Table 2. Significant trends in antimicrobial resistance rates over time per microorganism and hospitalisation unit (wards or ICU), WHONET-Greece AMR network, 2010–2017 (n = 48,211).
| Antibiotic | Year of isolation | p value | Trend | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | |||||||||||
| NS/tested | %NS | NS/tested | %NS | NS/tested | %NS | NS/tested | %NS | NS/tested | %NS | NS/tested | %NS | NS/tested | %NS | NS/tested | %NS | |||
| Escherichia coli | ||||||||||||||||||
| Ceftazidime non-susceptible | ||||||||||||||||||
| Wards | 117/1,032 | 11.3 | 126/1,034 | 12.2 | 136/1,047 | 13.0 | 152/1,097 | 13.9 | 166/1,092 | 15.2 | 156/1,119 | 13.9 | 179/1,318 | 13.6 | 176/1,198 | 14.7 | 0.012 | ↑ |
| Meropenem non-susceptible | ||||||||||||||||||
| Wards | 2/897 | 0.2 | 5/882 | 0.6 | 9/871 | 1.0 | 10/882 | 1.1 | 10/867 | 1.2 | 9/944 | 1.0 | 12/1,046 | 1.1 | 19/939 | 2.0 | < 0.001 | ↑ |
| Ciprofloxacin non-susceptible | ||||||||||||||||||
| Wards | 265/1,037 | 25.6 | 282/1,034 | 27.3 | 311/1,045 | 29.8 | 358/1,097 | 32.6 | 369/1,095 | 33.7 | 325/1,115 | 29.1 | 433/1,331 | 32.5 | 386/1,198 | 32.2 | < 0.001 | ↑ |
| Trimethoprim/sulfamethoxazole non-susceptible | ||||||||||||||||||
| Wards | 376/1,026 | 36.6 | 365/918 | 39.8 | 362/930 | 38.9 | 413/1,034 | 39.9 | 385/1,051 | 36.6 | 335/1,059 | 31.6 | 430/1,251 | 34.4 | 383/1,154 | 33.2 | < 0.001 | ↓ |
| Enterobacter spp. | ||||||||||||||||||
| Ceftazidime non-susceptible | ||||||||||||||||||
| Wards | 98/222 | 44.1 | 66/202 | 32.7 | 69/193 | 35.8 | 61/202 | 30.2 | 67/181 | 37.0 | 65/197 | 33.0 | 42/185 | 22.7 | 61/191 | 31.9 | 0.001 | ↓ |
| Imipenem non-susceptible | ||||||||||||||||||
| Wards | 34/219 | 15.5 | 22/200 | 11.0 | 35/194 | 18.0 | 31/200 | 15.5 | 32/177 | 18.1 | 36/195 | 18.5 | 32/185 | 17.3 | 39/191 | 20.4 | 0.044 | ↑ |
| Meropenem non-susceptible | ||||||||||||||||||
| Wards | 17/196 | 8.7 | 15/181 | 8.3 | 14/165 | 8.5 | 21/176 | 11.9 | 13/126 | 10.3 | 24/156 | 15.4 | 16/154 | 10.4 | 22/166 | 13.3 | 0.042 | ↑ |
| Ciprofloxacin non-susceptible | ||||||||||||||||||
| Wards | 44/222 | 19.8 | 22/201 | 10.9 | 25/194 | 12.9 | 24/201 | 11.9 | 22/179 | 12.3 | 29/196 | 14.8 | 16/187 | 8.6 | 21/189 | 11.1 | 0.023 | ↓ |
| Tobramycin non-susceptible | ||||||||||||||||||
