0-1)

(0-1)

(0-3)

(0-1)

(0-2)

(1-4)

(3-6)

(1-5)

(1-4)

(0-6)

(6-10)

(5-11)

(5-12)

17

34

13

530

301

149

986

807

545

570

202

417

52

785

461

264

0.0

0.0

**

0.0

0.3

4.8

0.8

1.4

2.5

3.1

0.0

0.6

0.0

3.2

(0-17)

(0-15)

(**)

(0-1)

(0-2)

(2-10)

(0-2)

(1-3)

(1-4)

(2-5)

(0-2)

(0-3)

(0-13)

(2-5)

20.3

(17-24)

9.6

(7-13)

11.2

(9-14)

16

31

12

546

294

111

808

685

628

533

213

289

64

679

411

258

941

13.4

(11-16)

1 049

14.6

(13-17)

10.5

(10-11)

12 330

12.3

(12-13)

13 920

14.9

(14-16)

10.5

(9-12)

2 043

11.9

(11-13)

2 448

16.5

(15-18)

14.6

(6-29)

25.8

(17-36)

17.6

(7-35)

44

104

56

18.2

(8-33)

22.1

(15-31)

28.6

(17-42)

84

89

39

19.0

(11-29)

19.1

(12-29)

25.6

(13-42)

N/A

17.0

(12-23)

1 803

17.0

(15-19)

2 202

25.8

(24-28)

16.7

(12-22)

19.7

(15-25)

17.7

(13-23)

14.7

(9-22)

25.0

(16-37)

17.3

(8-30)

45.8

(41-51)

28.6

(13-49)

272

358

405

125

77

61

422

41

22.4

(18-28)

27.9

(23-33)

26.2

(22-31)

26.4

(19-35)

39.0

(28-51)

21.3

(12-34)

44.1

(39-49)

46.3

(31-63)

315

412

400

122

64

80

442

41

28.3

(23-34)

30.8

(26-36)

31.5

(27-36)

32.0

(24-41)

34.4

(23-47)

36.3

(26-48)

38.2

(34-43)

43.9

(28-60)

–: No data
* 
 and 
 indicates a significant trend in the overall data; when only data from laboratories consistently reporting all four years included, no trend could be detected.
  N/A: Not applicable as data were not reported for all years, a significant change in data source occurred during the period or number of isolates was below 20 in 

 indicate significant increasing and decreasing trends, respectively.

any year during the period.

** Less than 10 isolates reported, no percentage calculated

60

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
References

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

Commission Implementing Decision (EU) 2018/945 of 22 June 2018 
on the communicable diseases and related special health issues to 
be covered by epidemiological surveillance as well as relevant case 
definitions.  Available  from:  https://eur-lex.europa.eu/legalcon-
tent/EN/TXT/?uri=uriserv%3AOJ.L_.2018.170.01.0001.01.ENG.

World  Health  Organization.  Central  Asian  and  Eastern  European 
Surveillance  of  Antimicrobial  Resistance.  Annual  Report  2017. 
Copenhagen: WHO Regional Office for Europe; 2017. Available from 
http://www.euro.who.int/__data/assets/pdf_file/0005/354434/
WHO_CAESAR_AnnualReport_2017.pdf.

European  Centre  for  Disease  Prevention  and  Control.  TESSy,  The 
European  Surveillance  System  –  Antimicrobial  resistance  (AMR) 
reporting  protocol  2018  –  European  Antimicrobial  Resistance 
Surveillance  Network  (EARS-Net)  surveillance  data  for  2017. 
Stockholm:  ECDC;  2018.  Available  from:  http://ecdc.europa.eu/
publications-data/ears-net-reporting-protocol-2018.

European  Committee  on  Antimicrobial  Susceptibility  Testing. 
EUCAST  guidelines  for  detection  of  resistance  mechanisms  and 
specific  resistances  of  clinical  and/or  epidemiological  impor-
tance  –  Version  2.0.  Växjö,  EUCAST;  2017.  Available  from:  http:// 
w w w.eucast.org/f ileadmin/src/media/PDFs/EUC A S T_ f iles/ 
Resistance_mechanisms/EUCAST_detection_of_resistance_mech-
anisms_170711.pdf.

European Centre for Disease Prevention and Control. External qual-
ity assessment (EQA) of performance of laboratories participating 
in  the  European  Antimicrobial  Resistance  Surveillance  Network 
(EARS-Net) – 2017. Stockholm: ECDC; 2018. Available from: http://
ecdc.europa.eu/publications-data/external-quality-assessment-
laboratory-performance-european-antimicrobial.

Eurostat [internet]. Brussels: Eurostat; 2018. Available from: http://
ec.europa.eu/eurostat.

European Centre for Disease Prevention and Control, European Food 
Safety Authority and European Medicines Agency. ECDC/EFSA/EMA 
second joint report on the integrated analysis of the consumption 
of  antimicrobial  agents  and  occurrence  of  antimicrobial  resist-
ance  in  bacteria  from  humans  and  food-producing  animals  –  Joint 
Interagency  Antimicrobial  Consumption  and  Resistance  Analysis 
(JIACRA)  Report.  Available  from:  http://ecdc.europa.eu/publica-
tions-data/ecdcefsaema-second-joint-report-integrated-analysis-
consumption-antimicrobial.

European  Centre  for  Disease  Prevention  and  Control.  Proposals 
in 
for  EU  guidelines  on  the  prudent  use  of  antimicrobials 
humans.  Stockholm:  ECDC;  2017.  Available  from:  http://ecdc.
e u r o p a . e u /p u b l i c a t i o n s - d a t a /p r o p o s a l s - e u - g u i d e l i n e s - 
prudent-use-antimicrobials-humans.

European  Centre  for  Disease  Prevention  and  Control.  Rapid  risk 
assessment:  Carbapenem-resistant  Enterobacteriaceae  –  first 
update 4 June 2018. Stockholm: ECDC; 2018. Available from: http://
ecdc.europa.eu/publications-data/rapid-risk-assessment-carbap-
enem-resistant-enterobacteriaceae-first-update.

European  Centre  for  Disease  Prevention  and  Control.  Rapid  risk 
assessment: Carbapenemase-producing (OXA-48) Klebsiella pneu-
moniae ST392 in travellers previously hospitalised in Gran Canaria, 
Spain – 10 July 2018. Stockholm: ECDC; 2018. Available from: http://
www.ecdc.europa.eu/publications-data/rapid-risk-assessment-
carbapenemase-producing-oxa-48-klebsiella-pneumoniae-st392.

  European  Centre  for  Disease  Prevention  and  Control.  ECDC  study 
protocol  for  genomic-based  surveillance  of  carbapenem-resistant 
and/or colistin-resistant Enterobacteriaceae at the EU level. Version 
2.0.  Stockholm:  ECDC;  2018.  Available  from:  http://ecdc.europa.
eu/publications-data/ecdc-study-protocol-genomic-based-surveil-
lance-carbapenem-resistant-andor.

European Centre for Disease Prevention and Control and European 
Food  Safety  Authority.  The  European  Union  summary  report  on 
antimicrobial  resistance  in  zoonotic  and  indicator  bacteria  from 
humans, animals and food in 2016. Stockholm and Parma: ECDC and 
EFSA;  2018.  Available  from:  http://ecdc.europa.eu/publications-
data/european-union-summary-report-antimicrobial-resistance-
zoonotic-and-indicator-4.

13  World Health Organization. Global priority list of antibiotic-resist-
ant bacteria to guide research, discovery, and development of new 
antibiotics.  Geneva:  WHO;  2017.  Available  from:  http://www.who.
int/medicines/publications/WHO-PPL-Short_Summary_25Feb-ET_ 
NM_WHO.pdf.

14 

European  Centre  for  Disease  Prevention  and  Control.  Directory  of 
online resources for prevention and control of antimicrobial resist-
ance  (AMR)  and  healthcare-associated  infections  (HAI)  [Internet]. 

Stockholm:  ECDC;  2018  [accessed  1  October  2018].  Available 
from:  http://ecdc.europa.eu/publications-data/directory-online-
resources-prevention-and-control-antimicrobial-resistance-amr.

15  Magiorakos  AP, Burns K, Rodríguez Baño J, Borg M, Daikos G, Dumpis 
U, et al. Infection prevention and control measures and tools for the 
prevention  of  entry  of  carbapenem-resistant  Enterobacteriaceae 
into  healthcare  settings:  guidance  from  the  European  Centre  for 
Disease  Prevention  and  Control.  Antimicrob  Resist  Infect  Control. 
2017 Nov;6:113.

16 

17 

18 

19 

20 

21 

22 

European  Centre  for  Disease  Prevention  and  Control.  Surveillance 
Atlas  of  Infectious  Diseases  [Internet].  Stockholm:  ECDC;  2018 
[accessed  1  October  2018].  Available  from:  http://atlas.ecdc.
europa.eu.

