10 How knowing the resistance mechanism contributes to AMR surveillance

10.1 The current picture

Globally, data on AMR and mechanisms are far from complete. For example, there are good data from Europe on isolates from humans and the food chain as a result of a longstanding surveillance scheme run by ECDC and EFSA, but even within these data there is variation between countries. If each centre or country only reports a few isolates this can bias the data. For countries without established regional surveillance schemes the existing data are very patchy. This makes it hard to understand the extent and distribution of resistance.

Two types of data are available:

• rates of mechanisms of resistance for specific species of organisms, for example ESBLs, CPRs, VREs (Figures 19 and 20)
• spatial distribution of particular types of resistance mechanism, for example the NDM carbapenemases or CTX-M ESBLs (Figure 21).

These data are still however far from complete.

Figure 19 Percentage of isolates in 2019 with resistance to third generation cephalosporins in K. pneumoniae (Data from ECDC, 2019)

Figure 20 Spatial distribution of combined resistance to ciprofloxacin and erythromycin in Campylobacter coli isolates from a) broilers and b) fattening pigs (EFSA and ECDC, 2021).

Figure 21 World-wide distribution of carbapenemases: (top) NDM-producers in Enterobacteriaceae and P. aeruginosa; (bottom) OXA-48-like producers in Enterobacteriaceae; (abbreviations) NDM = New Delhi metallo-β-lactamase; OXA-48 = oxacillinase-48 (Bonomo et al., 2018).