| Wards | 70/214 | 32.7 | 33/199 | 16.6 | 38/184 | 20.7 | 31/188 | 16.5 | 36/170 | 21.2 | 38/165 | 23.0 | 26/165 | 15.8 | 22/150 | 14.7 | 0.001 | ↓ |
| Multiresistance | ||||||||||||||||||
| Wards | 34/205 | 16.6 | 16/197 | 8.1 | 18/182 | 9.9 | 16/181 | 8.8 | 16/167 | 9.6 | 20/162 | 12.3 | 10/161 | 6.2 | 12/145 | 8.3 | 0.034 | ↓ |
| Klebsiella pneumoniae | ||||||||||||||||||
| Ceftazidime non-susceptible | ||||||||||||||||||
| Wards | 470/761 | 61.8 | 434/698 | 62.2 | 366/635 | 57.6 | 396/689 | 57.5 | 391/682 | 57.3 | 416/726 | 57.3 | 421/743 | 56.7 | 445/761 | 58.5 | 0.027 | ↓ |
| ICU | 567/612 | 92.6 | 589/652 | 90.3 | 504/556 | 90.6 | 397/455 | 87.3 | 387/442 | 87.6 | 349/403 | 86.6 | 396/453 | 87.4 | 364/411 | 88.6 | 0.001 | ↓ |
| Imipenem non-susceptible | ||||||||||||||||||
| Wards | 380/761 | 49.9 | 347/696 | 49.9 | 294/630 | 46.7 | 320/685 | 46.7 | 320/681 | 47.0 | 346/726 | 47.7 | 375/743 | 50.5 | 399/761 | 52.4 | 0.021 | ↑a |
| ICU | 536/608 | 88.2 | 567/653 | 86.8 | 461/552 | 83.5 | 366/454 | 80.6 | 369/439 | 84.1 | 341/404 | 84.4 | 399/453 | 88.1 | 351/409 | 85.8 | <0.001 | ↓b |
| Meropenem non-susceptible | ||||||||||||||||||
| Wards | 305/678 | 45.0 | 321/638 | 50.3 | 281/606 | 46.4 | 298/598 | 49.8 | 302/602 | 50.2 | 322/636 | 50.6 | 342/630 | 54.3 | 379/689 | 55.0 | < 0.001 | ↑ |
| ICU | 472/584 | 80.8 | 507/618 | 82.0 | 432/538 | 80.3 | 349/432 | 80.8 | 333/403 | 82.6 | 327/377 | 86.7 | 385/432 | 89.1 | 358/412 | 86.9 | < 0.001 | ↑ |
| Ciprofloxacin non-susceptible | ||||||||||||||||||
| ICU | 555/612 | 90.7 | 584/653 | 89.4 | 497/556 | 89.4 | 384/455 | 84.4 | 381/442 | 86.2 | 342/403 | 84.9 | 392/454 | 86.3 | 361/412 | 87.6 | 0.005 | ↓ |
| Gentamicin non-susceptible | ||||||||||||||||||
| Wards | 133/763 | 17.4 | 108/697 | 15.5 | 108/635 | 17.0 | 140/685 | 20.4 | 148/683 | 21.7 | 142/726 | 19.6 | 202/743 | 27.2 | 225/763 | 29.5 | < 0.001 | ↑ |
| ICU | 166/611 | 27.2 | 188/651 | 28.9 | 234/557 | 42.0 | 201/456 | 44.1 | 171/437 | 39.1 | 180/405 | 44.4 | 223/455 | 49.0 | 206/413 | 49.9 | < 0.001 | ↑ |
| Tobramycin non-susceptible | ||||||||||||||||||
| Wards | 458/744 | 61.6 | 427/682 | 62.6 | 304/537 | 56.6 | 335/587 | 57.1 | 354/640 | 55.3 | 293/564 | 52.0 | 319/610 | 52.3 | 313/589 | 53.1 | < 0.001 | ↓ |
| ICU | 509/570 | 89.3 | 556/634 | 87.7 | 420/472 | 89.0 | 309/370 | 83.5 | 327/408 | 80.1 | 248/288 | 86.1 | 268/327 | 82.0 | 211/256 | 82.4 | < 0.001 | ↓ |