European  Centre  for  Disease  Prevention  and  Control.  Plasmid-
mediated  colistin  resistance  in  Enterobacteriaceae,  15  June  2016. 
Stockholm:  ECDC;  2016.  Available  from:  http://ecdc.europa.eu/
publications-data/rapid-risk-assessment-plasmid-mediated-colis-
tin-resistance-enterobacteriaceae-15.

European  Committee  on  Antimicrobial  Susceptibility  Testing. 
Recommendations  for  MIC  determination  of  colistin  (polymyxin  E) 
as recommended by the joint CLSI-EUCAST Polymyxin Breakpoints 
Working Group. Växjö: EUCAST; 2016. Available from: http://www.
eucast.org/fileadmin/src/media/PDFs/EUCAST_files/General_
document s/Recommendations _ for_ MIC _deter mination _of_
colis¬tin_March_2016.pdf.

European  Centre  for  Disease  Prevention  and  Control.  Point  preva-
lence survey of healthcare-associated infections and antimicrobial 
use in European acute care hospitals 2011-2012. Stockholm: ECDC; 
2013.  Available  from:  http://ecdc.europa.eu/publications-data/
point-prevalence-survey-healthcare-associated-infections-and-
antimicrobial-use-0.

European  Centre  for  Disease  Prevention  and  Control.  Healthcare-
associated  infections  acquired  in  intensive  care  units.  In:  ECDC. 
Annual  epidemiological  report  for  2016.  Stockholm:  ECDC;  2018. 
Available  from:  http://ecdc.europa.eu/publications-data/health-
care-associated-infections-intensive-care-units-annual-epidemio-
logical-0.

European  Centre  for  Disease  Prevention  and  Control.  Rapid  risk 
assessment:  Carbapenem-resistant  Acinetobacter  baumannii  in 
healthcare  settings  –  8  December  2016.  Stockholm:  ECDC;  2016. 
Available 
from:  http://ecdc.europa.eu/publications-data/rapid-
risk-assessment-carbapenem-resistant-acinetobacter-baumannii-
healthcare.

European  Centre  for  Disease  Prevention  and  Control.  Invasive 
pneumococcal disease. In: Annual epidemiological report for 2016. 
Stockholm:  ECDC,  2018.  Available  from:  http://ecdc.europa.eu/
publications-data/invasive-pneumococcal-disease-annual-epide-
miological-report-2016.

23 

European Centre for Disease Prevention and Control. Vaccine sched-
uler [Internet]. Stockholm: ECDC; 2017. Available from: http://vac-
cine-schedule.ecdc.europa.eu.

24  Grundmann  H,  Schouls  LM,  Aanensen  DM,  Pluister  GN,  Tami  A, 
Chlebowicz  M,  et  al.  The  dynamic  changes  of  dominant  clones  of 
Staphylococcus  aureus  causing  bloodstream  infections  in  the 
European  region:  results  of  a  second  structured  survey.  Euro 
Surveill. 2014 Dec 11;19(49).

25 

Kinross  P,  Petersen  A,  Skov  R,  Van  Hauwermeiren  E,  Pantosti 
A,  Laurent  F,  et  al.  Livestock-associated  meticillin-resistant 
Staphylococcus  aureus  (MRSA)  among  human  MRSA  isolates, 
European  Union/European  Economic  Area  countries,  2013.  Euro 
Surveill. 2017 Nov;22(44).

26  Hammerum AM, Baig , Kamel Y, Roer L, Pinholt M, Gumpert H, et al. 
Emergence  of  vanA  Enterococcus  faecium  in  Denmark,  2005–15.  J 
Antimicrob Chemother. 2017 Aug 1;72(8):2184-2190.

27 

28 

Pinholt  M,  Larner-Svensson  H,  Littauer  P,  Moser  CE,  Pedersen  M, 
Lemming LE, et al. Multiple hospital outbreaks of vanA Enterococcus 
faecium in Denmark, 2012–13, investigated by WGS, MLST and PFGE. 
J Antimicrob Chemother. 2015 Sep;70(9):2474-82. doi: 10.1093/jac/
dkv142. Epub 2015 Jun 1.

Remschmidt  C,  Schröder  C,  Behnke  M,  Gastmeier  P,  Geffers  C, 
Kramer TS. Continuous increase of vancomycin resistance in ente-
rococci causing nosocomial infections in Germany – 10 years of sur-
veillance. Antimicrob Resist Infect Control. 2018 Apr 24;7:54.

61

Annex

63
63

63National institutions/organisations 
participating in EARS-Net

Austria
Federal Ministry of Labour, Social Affairs, Health and 
Consumer Protection
www.sozialministerium.at/site

Medical University Vienna
www.meduniwien.ac.at

Ordensklinikum Linz, Elisabethinen
www.ordensklinikum.at

Belgium
Sciensano 
www.sciensano.be

Bulgaria
Alexander University Hospital, Sofia

National Center of Infectious and Parasitic Diseases

Croatia
Reference Center for Antimicrobial Resistance 
Surveillance, Ministry of Health

Zagreb University Hospital for Infectious Diseases ‘Dr. 
Fran Mihaljević’

Cyprus
Microbiology Department, Nicosia General Hospital

Czech Republic
National Institute of Public Health
www.szu.cz

National Reference Laboratory for Antibiotics

Denmark
Statens Serum Institut, Danish Study Group for 
Antimicrobial Resistance Surveillance (DANRES)
www.danmap.org

Estonia
Estonian Health Board

East-Tallinn Central Hospital

Tartu University Hospital

Finland
National Institute for Health and Welfare
www.thl.fi

Finnish Hospital Infection Program (SIRO)
www.thl.fi/siro

Finnish Study Group for Antimicrobial Resistance (FiRe)
www.finres.fi

France
Santé Publique France, the French National Public 
Health Agency
www.santepubliquefrance.fr

French National Observatory for the Epidemiology 
of Bacterial Resistance to Antimicrobials (ONERBA) 
through 3 participating networks:

Azay-Résistance, Île-de-France and Réussir networks

64

www.onerba.org

National Reference Centre for Pneumococci
www.cnr-pneumo.com

Germany
Robert Koch Institute
www.rki.de

Greece
Hellenic Pasteur Institute

National School of Public Health

National and Kapodistrian University of Athens,  
Medical School 
www.mednet.gr/whonet

Hungary
National Public Health Institute

Iceland
National University Hospital of Iceland 

Centre for Health Security and Infectious Disease 
Control

Ireland
Health Protection Surveillance Centre
www.hpsc.ie

Italy
National Institute of Health
www.iss.it

Latvia
Disease Prevention and Control Center of Latvia 
www.spkc.gov.lv

Lithuania
National Public Health Surveillance Laboratory
www.nvspl.lt

Institute of Hygiene
www.hi.lt

Luxembourg
National Health Laboratory

Microbiology Laboratory, Centre Hospitalier de 
Luxembourg

Malta
Mater Dei Hospital, Msida

Netherlands
National Institute for Public Health and the Environment
www.rivm.nl

Norway
University Hospital of North Norway

Norwegian Institute of Public Health

St. Olav University Hospital, Trondheim

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Poland
National Medicines Institute, Department of 
Epidemiology and Clinical Microbiology

National Reference Centre for Susceptibility Testing

Portugal
National Institute of Health Doutor Ricardo Jorge 
www.insarj.pt

Ministry of Health

Directorate-General of Health

Romania
National Institute of Public Health 

Slovakia
National Reference Centre for Antimicrobial Resistance

Public Health Authority of the Slovak Republic

Regional Public Health Authority Banska Bystrica

Slovenia
National Institute of Public Health
www.nijz.si

Medical faculty, University of Ljubljana

National Laboratory of Health, Environment and Food

Spain
Health Institute Carlos lll 
www.isciii.es

National Centre for Microbiology

Sweden
Public Health Agency of Sweden 
www.folkhalsomyndigheten.se

United Kingdom
Public Health England
www.gov.uk/government/organisations/public-health-england

Health Protection Scotland
www.hps.scot.nhs.uk

Public Health Agency Northern Ireland

Public Health Wales
www.publichealthwales.org

65

Country summaries

The  country  summaries  provide  information  on  the 
population  coverage,  hospital  coverage  and  repre-
sentativeness  of  data  provided  by  the  laboratories  that 
reported  data  to  EARS-Net.  The  summaries  include 
quantitative  and  qualitative  measures  related  to  the 
population  under  surveillance,  the  hospitals  served  by 
participating laboratories, laboratory practices, and the 
use of blood cultures. For more information on how dif-
ferences  in  patient  sampling  and  laboratory  practices 
might impact data validity, please refer to Chapter 2.

from 
In  addition,  national  resistance  percentages 
2010  to  2017  are  presented  together  with  the  EU/EEA 
population-weighted  mean  percentages  for  selected 
bacterium–antimicrobial  group  combinations.  Data 
for  all  bacterium–antimicrobial  groups  under  regular 
surveillance  by  EARS-Net  for  the  period  2000–2017 
are  available  in  ECDC’s  Surveillance  Atlas  of  Infectious 
Diseases [16].