| Cefoxitin non-susceptible | ||||||||||||||||||
| ICU | 481/529 | 90.9 | 488/551 | 88.6 | 367/483 | 76.0 | 276/364 | 75.8 | 271/364 | 74.5 | 266/360 | 73.9 | 309/425 | 72.7 | 313/395 | 79.2 | < 0.001 | ↓ |
| Multiresistance | ||||||||||||||||||
| Wards | 391/738 | 53.0 | 372/680 | 54.7 | 272/536 | 50.7 | 282/587 | 48.0 | 308/639 | 48.2 | 252/564 | 44.7 | 268/610 | 43.9 | 271/588 | 46.1 | < 0.001 | ↓ |
| ICU | 498/569 | 87.5 | 540/628 | 86.0 | 405/471 | 86.0 | 296/369 | 80.2 | 318/406 | 78.3 | 234/288 | 81.3 | 254/325 | 78.2 | 208/256 | 81.3 | < 0.001 | ↓ |
| Pseudomonas aeruginosa | ||||||||||||||||||
| Piperacillin/tazobactam non-susceptible | ||||||||||||||||||
| ICU | 179/435 | 41.1 | 88/283 | 31.1 | 62/197 | 31.5 | 73/339 | 21.5 | 98/304 | 32.2 | 54/209 | 25.8 | 65/256 | 25.4 | 47/221 | 21.3 | < 0.001 | ↓ |
| Ceftazidime non-susceptible | ||||||||||||||||||
| ICU | 226/433 | 52.2 | 173/353 | 49.0 | 182/346 | 52.6 | 201/389 | 51.7 | 153/313 | 48.9 | 102/237 | 43.0 | 118/274 | 43.1 | 97/237 | 40.9 | < 0.001 | ↓ |
| Imipenem non-susceptible | ||||||||||||||||||
| Wards | 222/404 | 55.0 | 240/425 | 56.5 | 258/410 | 62.9 | 319/455 | 70.1 | 258/377 | 68.4 | 282/409 | 68.9 | 297/446 | 66.6 | 283/448 | 63.2 | < 0.001 | ↑b |
| ICU | 315/431 | 73.1 | 252/354 | 71.2 | 255/346 | 73.7 | 290/389 | 74.6 | 250/313 | 79.9 | 192/237 | 81.0 | 214/273 | 78.4 | 179/235 | 76.2 | 0.005 | ↑ |
| Meropenem non-susceptible | ||||||||||||||||||
| Wards | 157/406 | 38.7 | 162/414 | 39.1 | 167/398 | 42.0 | 208/432 | 48.1 | 117/348 | 33.6 | 162/393 | 41.2 | 160/425 | 37.6 | 168/423 | 39.7 | 0.004 | ↑b |
| ICU | 264/435 | 60.7 | 206/325 | 63.4 | 203/335 | 60.6 | 244/385 | 63.4 | 177/301 | 58.8 | 118/228 | 51.8 | 122/254 | 48.0 | 116/230 | 50.4 | < 0.001 | ↓ |
| Ciprofloxacin non-susceptible | ||||||||||||||||||
| ICU | 244/435 | 56.1 | 174/352 | 49.4 | 185/346 | 53.5 | 205/391 | 52.4 | 148/315 | 47.0 | 106/240 | 44.2 | 98/275 | 35.6 | 96/238 | 40.3 | < 0.001 | ↓ |
| Tobramycin non-susceptible | ||||||||||||||||||
| Wards | 123/391 | 31.5 | 121/411 | 29.4 | 121/354 | 34.2 | 141/399 | 35.3 | 98/357 | 27.5 | 76/286 | 26.6 | 101/357 | 28.3 | 91/338 | 26.9 | 0.039 | ↓ |
| ICU | 214/395 | 54.2 | 165/340 | 48.5 | 144/289 | 49.8 | 169/331 | 51.1 | 125/276 | 45.3 | 60/159 | 37.7 | 68/205 | 33.2 | 60/163 | 36.8 | < 0.001 | ↓ |