The  following  section  describes  the  format  and  meth-
odology  underpinning  the  country-specific  information 
listed in the tables and figures of this annex.

Coverage and 
representativeness of 
population, hospitals and 
isolates included in EARS-Net
Data sources

The  collection  of  national  surveillance  system  charac-
teristics  as  part  of  the  EARS-Net  data  call  is  currently 
under  revision;  therefore,  two  separate  data  sources 
were used.

In  addition  to  the  data  reported  to  TESSy,  a  question-
naire  covering  all  indicators  was  sent  to  the  nominated 
National  Focal  Points  for  Antimicrobial  Resistance  in 
June  and  July  2018.  For  countries  not  responding  or 
indicating  that  similar  data  had  already  been  provided 
to  TESSy,  TESSy  data  were  used  as  data  source  to  the 
extent possible. 

Indicators

Estimated  national  population  coverage  is  expressed 
as  the  estimated  percentage  of  the  national  population 
under surveillance by the laboratories contributing data 
to  EARS-Net.  It  should  be  considered  as  an  indication 
of  the  national  coverage  because  the  exact  proportion 
of the population under surveillance is often difficult to 
assess. 

Country  coverage  was  calculated  as  the  mean  of  the 
population  coverages  of  the  following  microorgan-
isms:  E. coli,  K. pneumoniae,  S. aureus,  E. faecalis  and 

66

E. faecium.  Due  to  outliers  in  some  countries,  S. pneu-
moniae,  P. aeruginosa  and  Acinetobacter  spp.  were  not 
included in the calculation.

Population  sample  representativeness  is  a  qualitative 
indicator  referring  to  the  geographical  representative-
ness of data. The categories are:

•  High:  All  main  geographical  regions  are  covered  and 
data  are  considered  as  representative  of  the  national 
epidemiology.

•  Medium:  Most  geographical  regions  are  covered  and 
data are considered of medium representativeness of 
the national epidemiology.

•  Poor:  Only  a  few  geographical  areas  are  covered 
and  data  are  poorly  representative  of  the  national 
epidemiology.

•  Unknown: unknown or no data provided.

Hospital  sample  representativeness  is  a  qualitative 
indicator  referring  to  the  representativeness  of  hospi-
tals  served  by  the  EARS-Net  participating  laboratories, 
compared  to  the  national  distribution  of  the  types  of 
hospitals (specialised, tertiary care, secondary care and 
primary care). The categories are:

•  High:  The  hospital  sample  is  representative  of  the 

acute care hospital distribution in the country.

•  Medium: The hospital sample is partly representative 
of the acute care hospital distribution in the country.

•  Poor:  The  hospital  sample  is  poorly  representative  of 
the acute care hospital distribution in the country.

•  Unknown: Unknown or no data provided.

Blood culture sets/1000 patient-days refers to the num-
ber  of  blood  culture  sets  per  1000  inpatient  occupied 
bed-days  in  hospitals  served  by  EARS-Net  laborato-
ries.  The  definition  of  an  inpatient  bed  day  might  differ 
between countries, and influence the estimate.

Isolate  sample  representativeness  is  a  qualitative  indi-
cator  referring  to  representativeness  of  blood  cultures 
reported by EARS-Net laboratories. The categories are:

•  High:  The  isolate  sample  is  representative  of  micro-
organisms  causing  invasive  infections  and  of  patient 
case-mix of the included hospitals.

•  Medium:  The  isolate  sample  is  partly  representative 
of  microorganisms  causing  invasive  infections  and  of 
patient case-mix of the included hospitals.

•  Poor:  The  isolate  sample  is  poorly  representative  of 
microorganisms  causing  invasive  infections  and  of 
patient case-mix of the included hospitals.

•  Unknown: Unknown or no data provided.

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017Percentage (%) of invasive 
isolates with resistance to 
selected antimicrobial groups
Data source

EARS-Net  data  2010–2017.  For  an  explanation  on  the 
methodology  used  for  the  EU/EEA  population-weighted 
mean, please refer to Chapter 2.

Indicators

invasive 

Percentage  of 
isolates  with  resistance  to 
selected  antimicrobial  groups:  Staphylococcus  aureus 
with  resistance  to  meticillin  (MRSA),  Escherichia  coli 
with  resistance  to  third-generation  cephalosporins, 
Klebsiella  pneumoniae  with  resistance  to  carbapenems 
and Enterococcus faecium with resistance to vancomycin.

Laboratories contributing data 
to EARS-Net – participation in 
EARS-Net EQA exercise and use 
of EUCAST guidelines
Data source

Data  were  provided  from  the  annual  EARS-Net  exter-
nal  quality  assessment  (EQA)  exercise,  coordinated  by 
the  ECDC  contractor  United  Kingdom  National  External 
Quality Assessment Service (UK NEQAS). For more infor-
mation on the EARS-Net EQA exercise, please refer to the 
separate EQA report [5].

Indicators

‘Percentage  of  laboratories  participating  in  EARS-Net 
EQA’ represents the proportion of laboratories invited to 
participate  in  the  EARS-Net  EQA  exercise  that  returned 
reports within the agreed time.

Percentage  of  laboratories  using  EUCAST  or  EUCAST 
harmonised guidelines’ refers to the proportion of labo-
ratories reporting to use EUCAST or EUCAST-harmonised 
clinical guidelines among laboratories returning reports 
on  the  EARS-Net  EQA  exercise.  Guidelines  from  the 
British  Society  for  Antimicrobial  Chemotherapy  (BSAC) 
and  the  Société  Française  de  Microbiologie  (SFM)  were 
considered  as  harmonised  with  EUCAST  as  both  have 
implemented  EUCAST  breakpoints  in  their  national  MIC 
breakpoint recommendations and adjusted the interpre-
tation of their disk diffusion methods accordingly.

Annual number of reporting 
laboratories, number of 
reported isolates and 
proportion of isolates reported 
from patients in intensive care 
units (ICU)
Data source

EARS-Net data 2014 to 2017.

Indicators

Table  3  provides  information  on  the  number  of  labora-
tories,  the  number  of  isolates  and  the  proportion  of 
isolates  from  patients  in  intensive  care  units  (ICUs),  by 
year  and  by  pathogen.  The  percentage  of  isolates  from 
patients  in  ICUs  was  only  calculated  if  information  on 
hospital unit type was available from more than 50% of 
the isolates.

The  actual  total  number  of  laboratories  participating  in 
EARS-Net  could  for  some  countries  be  higher  than  the 
number  presented,  as  only  laboratories  reporting  at 
least one isolate during each specific year are included.

67

Austria

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Austria, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Austria, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

90

High

2015

90

High

2016

90

High

2017

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

16.0

15.7

16.2

Unknown

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

95

2016

100

2017

100

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Austria 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

39
39
39
21
39
39
38
37

4 757
996
638
79
410
2 662
660
480

Isolates 
from 
ICUs (%)
9
13
14
17
14
11
16
27

Laboratories 
(N)

Isolates 
(N)

39
39
39
21
38
39
39
38

4 919
1 065
680
64
450
2 815
685
485

Isolates 
from 
ICUs (%)
8
13
17
17
20
13
15
31

Laboratories 
(N)

Isolates 
(N)

39
38
39
24
39
39
38
38

5 285
1 247
697
81
457
3 057
677
535

Isolates 
from 
ICUs (%)
8
12
17
14
21
13
15
28

Laboratories 
(N)

Isolates 
(N)

39
39
39
25
39
39
38
38

5 381
1 152
725
75
513
3 162
769
573

Isolates 
from ICUs 
(%)
9
13
16
11
18
13
18
31

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Austria and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Austria and EU/EEA 
population-weighted mean, 2010–2017

Austria
EU/EEA population-weighted mean

Austria
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Austria and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Austria and EU/EEA population-
weighted mean, 2010–2017

Austria
EU/EEA population-weighted mean

Austria
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

68

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Belgium

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Belgium, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Belgium, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

25

High

High

2015

24

High

High

2016

29

High

High

2017

30

High

High

Unknown

Unknown

Unknown

Unknown

High

High

High

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

87

60

87

67

2016

100

65

2017

90

68

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Belgium 2014–2017

Pathogen

Laboratories 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

27
26
27
3
96
27
25
23

2014

2015

2016

2017

Isolates 
(N)

Isolates 
from 
ICUs (%)
2 895 Unknown
506 Unknown
357 Unknown
4 Unknown
1 181 Unknown
1 034 Unknown
363 Unknown
195 Unknown

Laboratories 
(N)

25
24
25
8
91
25
25
23

Isolates 
(N)

Isolates 
from 
ICUs (%)
2 685 Unknown
406 Unknown
263 Unknown
26 Unknown
1 361 Unknown
994 Unknown
386 Unknown
164 Unknown

Laboratories 
(N)

31
28
31
18
97
31
30
27

Isolates 
(N)

Isolates 
from 
ICUs (%)
3 856 Unknown
669 Unknown
366 Unknown
79 Unknown
1 327 Unknown
1 368 Unknown
465 Unknown
289 Unknown