| Gentamicin non-susceptible | ||||||||||||||||||
| Wards | 138/414 | 33.3 | 141/426 | 33.1 | 154/414 | 37.2 | 163/457 | 35.7 | 101/374 | 27.0 | 106/409 | 25.9 | 137/451 | 30.4 | 123/449 | 27.4 | < 0.001 | ↓ |
| ICU | 239/433 | 55.2 | 185/353 | 52.4 | 170/345 | 49.3 | 170/390 | 43.6 | 126/305 | 41.3 | 87/240 | 36.3 | 94/276 | 34.1 | 79/237 | 33.3 | < 0.001 | ↓ |
| Amikacin non-susceptible | ||||||||||||||||||
| ICU | 201/434 | 46.3 | 147/353 | 41.6 | 147/347 | 42.4 | 183/383 | 47.8 | 130/309 | 42.1 | 90/237 | 38.0 | 91/274 | 33.2 | 81/235 | 34.5 | < 0.001 | ↓ |
| Multiresistance | ||||||||||||||||||
| ICU | 156/429 | 36.4 | 116/342 | 33.9 | 127/337 | 37.7 | 155/376 | 41.2 | 118/305 | 38.7 | 72/235 | 30.6 | 74/271 | 27.3 | 73/235 | 31.1 | 0.018 | ↓ |
| Acinetobacter baumannii | ||||||||||||||||||
| Cefepime non-susceptible | ||||||||||||||||||
| Wards | 265/299 | 88.6 | 285/335 | 85.1 | 324/369 | 87.8 | 282/316 | 89.2 | 323/347 | 93.1 | 398/442 | 90.0 | 369/401 | 92.0 | 444/459 | 96.7 | < 0.001 | ↑ |
| ICU | 607/629 | 96.5 | 562/619 | 90.8 | 526/570 | 92.3 | 460/474 | 97.0 | 491/495 | 99.2 | 485/495 | 98.0 | 481/491 | 98.0 | 425/434 | 97.9 | < 0.001 | ↑ |
| Imipenem non-susceptible | ||||||||||||||||||
| Wards | 243/303 | 80.2 | 290/337 | 86.1 | 322/363 | 88.7 | 281/319 | 88.1 | 300/331 | 90.6 | 369/415 | 88.9 | 351/389 | 90.2 | 416/445 | 93.5 | < 0.001 | ↑ |
| ICU | 555/576 | 96.4 | 610/637 | 95.8 | 552/567 | 97.4 | 449/460 | 97.6 | 483/486 | 99.4 | 472/482 | 97.9 | 470/475 | 98.9 | 419/426 | 98.4 | < 0.001 | ↑ |
| Meropenem non-susceptible | ||||||||||||||||||
| Wards | 244/306 | 79.7 | 282/324 | 87.0 | 321/362 | 88.7 | 259/300 | 86.3 | 290/319 | 90.9 | 358/404 | 88.6 | 346/380 | 91.1 | 423/448 | 94.4 | < 0.001 | ↑ |
| ICU | 605/635 | 95.3 | 552/576 | 95.8 | 528/546 | 96.7 | 420/437 | 96.1 | 422/428 | 98.6 | 405/418 | 96.9 | 441/447 | 98.7 | 419/427 | 98.1 | < 0.001 | ↑ |
| Tobramycin non-susceptible | ||||||||||||||||||
| Wards | 132/284 | 46.5 | 149/330 | 45.2 | 204/325 | 62.8 | 179/270 | 66.3 | 204/322 | 63.4 | 232/316 | 73.4 | 189/276 | 68.5 | 231/271 | 85.2 | < 0.001 | ↑ |
| ICU | 339/562 | 60.3 | 412/632 | 65.2 | 341/491 | 69.5 | 311/411 | 75.7 | 352/443 | 79.5 | 317/371 | 85.4 | 290/346 | 83.8 | 227/252 | 90.1 | < 0.001 | ↑ |
| Amikacin non-susceptible | ||||||||||||||||||
| Wards | 208/291 | 71.5 | 218/301 | 72.4 | 248/344 | 72.1 | 231/304 | 76.0 | 244/316 | 77.2 | 295/390 | 75.6 | 276/343 | 80.5 | 338/408 | 82.8 | < 0.001 | ↑ |
| ICU | 484/594 | 81.5 | 451/598 | 75.4 | 405/536 | 75.6 | 379/431 | 87.9 | 396/445 | 89.0 | 388/430 | 90.2 | 370/394 | 93.9 | 299/332 | 90.1 | < 0.001 | ↑ |
| Gentamicin non-susceptible | ||||||||||||||||||
| Wards | 199/306 | 65.0 | 261/337 | 77.4 | 303/371 | 81.7 | 267/328 | 81.4 | 270/335 | 80.6 | 340/421 | 80.8 | 330/393 | 84.0 | 395/448 | 88.2 | < 0.001 | ↑ |
| ICU | 474/610 | 77.7 | 548/658 | 83.3 | 512/585 | 87.5 | 427/466 | 91.6 | 457/491 | 93.1 | 462/488 | 94.7 | 447/480 | 93.1 | 399/426 | 93.7 | < 0.001 | ↑ |
| Ciprofloxacin non-susceptible | ||||||||||||||||||
| Wards | 264/298 | 88.6 | 308/336 | 91.7 | 338/370 | 91.4 | 298/326 | 91.4 | 315/338 | 93.2 | 381/421 | 90.5 | 360/394 | 91.4 | 426/445 | 95.7 | 0.009 | ↑ |
| Multiresistance | ||||||||||||||||||
| Wards | 206/291 | 70.8 | 215/285 | 75.4 | 245/329 | 74.5 | 226/297 | 76.1 | 240/314 | 76.4 | 292/388 | 75.3 | 273/339 | 80.5 | 338/404 | 83.7 | < 0.001 | ↑ |
| ICU | 482/590 | 81.7 | 447/551 | 81.1 | 403/502 | 80.3 | 372/422 | 88.2 | 390/438 | 89.0 | 385/429 | 89.7 | 366/393 | 93.1 | 297/331 | 89.7 | < 0.001 | ↑ |
| Staphylococcus aureus | ||||||||||||||||||
| Oxacillin non-susceptiblec | ||||||||||||||||||
| ICU | 43/90 | 47.8 | 57/104 | 54.8 | 58/99 | 58.6 | 41/74 | 55.4 | 34/74 | 45.9 | 27/57 | 47.4 | 30/65 | 46.2 | 25/75 | 33.3 | 0.01 | ↓ |
| Ciprofloxacin non-susceptible | ||||||||||||||||||
| Wards | 67/268 | 25.0 | 77/328 | 23.5 | 122/463 | 26.3 | 162/513 | 31.6 | 118/469 | 25.2 | 145/523 | 27.7 | 193/595 | 32.4 | 189/556 | 34.0 | 0.001 | ↑ |
| ICU | 26/49 | 53.1 | 40/74 | 54.1 | 48/85 | 56.5 | 27/65 | 41.5 | 23/67 | 34.3 | 21/54 | 38.9 | 22/59 | 37.3 | 20/70 | 28.6 | < 0.001 | ↓ |
| Gentamicin non-susceptible | ||||||||||||||||||
| Wards | 52/573 | 9.1 | 33/570 | 5.8 | 36/623 | 5.8 | 38/601 | 6.3 | 26/512 | 5.1 | 26/575 | 4.5 | 33/653 | 5.1 | 31/630 | 4.9 | 0.003 | ↓ |
| ICU | 26/98 | 26.5 | 28/104 | 26.9 | 29/99 | 29.3 | 19/72 | 26.4 | 6/76 | 7.9 | 8/57 | 14.0 | 4/65 | 6.2 | 5/75 | 6.7 | < 0.001 | ↓ |
| Multiresistance | ||||||||||||||||||
| Wards | 40/552 | 7.2 | 24/569 | 4.2 | 27/622 | 4.3 | 32/598 | 5.4 | 18/502 | 3.6 | 21/571 | 3.7 | 18/644 | 2.8 | 20/630 | 3.2 | < 0.001 | ↓ |