Laboratories 
(N)

32
31
31
21
91
31
31
30

Isolates 
(N)

Isolates 
from ICUs 
(%)
4 676 Unknown
803 Unknown
474 Unknown
131 Unknown
1 472 Unknown
1 531 Unknown
551 Unknown
418 Unknown

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Belgium and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Belgium and EU/
EEA population-weighted mean, 2010–2017

Belgium
EU/EEA population-weighted mean

Belgium
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Belgium and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Belgium and EU/EEA population-
weighted mean, 2010–2017

Belgium
EU/EEA population-weighted mean

Belgium
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

69

 
 
 
 
 
 
 
 
Bulgaria

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Bulgaria, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Bulgaria, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

30

2015

30

2016

30

2017

30

Medium

Medium

Medium

Medium

Poor

Unknown

High

Poor

8.2

High

Poor

7.2

High

Poor

8.3

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

100

5

5

2016

2017

91

100

95

95

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Bulgaria 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

20
17
12
15
12
20
19
13

218
151
48
115
32
216
122
60

Isolates 
from 
ICUs (%)
12
28
38
57
19
25
30
37

Laboratories 
(N)

Isolates 
(N)

19
16
13
18
10
20
19
13

205
96
55
133
36
222
113
43

Isolates 
from 
ICUs (%)
18
19
22
59
28
20
35
42

Laboratories 
(N)

Isolates 
(N)

20
17
12
15
13
18
17
12

241
161
56
106
33
231
114
45

Isolates 
from 
ICUs (%)
13
29
39
48
18
19
25
53

Laboratories 
(N)

Isolates 
(N)

20
18
16
15
12
18
17
17

247
169
71
92
29
227
133
84

Isolates 
from ICUs 
(%)
16
33
24
62
38
23
26
39

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Bulgaria and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Bulgaria and EU/
EEA population-weighted mean, 2010–2017

Bulgaria
EU/EEA population-weighted mean

Bulgaria
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

50

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Bulgaria and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Bulgaria and EU/EEA population-
weighted mean, 2010–2017

Bulgaria
EU/EEA population-weighted mean

Bulgaria
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

15

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

70

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Croatia

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Croatia, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Croatia, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

80

High

2015

78

High

2016

78

High

2017

80

High

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

91

2016

94

2017

94

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Croatia 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

18
16
16
15
14
16
15
13

1080
334
232
167
129
485
152
68

Isolates 
from 
ICUs (%)
4
12
25
37
19
13
16
12

Laboratories 
(N)

Isolates 
(N)

18
17
17
17
15
16
13
14

1046
380
257
200
126
488
205
93

Isolates 
from 
ICUs (%)
5
17
11
27
7
12
13
18

Laboratories 
(N)

Isolates 
(N)

18
17
16
14
17
18
15
15

1045
323
260
182
155
458
179
104

Isolates 
from 
ICUs (%)
6
19
23
41
22
12
12
17

Laboratories 
(N)

Isolates 
(N)

19
19
17
17
16
18
17
12

1160
313
238
208
130
520
171
89

Isolates 
from ICUs 
(%)
6
18
17
42
13
16
11
12

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Croatia and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Croatia and EU/EEA 
population-weighted mean, 2010–2017

Croatia
EU/EEA population-weighted mean

Croatia
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

30

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Croatia and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Croatia and EU/EEA population-
weighted mean, 2010–2017

Croatia
EU/EEA population-weighted mean

Croatia
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

71

 
 
 
 
 
 
 
 
Cyprus

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Cyprus, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Cyprus, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

85

High

High

38.7

High

2015

85

High

High

41.4

High

2016

85

High

High

46.2

High

2017

85

High

High

44.9

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

100

0

0

2016

80

0

2017

100

20

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Cyprus 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

5
5
5
5
4
5
5
5

153
80
42
58
12
138
80
35

Isolates 
from 
ICUs (%)
17
41
28
68
17
23
51
50

Laboratories 
(N)

Isolates 
(N)

5
5
5
5
4
5
5
5

123
62
43
61
7
145
58
28

Isolates 
from 
ICUs (%)
12
43
47
66
14
22
49
50

Laboratories 
(N)

Isolates 
(N)

5
5
5
5
4
5
5
4

149
75
64
29
10
141
39
41

Isolates 
from 
ICUs (%)
16
30
40
69
11
21
42
28

Laboratories 
(N)

Isolates 
(N)

5
5
4
5
4
5
5
5

156
71
53
50
19
129
70
41

Isolates 
from ICUs 
(%)
14
33
33
46
37
26
30
26

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Cyprus and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Cyprus and EU/EEA 
population-weighted mean, 2010–2017

Cyprus
EU/EEA population-weighted mean

Cyprus
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

50

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Cyprus and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Cyprus and EU/EEA population-weighted 
mean, 2010–2017

Cyprus
EU/EEA population-weighted mean

Cyprus
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

50

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

20

15

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

72

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Czech Republic

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Austria, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Austria, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

79

High

High

18.8

High

2015

85

High

High

18.6

High

2016

85

High

High

18.0

High

2017

85

High

High

18.0

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

2016

96

98

94

98

96

98

2017

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Czech Republic 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

45
44
40
18
45
44
42
34

2 981
1 383
448
59
274
1 695
525
250

Isolates 
from 
ICUs (%)
17
37
42
53
28
25
40
32

Laboratories 
(N)

Isolates 
(N)

45
46
44
15
44
46
43
36

3 174
1 418
464
60
284
1 806
547
322

Isolates 
from 
ICUs (%)
17
34
37
33
32
23
35
40

Laboratories 
(N)

Isolates 
(N)

44
45
43
15
42
45
42
38

3 075
1 385
465
57
267
1 887
515
259

Isolates 
from 
ICUs (%)
16
30
37
22
32
21
31
39

Laboratories 
(N)

Isolates 
(N)

43
46
44
17
46
47
41
39

3 201
1 330
411
55
366
1 944
529
264

Isolates 
from ICUs 
(%)
17
27
36
31
24
21
30
36

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Czech Republic and EU/EEA 
population-weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Czech Republic and 
EU/EEA population-weighted mean, 2010–2017

Czech Republic
EU/EEA population-weighted mean

Czech Republic
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates 
with resistance to carbapenems, Czech Republic and EU/EEA 
population-weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Czech Republic and EU/EEA population-
weighted mean, 2010–2017

Czech Republic
EU/EEA population-weighted mean

Czech Republic
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

73

 
 
 
 
 
 
 
 
Denmark

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Denmark, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Denmark, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

100

High

High

108.1

High

2015

100

High

High

117.2

High

2016

100

High

High

121.9

High

2017

100

High

High

138.5

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

77

2015

100

2016

92

2017

91

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Denmark 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

10
10
10
10
11
11
10
10

Isolates 
(N)

Isolates 
from 
ICUs (%)
4
4 496
5
943
7
388
72
3
709 Unknown
1 874 Unknown
9
587
32
721

Laboratories 
(N)

11
11
11
10
11
11
11
11

Isolates 
(N)

Isolates 
from 
ICUs (%)
3
4 597
5
939
442
4
68 Unknown
747 Unknown
1 876 Unknown
8
35

610
693

Laboratories 
(N)

11
11
11
11
10
10
11
11

Isolates 
(N)

Isolates 
from 
ICUs (%)
2
4 847
4
1 156
5
460
72
8
707 Unknown
1 963 Unknown
8
600
31
685

Laboratories 
(N)

10
10
10
9
10
10
10
10

Isolates 
(N)

Isolates 
from ICUs 
(%)
2
5 123
3
1 186
6
484
68
5
727 Unknown
1 996 Unknown
6
30

674
786

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Denmark and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Denmark and EU/
EEA population-weighted mean, 2010–2017

Denmark
EU/EEA population-weighted mean

Denmark
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Denmark and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Denmark and EU/EEA population-
weighted mean, 2010–2017

Denmark
EU/EEA population-weighted mean

Denmark
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

74

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Estonia

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Estonia, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Estonia, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

100

High

High

16.7

High

2015

100

High

High

23.2

High

2016

100

High

High

26.6

High

2017

100

High

High

34.1

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

91

2016

100

2017

100

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Estonia 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

11
10
7
-
10
11
8
7

412
136
40
-
72
226
31
50

Isolates 
from 
ICUs (%)
18
31
25
-
19
16
32
40

Laboratories 
(N)

Isolates 
(N)

11
9
7
5
10
11
10
7

513
133
38
8
102
231
59
44

Isolates 
from 
ICUs (%)
13
28
37
25
19
15
34
34

Laboratories 
(N)

Isolates 
(N)

11
10
8
3
11
11
9
8

702
183
56
8
112
314
56
64

Isolates 
from 
ICUs (%)
10
20
33
13
16
12
25
38

Laboratories 
(N)

Isolates 
(N)

10
10
9
9
11
10
10
10

788
161
57
16
141
290
71
52

Isolates 
from ICUs 
(%)
9
20
39
19
10
8
23
37

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Estonia and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Estonia and EU/EEA 
population-weighted mean, 2010–2017

Estonia
EU/EEA population-weighted mean

Estonia
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Estonia and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Estonia and EU/EEA population-
weighted mean, 2010–2017

Estonia
EU/EEA population-weighted mean

Estonia
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

75

 
 
 
 
 
 
 
 
Finland

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Finland, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Finland, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

98

High

High

88.3

High

2015

100

High

High

2016

98

High

Unknown

2017

100

High

High

104.7

Unknown

154.9

High

Unknown

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

94

2016

100

2017

94

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Finland 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

19
19
19
14
19
19
19
19

4 013
583
307
32
659
1 831
476
368

Isolates 
from 
ICUs (%)
1
2
4
0
1
3
2
13

Laboratories 
(N)

Isolates 
(N)

20
20
20
16
20
20
20
20

4 425
658
341
43
788
2 070
478
299

Isolates 
from 
ICUs (%)
1
3
4
4
2
2
2
7

Laboratories 
(N)

Isolates 
(N)

20
20
20
12
20
18
20
20

4 833
770
352
28
810
1 890
499
295

Isolates 
from 
ICUs (%)
1
3
6
0
1
3
3
10

Laboratories 
(N)

Isolates 
(N)

20
20
20
11
20
20
20
20

5 315
758
378
37
835
2 439
549
301

Isolates 
from ICUs 
(%)
1
2
3
0
1
3
0
6

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Finland and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Finland and EU/EEA 
population-weighted mean, 2010–2017

Finland
EU/EEA population-weighted mean

Finland
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Finland and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Finland and EU/EEA population-
weighted mean, 2010–2017

Finland
EU/EEA population-weighted mean

Finland
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

76

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
France

Coverage and representativeness of population, hospitals 
and isolates included in EARS-Net, France, 2014–2017

Estimated national population coverage (%)* 

Laboratories collecting 
S. pneumoniae (CNRP)
Laboratories collecting 
others species (Onerba)

Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days***
Isolate sample 
representativeness

2014

2015

2016

44

19

High

High

81.2

High

67

19

High

High

79.9

High

51

20

High

High

77.1

High

2017

58**

22

High

High

88.1

High

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, France, 2014–2017

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

89

2015

95

2016

86

2017

87

100

100

100

100

* Calculation based on proportion hospital days in participating hospitals out 
of total hospital days in the country / ** Restricted to first half of the year / 
*** Calculated only for Onerba Network

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), France 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

53
53
53
49
150
53
53
51

Isolates 
(N)

Isolates 
from 
ICUs (%)
8
10 350
16
2 196
24
1 789
409
13
656 Unknown
13
19
28

5 498
1 940
753

Laboratories 
(N)

54
53
53
48
198
54
53
53

Isolates 
(N)

Isolates 
from 
ICUs (%)
8
11 067
17
2 350
24
1 956
434
14
1 068 Unknown
15
5 597
21
1 999
29
853

Laboratories 
(N)

49
49
49
48
175
50
49
48

Isolates 
(N)

11 337
2 608
1 988
454

Isolates 
from 
ICUs (%)
9
17
23
18
1 046 Unknown
14
5 699
19
2 022
28
819

Laboratories 
(N)

54
54
36
52
169**
54
53
53

Isolates 
(N)

13 392
2 904
1 721
475

Isolates 
from ICUs 
(%)
8
16
22
16
614** Unknown
14
6 668
19
2 259
27
1 000

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.
** Restricted to first half of the year for 2017

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), France and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, France and EU/EEA 
population-weighted mean, 2010–2017

France
EU/EEA population-weighted mean

France
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates 
with resistance to carbapenems, France and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, France and EU/EEA population-weighted 
mean, 2010–2017

France
EU/EEA population-weighted mean

France
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

77

 
 
 
 
 
 
 
 
Germany

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Germany, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Germany, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

15

Medium

2015

22

High

2016

26

High

2017

30

High

Medium

Medium

Medium

Medium

16.3

High

24.9

High

26.2

High

27.2

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

88

2015

2016

2017

92

94

93

83

91

81

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Germany 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

21
20
20
17
21
21
21
21

6 251
1 008
643
208
502
3 417
1 146
889

Isolates 
from 
ICUs (%)
16
25
28
17
22
23
26
40

Laboratories 
(N)

Isolates 
(N)

30
29
29
25
29
30
30
29

9 036
1 584
972
340
772
5 026
1 725
1 348

Isolates 
from 
ICUs (%)
14
20
27
19
21
21
23
42

Laboratories 
(N)

Isolates 
(N)

41
40
39
38
40
41
41
41

17 199
3 070
1 423
463
1 403
9 870
2 959
2 049

Isolates 
from 
ICUs (%)
14
22
27
18
23
20
24
40

Laboratories 
(N)

Isolates 
(N)

53
52
52
48
51
53
53
53

21 085
3 549
1 756
505
1 872
12 034
3 725
2 454

Isolates 
from ICUs 
(%)
14
22
26
17
22
21
24
40

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Germany and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Germany and EU/
EEA population-weighted mean, 2010–2017

Germany
EU/EEA population-weighted mean

Germany
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Germany and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Germany and EU/EEA population-
weighted mean, 2010–2017

Germany
EU/EEA population-weighted mean

Germany
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

78

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Greece

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Greece, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Greece, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

56

2015

55

2016

55

2017

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

2016

2017

89

8

89

7

96

12

89

13

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Greece 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

26
27
26
26
-
27
26
25

1 123
1 093
700
844
-
575
449
276

Isolates 
from 
ICUs (%)
4
43
46
62
-
12
31
30

Laboratories 
(N)

Isolates 
(N)

29
28
28
29
-
29
28
26

1 218
1 187
680
1 001
-
635
506
320

Isolates 
from 
ICUs (%)
3
37
35
52
-
8
27
30

Laboratories 
(N)

Isolates 
(N)

31
30
31
29
-
31
28
28

1 306
1 183
705
903
-
682
576
358

Isolates 
from 
ICUs (%)
4
40
41
57
-
10
34
31

Laboratories 
(N)

Isolates 
(N)

32
33
31
32
-
33
33
31

1 472
1 363
821
1 096
-
833
638
412

Isolates 
from ICUs 
(%)
5
37
37
50
-
10
24
25

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Greece and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Greece and EU/EEA 
population-weighted mean, 2010–2017

Greece
EU/EEA population-weighted mean

Greece
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

50

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Greece and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Greece and EU/EEA population-weighted 
mean, 2010–2017

Greece
EU/EEA population-weighted mean

Greece
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

80

60

40

20

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

79

 
 
 
 
 
 
 
 
Hungary

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Hungary, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Hungary, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

90

High

2015

90

High

2016

90

High

2017

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

11.7

10.4

9.8

11.5

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

97

2015

100

2016

100

2017

97

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Hungary 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

30
28
29
27
25
26
28
21

1 622
644
746
446
129
1 279
659
224

Isolates 
from 
ICUs (%)
14
26
46
59
32
22
36
46

Laboratories 
(N)

Isolates 
(N)

30
27
29
25
27
27
27
23

2 026
706
770
467
181
1 517
730
240

Isolates 
from 
ICUs (%)
14
31
47
53
28
20
35
44

Laboratories 
(N)

Isolates 
(N)

29
29
29
26
27
28
28
25

1 995
723
740
401
174
1 668
786
272

Isolates 
from 
ICUs (%)
12
27
44
56
24
19
36
46

Laboratories 
(N)

Isolates 
(N)

31
29
30
31
27
28
30
27

2 061
693
735
358
204
1 566
769
315

Isolates 
from ICUs 
(%)
12
24
49
50
16
18
36
44

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Hungary and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Hungary and EU/
EEA population-weighted mean, 2010–2017

Hungary
EU/EEA population-weighted mean

Hungary
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Hungary and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Hungary and EU/EEA population-
weighted mean, 2010–2017

Hungary
EU/EEA population-weighted mean

Hungary
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

80

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Iceland

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Iceland, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Iceland, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

100

High

2015

100

High

2016

100

High

2017

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

100

2016

100

2017

100

50

50

50

50

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Iceland 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

2
1
1
1
2
2
1
1

152
28
11
3
25
61
12
11

Isolates 
from 
ICUs (%)
2
4
22
50
0
9
9
20

Laboratories 
(N)

Isolates 
(N)

2
2
2
1
1
2
2
1

173
36
12
6
25
88
21
20

Isolates 
from 
ICUs (%)
1
0
0
17
0
3
0
16

Laboratories 
(N)

Isolates 
(N)

2
2
2
1
2
2
2
1

192
25
17
3
19
76
24
16

Isolates 
from 
ICUs (%)
1
4
13
0
5
1
5
13

Laboratories 
(N)

Isolates 
(N)

2
2
1
1
2
2
2
1

213
17
17
6
27
69
33
17

Isolates 
from ICUs 
(%)
0
0
18
0
4
7
3
12

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Iceland and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Iceland and EU/EEA 
population-weighted mean, 2010–2017