| ICU | 18/88 | 20.5 | 19/104 | 18.3 | 25/99 | 25.3 | 17/72 | 23.6 | 6/74 | 8.1 | 6/57 | 10.5 | 4/65 | 6.2 | 3/75 | 4.0 | < 0.001 | ↓ |
| Enterococcus faecalis | ||||||||||||||||||
| Gentamicin HLR | ||||||||||||||||||
| Wards | 128/341 | 37.5 | 118/342 | 34.5 | 100/403 | 24.8 | 70/360 | 19.4 | 65/326 | 19.9 | 48/348 | 13.8 | 65/379 | 17.2 | 47/417 | 11.3 | < 0.001 | ↓ |
| ICU | 85/173 | 49.1 | 60/190 | 31.6 | 52/195 | 26.7 | 33/147 | 22.4 | 25/125 | 20.0 | 16/138 | 11.6 | 29/183 | 15.8 | 17/143 | 11.9 | < 0.001 | ↓b |
| Streptomycin HLR | ||||||||||||||||||
| Wards | 145/325 | 44.6 | 118/325 | 36.3 | 84/390 | 21.5 | 54/323 | 16.7 | 51/287 | 17.8 | 39/318 | 12.3 | 46/342 | 13.5 | 35/383 | 9.1 | < 0.001 | ↓ |
| ICU | 89/171 | 52.0 | 65/182 | 35.7 | 63/194 | 32.5 | 24/136 | 17.6 | 14/110 | 12.7 | 12/128 | 9.4 | 13/157 | 8.3 | 10/130 | 7.7 | < 0.001 | ↓d |
| Enterococcus faecium | ||||||||||||||||||
| Gentamicin HLR | ||||||||||||||||||
| Wards | 121/240 | 50.4 | 94/214 | 43.9 | 77/235 | 32.8 | 63/236 | 26.7 | 41/204 | 20.1 | 33/215 | 15.3 | 57/255 | 22.4 | 43/279 | 18.9 | < 0.001 | ↓b |
| ICU | 67/123 | 54.5 | 41/107 | 38.3 | 27/111 | 24.3 | 25/95 | 26.3 | 16/77 | 20.8 | 8/84 | 9.5 | 21/102 | 20.6 | 22/92 | 16.9 | < 0.001 | ↓b |
| Streptomycin HLR | ||||||||||||||||||
| Wards | 145/226 | 64.2 | 113/205 | 55.1 | 69/224 | 30.8 | 63/220 | 28.6 | 43/183 | 23.5 | 50/201 | 24.9 | 66/238 | 27.7 | 54/268 | 20.1 | < 0.001 | ↓b |
| ICU | 73/122 | 59.8 | 43/103 | 41.7 | 36/111 | 32.4 | 24/88 | 27.3 | 14/69 | 20.3 | 12/80 | 15.0 | 17/91 | 18.7 | 24/81 | 29.6 | < 0.001 | ↓b |
AMR: antimicrobial resistance; HLR: high-level resistance; ICU: intensive care unit; NS: non-susceptible; NS/tested: number of non-susceptible isolates for an antibiotic divided by the number of isolates tested for the respective antibiotic; WHONET-Greece: Greek electronic surveillance system for monitoring antimicrobial resistance in hospitals based on routine data.
‘↑’ and ‘↓’ indicate significant increasing and decreasing trends, respectively.
a A significant trend was only observed in the last 4 years of the study (2014–2017).
b A significant trend was only observed in the first 4 years of the study (2010–2013).
c Oxacillin non-susceptibility is used to test for meticillin resistance in S. aureus (MRSA).
d A significant non-linear trend.