Iceland
EU/EEA population-weighted mean

Iceland
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Iceland and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Iceland and EU/EEA population-
weighted mean, 2010–2017

Iceland
EU/EEA population-weighted mean

Iceland
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

81

 
 
 
 
 
 
 
 
Ireland

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Ireland, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Ireland, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

100

High

High

52.3

High

2015

97

High

High

53.0

High

2016

99

High

High

57.5

High

2017

100

High

High

58.0

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

2016

2017

92

86

92

92

90

91

85

94

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Ireland 2014–2017

Pathogen

Laboratories 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

39
34
31
24
34
37
32
29

2014

2015

2016

2017

Isolates 
(N)

Isolates 
from 
ICUs (%)
2 705 Unknown
355 Unknown
178 Unknown
89 Unknown
328 Unknown
1 075 Unknown
308 Unknown
390 Unknown

Laboratories 
(N)

39
30
29
21
30
37
35
29

Isolates 
(N)

Isolates 
from 
ICUs (%)
2 649 Unknown
389 Unknown
195 Unknown
86 Unknown
303 Unknown
1 057 Unknown
292 Unknown
405 Unknown

Laboratories 
(N)

Isolates 
(N)

39
32
30
25
31
37
34
31

2 991
453
243
68
363
1 143
290
423

Isolates 
from 
ICUs (%)
5
10
11
9
3
6
8
26

Laboratories 
(N)

39
35
33
23
31
37
33
33

Isolates 
(N)

Isolates 
from ICUs 
(%)
3 125 Unknown
479 Unknown
288 Unknown
66 Unknown
412 Unknown
1 144 Unknown
340 Unknown
442 Unknown

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Ireland and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Ireland and EU/EEA 
population-weighted mean, 2010–2017

Ireland
EU/EEA population-weighted mean

Ireland
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Ireland and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Ireland and EU/EEA population-
weighted mean, 2010–2017

Ireland
EU/EEA population-weighted mean

Ireland
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

50

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

82

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Italy

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Italy, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Italy, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

16

2015

15

2016

17

2017

21

Unknown

Unknown

Unknown

Medium

Unknown

Unknown

Unknown

Unknown

31.6

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

86

2015

95

100

100

2016

92

98

2017

97

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Italy 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

38
45
37
31
42
46
32
46

3 802
1 352
760
483
284
2 270
863
558

Isolates 
from 
ICUs (%)
7
27
32
58
12
11
21
22

Laboratories 
(N)

Isolates 
(N)

45
43
41
40
39
46
45
45

5 605
2 015
1 083
667
479
3 300
1 622
771

Isolates 
from 
ICUs (%)
8
28
29
56
10
15
24
27

Laboratories 
(N)

Isolates 
(N)

46
47
43
41
43
46
47
47

6 110
2 314
1 207
708
515
3 309
1 617
958

Isolates 
from 
ICUs (%)
7
27
25
46
11
13
22
21

Laboratories 
(N)

Isolates 
(N)

54
55
54
48
52
55
55
54

7 478
2 720
1 455
878
673
4 213
2 004
1 085

Isolates 
from ICUs 
(%)
6
25
24
42
9
14
23
20

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Italy and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Italy and EU/EEA 
population-weighted mean, 2010–2017

Italy
EU/EEA population-weighted mean

Italy
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Italy and EU/EEA population-weighted 
mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Italy and EU/EEA population-weighted 
mean, 2010–2017

Italy
EU/EEA population-weighted mean

Italy
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

83

 
 
 
 
 
 
 
 
Latvia

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Latvia, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Latvia, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

90

2015

90

Medium

Medium

2016

90

High

2017

90

High

Medium

Medium

Medium

Medium

5.7

6.7

6.6

6.1

Medium

Medium

Medium

Medium

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

100

13

13

2016

2017

94

27

88

21

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Latvia 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

10
12
6
6
7
13
8
6

182
118
18
52
51
222
44
35

Isolates 
from 
ICUs (%)
33
47
44
60
71
25
30
37

Laboratories 
(N)

Isolates 
(N)

11
11
6
6
9
15
10
10

201
115
13
61
64
253
60
34

Isolates 
from 
ICUs (%)
29
51
15
56
53
18
37
47

Laboratories 
(N)

Isolates 
(N)

11
8
5
7
8
14
12
6

253
95
16
82
63
286
89
56

Isolates 
from 
ICUs (%)
18
33
31
56
60
19
33
46

Laboratories 
(N)

Isolates 
(N)

12
7
4
7
9
11
8
5

205
116
14
34
53
229
74
39

Isolates 
from ICUs 
(%)
20
41
64
62
38
22
36
54

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Latvia and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Latvia and EU/EEA 
population-weighted mean, 2010–2017

Latvia
EU/EEA population-weighted mean

Latvia
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates 
with resistance to carbapenems, Latvia and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Latvia and EU/EEA population-weighted 
mean, 2010–2017

Latvia
EU/EEA population-weighted mean

Latvia
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

84

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Lithuania

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Lithuania, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Lithuania, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

Unknown

Unknown

2015

90

High

Unknown

Unknown

2016

100

High

High

Unknown

Unknown

7.1

High

High

High

2017

100

High

High

6.3

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

91

80

2015

100

2016

100

2017

94

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Lithuania 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

13
12
9
11
10
13
12
10

594
154
31
66
67
383
78
44

Isolates 
from 
ICUs (%)
18
38
52
52
39
22
38
23

Laboratories 
(N)

Isolates 
(N)

15
12
9
11
14
14
12
8

583
179
41
73
87
376
81
52

Isolates 
from 
ICUs (%)
22
39
37
62
41
24
37
40

Laboratories 
(N)

Isolates 
(N)

17
16
13
11
12
17
13
13

797
326
74
87
99
505
86
61

Isolates 
from 
ICUs (%)
21
31
36
64
24
22
25
38

Laboratories 
(N)

Isolates 
(N)

16
15
13
12
14
16
13
13

852
326
89
87
109
515
111
80

Isolates 
from ICUs 
(%)
19
30
36
56
24
19
23
31

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Lithuania and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Lithuania and EU/
EEA population-weighted mean, 2010–2017

Lithuania
EU/EEA population-weighted mean

Lithuania
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Lithuania and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Lithuania and EU/EEA population-
weighted mean, 2010–2017

Lithuania
EU/EEA population-weighted mean

Lithuania
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

85

 
 
 
 
 
 
 
 
Luxembourg

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, 
Luxembourg, 2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Luxembourg, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

100

High

2015

100

High

2016

100

High

2017

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

26.0

Unknown

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

67

2015

83

60

2016

100

80

2017

50

80

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Luxembourg 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

5
4
5
3
5
5
5
4

371
66
42
6
35
125
45
32

Isolates 
from 
ICUs (%)
7
10
13
20
12
19
23
41

Laboratories 
(N)

Isolates 
(N)

5
4
4
2
5
7
5
4

347
60
28
8
29
135
58
23

Isolates 
from 
ICUs (%)
7
19
17
0
17
21
17
55

Laboratories 
(N)

Isolates 
(N)

4
4
4
2
4
4
4
4

419
78
40
8
51
188
48
31

Isolates 
from 
ICUs (%)
11
25
15
38
10
25
24
20

Laboratories 
(N)

Isolates 
(N)

4
4
4
2
4
4
4
4

433
99
56
8
49
200
87
34

Isolates 
from ICUs 
(%)
8
21
21
0
12
17
27
32

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates 
with resistance to meticillin (MRSA), Luxembourg and EU/EEA 
population-weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Luxembourg and 
EU/EEA population-weighted mean, 2010–2017

Luxembourg
EU/EEA population-weighted mean

Luxembourg
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Luxembourg and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Luxembourg and EU/EEA population-
weighted mean, 2010–2017

Luxembourg
EU/EEA population-weighted mean

Luxembourg
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

86

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Malta

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Malta, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Malta, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

95

High

High

21.0

High

2015

95

High

High

22.7

High

2016

95

High

High

25.0

High

2017

95

High

High

26.3

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

100

2016

100

2017

100

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Malta 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

1
1
1
1
1
1
1
1

268
99
36
10
8
79
30
11

Isolates 
from 
ICUs (%)
2
11
18
20
0
3
3
0

Laboratories 
(N)

Isolates 
(N)

1
1
1
1
1
1
1
1

238
88
25
15
20
87
31
6

Isolates 
from 
ICUs (%)
2
10
8
0
5
4
7
0

Laboratories 
(N)

Isolates 
(N)

1
1
1
1
1
1
1
1

328
102
40
7
10
97
33
12

Isolates 
from 
ICUs (%)
4
9
5
14
0
4
0
25

Laboratories 
(N)

Isolates 
(N)

1
1
1
1
1
1
1
1

314
117
37
9
19
97
29
13

Isolates 
from ICUs 
(%)
1
10
19
0
7
1
5
10

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Malta and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Malta and EU/EEA 
population-weighted mean, 2010–2017

Malta
EU/EEA population-weighted mean

Malta
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

60

50

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates 
with resistance to carbapenems, Malta and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Malta and EU/EEA population-weighted 
mean, 2010–2017

Malta
EU/EEA population-weighted mean

Malta
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

As less than 10 isolates were reported for Malta for 2012 and 2015, no 
resistance percentages are displayed for these years.

87

 
 
 
 
 
 
 
 
Netherlands

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, 
Netherlands, 2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Netherlands, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

65

High

High

2015

65

High

High

2016

65

High

High

2017

65

High

High

Unknown

Unknown

Unknown

Unknown

High

High

High

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

82

96

73

93

2016

85

2017

85

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Netherlands 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

35
35
35
26
35
35
35
34

6 514
926
555
75
1 406
2 580
721
535

Isolates 
from 
ICUs (%)
10
14
24
22
16
15
23
50

Laboratories 
(N)

Isolates 
(N)

27
27
27
21
27
27
27
27

5 380
908
502
74
1 301
2 107
648
572

Isolates 
from 
ICUs (%)
10
13
22
19
15
15
22
53

Laboratories 
(N)

Isolates 
(N)

32
32
31
31
32
32
32
32

6 398
1 135
543
108
1 517
2 702
783
686

Isolates 
from 
ICUs (%)
9
11
14
13
12
11
21
50

Laboratories 
(N)

Isolates 
(N)

33
33
33
30
33
33
33
33

6 687
1 190
657
122
1 511
2 695
895
808

Isolates 
from ICUs 
(%)
7
11
17
21
10
11
19
47

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates 
with resistance to meticillin (MRSA), Netherlands and EU/EEA 
population-weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Netherlands and 
EU/EEA population-weighted mean, 2010–2017

Netherlands
EU/EEA population-weighted mean

Netherlands
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Netherlands and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Netherlands and EU/EEA population-
weighted mean, 2010–2017

Netherlands
EU/EEA population-weighted mean

Netherlands
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

88

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Norway

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Norway, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Norway, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

100

High

2015

100

High

2016

100

High

Unknown

Unknown

Unknown

2017

100

High

High

55.4

56.9

63.2

Unknown

Unknown

Unknown

Unknown

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

89

2015

100

2016

95

2017

95

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Norway 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

19
18
19
13
19
19
19
18

3 422
746
257
34
536
1 546
536
228

Isolates 
from 
ICUs (%)
4
5
7
3
7
6
6
11

Laboratories 
(N)

Isolates 
(N)

18
18
18
11
18
18
18
18

3 302
701
230
32
429
1 457
439
186

Isolates 
from 
ICUs (%)
4
6
7
13
5
6
5
11

Laboratories 
(N)

Isolates 
(N)

18
18
18
12
18
18
18
18

3 618
811
227
33
504
1 485
530
215

Isolates 
from 
ICUs (%)
4
5
5
6
3
4
6
15

Laboratories 
(N)

Isolates 
(N)

18
18
18
12
18
18
18
18

3 734
781
205
31
482
1 507
526
209

Isolates 
from ICUs 
(%)
3
4
5
10
6
5
5
10

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Norway and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Norway and EU/EEA 
population-weighted mean, 2010–2017

Norway
EU/EEA population-weighted mean

Norway
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Norway and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Norway and EU/EEA population-
weighted mean, 2010–2017

Norway
EU/EEA population-weighted mean

Norway
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

89

 
 
 
 
 
 
 
 
Poland

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Poland, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Poland, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

11

2015

14

2016

20

2017

19

Medium

Medium

Medium

Medium

28.3

31.9

Medium

Medium

Medium/
High

Medium/
High

High

30.3

High

High

38.1

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

96

2015

93

2016

92

2017

96

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Poland 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

32
32
30
27
31
32
29
28

1 096
466
187
189
133
750
272
185

Isolates 
from 
ICUs (%)
11
33
43
58
14
14
35
36

Laboratories 
(N)

Isolates 
(N)

48
47
40
38
40
48
47
41

1 616
679
260
246
230
1 192
432
216

Isolates 
from 
ICUs (%)
12
36
38
59
14
16
37
37

Laboratories 
(N)

Isolates 
(N)

67
66
60
53
57
65
65
55

2 735
1 142
403
394
343
1 842
743
405

Isolates 
from 
ICUs (%)
13
35
32
50
14
16
29
30

Laboratories 
(N)

Isolates 
(N)

65
65
64
56
60
66
65
60

2 881
1 203
417
352
374
1 848
758
410

Isolates 
from ICUs 
(%)
28
41
45
59
30
32
46
43

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Poland and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Poland and EU/EEA 
population-weighted mean, 2010–2017

Poland
EU/EEA population-weighted mean

Poland
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Poland and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Poland and EU/EEA population-weighted 
mean, 2010–2017

Poland
EU/EEA population-weighted mean

Poland
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

90

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Portugal

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Portugal, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Portugal, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

95

High

High

196.8

High

2015

96

High

High

2016

97

High

High

2017

97

High

High

195.4

Unknown

148.1

High

High

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

2016

94

98

92

97

88

99

2017

88

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Portugal 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

56
53
51
40
50
53
50
42

5 027
1 714
1 064
266
668
3 241
1 324
634

Isolates 
from 
ICUs (%)
4
9
12
24
3
8
16
26

Laboratories 
(N)

Isolates 
(N)

58
58
56
43
51
57
53
43

5 377
2 099
1 192
312
843
3 645
981
459

Isolates 
from 
ICUs (%)
5
10
15
17
3
7
10
22

Laboratories 
(N)

Isolates 
(N)

60
59
57
39
57
59
56
45

5 786
2 352
1 230
207
928
3 482
972
411

Isolates 
from 
ICUs (%)
4
10
13
21
2
7
1
2

Laboratories 
(N)

Isolates 
(N)

62
61
57
36
54
64
58
46

6 452
2 743
1 220
174
1 056
3 789
1 014
467

Isolates 
from ICUs 
(%)
4
9
12
16
1
5
8
16

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Portugal and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Portugal and EU/
EEA population-weighted mean, 2010–2017

Portugal
EU/EEA population-weighted mean

Portugal
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

60

50

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Portugal and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Portugal and EU/EEA population-
weighted mean, 2010–2017

Portugal
EU/EEA population-weighted mean

Portugal
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

91

 
 
 
 
 
 
 
 
Romania

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Romania, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Romania, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

Unknown

2015

15

2016

2017

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

24.4

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

2016

2017

95

28

94

31

87

38

93

77

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Romania 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

16
16
15
16
12
15
15
12

309
258
94
124
50
399
102
56

Isolates 
from 
ICUs (%)
8
39
40
67
8
19
25
45

Laboratories 
(N)

Isolates 
(N)

12
13
11
13
9
13
12
10

371
271
92
190
70
424
113
72

Isolates 
from 
ICUs (%)
10
39
49
56
1
21
21
35

Laboratories 
(N)

Isolates 
(N)

13
13
13
13
8
14
13
13

420
344
93
160
60
495
115
78

Isolates 
from 
ICUs (%)
10
38
39
54
12
25
34
46

Laboratories 
(N)

Isolates 
(N)

14
14
14
12
11
14
14
13

518
339
132
183
81
535
128
64

Isolates 
from ICUs 
(%)
12
40
45
70
21
21
33
44

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Romania and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Romania and EU/
EEA population-weighted mean, 2010–2017

Romania
EU/EEA population-weighted mean

Romania
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

80

60

40

20

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Romania and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Romania and EU/EEA population-
weighted mean, 2010–2017

Romania
EU/EEA population-weighted mean

Romania
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

40

30

20

10

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

92

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Slovakia

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Slovakia, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Slovakia, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

75

High

High

19.4

2015

75

High

High

20.1

2016

70

High

High

20.3

2017

68

High

High

20.8

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

100

2016

100

2017

100

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Slovakia 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

14
14
14
14
9
14
13
13

889
494
276
171
32
640
282
129

Isolates 
from 
ICUs (%)
11
30
30
37
47
16
29
25

Laboratories 
(N)

Isolates 
(N)

14
14
14
14
9
14
14
14

896
475
278
154
34
583
255
146

Isolates 
from 
ICUs (%)
14
31
35
33
35
16
31
36

Laboratories 
(N)

Isolates 
(N)

13
13
12
13
5
13
13
12

829
466
191
115
13
572
233
126

Isolates 
from 
ICUs (%)
14
26
35
32
31
19
22
27

Laboratories 
(N)

Isolates 
(N)

13
13
13
13
10
13
13
11

882
468
211
126
40
614
226
122

Isolates 
from ICUs 
(%)
13
28
27
35
28
16
28
32

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Slovakia and EU/EEA population-
weighted mean, 2011–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Slovakia and EU/
EEA population-weighted mean, 2011–2017

Slovakia
EU/EEA population-weighted mean

Slovakia
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

50

40

30

20

10

0

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Slovakia and EU/EEA population-
weighted mean, 2011–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Slovakia and EU/EEA population-
weighted mean, 2011–2017

Slovakia
EU/EEA population-weighted mean

Slovakia
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

40

30

20

10

0

2011

2012

2013

2014

2015

2016

2017

93

 
 
 
 
 
 
 
 
Slovenia

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Slovenia, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Slovenia, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

99

High

High

34.8

High

2015

99

High

High

35.1

High

2016

99

High

High

35.0

High

2017

99

High

High

41.2

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

100

2016

100

2017

100

91

91

91

91

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Slovenia 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

10
10
9
8
10
10
10
10

1 216
233
112
34
300
495
120
115

Isolates 
from 
ICUs (%)
8
18
34
35
9
11
23
38

Laboratories 
(N)

Isolates 
(N)

10
10
10
7
10
10
10
9

1 326
237
141
31
323
513
133
124

Isolates 
from 
ICUs (%)
8
17
26
29
14
11
17
34

Laboratories 
(N)

Isolates 
(N)

10
10
10
7
10
10
10
9

1 420
267
143
60
269
534
161
111

Isolates 
from 
ICUs (%)
10
19
38
35
12
11
24
42

Laboratories 
(N)

Isolates 
(N)

10
10
10
4
10
10
10
9

1 435
312
138
36
319
576
171
149

Isolates 
from ICUs 
(%)
9
18
28
50
10
12
16
41

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Slovenia and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Slovenia and EU/
EEA population-weighted mean, 2010–2017

Slovenia
EU/EEA population-weighted mean

Slovenia
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Slovenia and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Slovenia and EU/EEA population-
weighted mean, 2010–2017

Slovenia
EU/EEA population-weighted mean

Slovenia
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

94

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
Spain

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Spain, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Spain, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

39

High

High

43.7

High

2015

40

High

High

46.2

High

2016

38

High

High

60.4

High

2017

37

High

High

Unknown

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

2015

2016

2017

88

39

98

43

98

46

90

58

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Spain 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

Isolates 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

38
39
39
23
38
39
39
37

5 824
1 266
874
83
583
1 943
998
554

Isolates 
from 
ICUs (%)
5
11
16
24
9
10
15
17

Laboratories 
(N)

Isolates 
(N)

40
40
40
26
36
39
39
38

6 493
1 510
884
96
672
2 002
992
580

Isolates 
from 
ICUs (%)
5
12
21
41
9
11
15
15

Laboratories 
(N)

Isolates 
(N)

38
38
37
24
36
37
37
35

6 800
1 680
843
106
672
1 972
986
630

Isolates 
from 
ICUs (%)
5
11
19
37
7
10
13
18

Laboratories 
(N)

Isolates 
(N)

36
35
35
21
33
36
35
34

5 808
1 446
843
88
722
1 873
931
574

Isolates 
from ICUs 
(%)
5
11
16
47
7
10
14
15

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Spain and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Spain and EU/EEA 
population-weighted mean, 2010–2017

Spain
EU/EEA population-weighted mean

Spain
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates 
with resistance to carbapenems, Spain and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Spain and EU/EEA population-weighted 
mean, 2010–2017

Spain
EU/EEA population-weighted mean

Spain
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

95

 
 
 
 
 
 
 
 
Sweden

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, Sweden, 
2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, Sweden, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

73

High

High

118.8

High

2015

75

High

High

128.2

High

2016

75

High

High

139.0

High

2017

57

High

High

156.7

High

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

100

2015

89

2016

100

2017

100

100

100

100

100

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), Sweden 2014–2017

2014

2015

2016

2017

Pathogen

Laboratories 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

16
16
16
10
16
16
16
16

Isolates 
(N)

Isolates 
from 
ICUs (%)
1
6 549
1 000
3
438 Unknown
7
1
3
2
9

52
792
3 501
905
453

Laboratories 
(N)

17
17
17
9
17
17
17
17

Isolates 
(N)

Isolates 
from 
ICUs (%)
6 768 Unknown
1 141 Unknown
435 Unknown
35 Unknown
867 Unknown
3 415 Unknown
868 Unknown
412 Unknown

Laboratories 
(N)

14
15
13
12
14
15
14
14

Isolates 
(N)

Isolates 
from 
ICUs (%)
6 970 Unknown
1 537 Unknown
473 Unknown
86 Unknown
904 Unknown
3 903 Unknown
1 019 Unknown
561 Unknown

Laboratories 
(N)

10
10
10
1
11
11
11
11

Isolates 
(N)

Isolates 
from ICUs 
(%)
5 807 Unknown
1 034 Unknown
446 Unknown
54 Unknown
755 Unknown
3 800 Unknown
1 630 Unknown
622 Unknown

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), Sweden and EU/EEA population-
weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, Sweden and EU/
EEA population-weighted mean, 2010–2017

Sweden
EU/EEA population-weighted mean

Sweden
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates with 
resistance to carbapenems, Sweden and EU/EEA population-
weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, Sweden and EU/EEA population-
weighted mean, 2010–2017

Sweden
EU/EEA population-weighted mean

Sweden
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

2010

2011

2012

2013

2014

2015

2016

2017

10

5

0

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

96

SURVEILLANCE REPORTSurveillance of antimicrobial resistance in Europe 2017 
 
 
 
 
 
 
 
United Kingdom

Coverage and representativeness of population, 
hospitals and isolates included in EARS-Net, United 
Kingdom, 2014–2017

Laboratories contributing data to EARS-Net: 
participation in EARS-Net EQA and use of clinical 
guidelines, United Kingdom, 2014–2017

Estimated national 
population coverage (%) 
Population sample 
representativeness
Hospital sample 
representativeness
Blood culture sets/1000 
patient-days
Isolate sample 
representativeness

2014

2015

2016

2017

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

Unknown

44.5

65.4

59.8

52.0

Unknown

Unknown

Unknown

Unknown

Percentage laboratories 
participating in EARS-Net 
EQA
Percentage laboratories 
using EUCAST or EUCAST 
harmonised guidelines 

2014

90

100

2015

2016

2017

90

98

88

98

82

96

Annual number of reporting laboratories*, number of reported isolates and proportion of isolates reported from 
patients in intensive care units (ICU), United Kingdom 2014–2017

Pathogen

Laboratories 
(N)

E. coli
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
S. pneumoniae
S. aureus
E. faecalis
E. faecium

31
29
29
27
56
56
29
28

2014

2015

2016

2017

Isolates 
(N)

Isolates 
from 
ICUs (%)
7 369 Unknown
1 180 Unknown
649 Unknown
129 Unknown
1 418 Unknown
3 569 Unknown
512 Unknown
433 Unknown

Laboratories 
(N)

22
22
22
20
44
47
22
20

Isolates 
(N)

Isolates 
from 
ICUs (%)
6 117 Unknown
1 077 Unknown
541 Unknown
153 Unknown
1 126 Unknown
3 125 Unknown
422 Unknown
354 Unknown

Laboratories 
(N)

91
89
87
77
90
92
87
85

Isolates 
(N)

Isolates 
from 
ICUs (%)
23 714 Unknown
4 236 Unknown
2 187 Unknown
615 Unknown
3 522 Unknown
7 798 Unknown
1 868 Unknown
1 919 Unknown

Laboratories 
(N)

106
105
104
96
102
106
103
101

Isolates 
(N)

Isolates 
from ICUs 
(%)
31 579 Unknown
5 519 Unknown
2 911 Unknown
818 Unknown
4 373 Unknown
10 031 Unknown
2 792 Unknown
2 306 Unknown

* Number of laboratories reporting at least one isolate during the specific year. Total number of laboratories participating in EARS-Net might be higher.

Staphylococcus aureus. Percentage (%) of invasive isolates with 
resistance to meticillin (MRSA), United Kingdom and EU/EEA 
population-weighted mean, 2010–2017

Escherichia coli. Percentage (%) of invasive isolates with 
resistance to third-generation cephalosporins, United Kingdom 
and EU/EEA population-weighted mean, 2010–2017

United Kingdom
EU/EEA population-weighted mean

United Kingdom
EU/EEA population-weighted mean

)

%

(
A
S
R
M
e
g
a
t
n
e
c
r
e
P

25

20

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

15

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

Klebsiella pneumoniae. Percentage (%) of invasive isolates 
with resistance to carbapenems, United Kingdom and EU/EEA 
population-weighted mean, 2010–2017

Enterococcus faecium. Percentage (%) of invasive isolates with 
resistance to vancomycin, United Kingdom and EU/EEA population-
weighted mean, 2010–2017

United Kingdom
EU/EEA population-weighted mean

United Kingdom
EU/EEA population-weighted mean

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

10

5

0

2010

2011

2012

2013

2014

2015

2016

2017

)

%

(
e
c
n
a
t
i
s
e
r
e
g
a
t
n
e
c
r
e
P

30

20

10

0

2010

2011

2012

2013

2014

2015

2016

2017

97

 
 
 
 
 
 
 
 
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