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Erschienen in: BMC Infectious Diseases 1/2011

Open Access 01.12.2011 | Research article

Antibiotic resistance in primary care in Austria - a systematic review of scientific and grey literature

verfasst von: Kathryn Hoffmann, Gernot Wagner, Petra Apfalter, Manfred Maier

Erschienen in: BMC Infectious Diseases | Ausgabe 1/2011

Abstract

Background

Antibiotic resistance is an increasing challenge for health care services worldwide. While up to 90% of antibiotics are being prescribed in the outpatient sector recommendations for the treatment of community-acquired infections are usually based on resistance findings from hospitalized patients. In context of the EU-project called "APRES - the appropriateness of prescribing antibiotic in primary health care in Europe with respect to antibiotic resistance" it was our aim to gain detailed information about the resistance data from Austria in both the scientific and the grey literature.

Methods

A systematic review was performed including scientific and grey literature published between 2000 and 2010. Inclusion and exclusion criteria were defined and the review process followed published recommendations.

Results

Seventeen scientific articles and 23 grey literature documents could be found. In contrast to the grey literature, the scientific publications describe only a small part of the resistance situation in the primary health care sector in Austria. Merely half of these publications contain data from the ambulatory sector exclusively but these data are older than ten years, are very heterogeneous concerning the observed time period, the number and origin of the isolates and the kind of bacteria analysed. The grey literature yields more comprehensive and up-to-date information of the content of interest. These sources are available in German only and are not easily accessible. The resistance situation described in the grey literature can be summarized as rather stable over the last two years. For Escherichia coli e.g. the highest antibiotic resistance rates can be seen with fluorochiniolones (19%) and trimethoprim/sulfamethoxazole (27%).

Conclusion

Comprehensive and up-to-date antibiotic resistance data of different pathogens isolated from the community level in Austria are presented. They could be found mainly in the grey literature, only few are published in peer-reviewed journals. The grey literature, therefore, is a very valuable source of relevant information. It could be speculated that the situation of published literature is similar in other countries as well.
Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2334-11-330) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

KH and GW performed the literature search; KH performed the extraction of the data and drafted the initial manuscript, GW helped with the extraction of the grey literature data; MM conceptualized the study and helped with data interpretation; PA and MM critically revised the manuscript for important content. All authors read and approved the final manuscript.

Background

The increasing prevalence of antibiotic resistance (AR) is one of the major challenges for the healthcare systems worldwide. Antibiotic resistant infections are associated with a 1.3 to 2-fold increase in mortality compared to antibiotic susceptible infections [1]. If antibiotics become ineffective, infectious diseases will lead to an increase in morbidity and eventually premature mortality [24]. Moreover, AR imposes enormous health expenditure from higher treatment costs and longer hospital stays [510]. In addition, the development of new generations of antibiotic drugs is stalling [11]. Therefore, restrictive and appropriate use of antibiotics is even more needed to ensure the availability of effective treatment of bacterial infections. While up to 90% of antibiotics are being prescribed to patients in the outpatient sector existing information on the antibiotic resistance pattern is, with exceptions, based on samples from hospitalized patients [12]. Excessive use of antibiotics by humans, mainly due to antibiotic overtreatment of viral infections and in livestock breeding has led to a large output of resistant bacteria into the environment, where resistant bacteria and resistance genes can disseminate [13, 14]. And indeed, the highest bacterial resistances rate was found where antibiotics are used most [12].
Two European initiatives provide valuable information on the topic "antibiotic resistance" in Austria: EARS-Net (formerly EARSS, European Antimicrobial Resistance Surveillance System) [15] and ESAC (European Surveillance of Antimicrobial Consumption) [16]. EARS-Net e.g. performs a continuous surveillance of antimicrobial susceptibility on the basis of laboratory analyses of invasive, blood-culture derived isolates from hospitalized patients. However, the antibiotic resistance pattern of the microbial flora of hospitalized patients differs from that seen in the community and, in addition, the resistance pattern of bacteria in routine primary health care is usually only tested after initial treatment failure [17]. Guidelines for prescribing antibiotics to patients at a community level should, therefore, be based on empirical and up to date evidence about antibiotic resistance of bacteria circulating in the community. Ideally, continuous surveillance of resistance patterns and antibiotic consumption in the outpatient setting should be carried out to detect changes.
In the year 2010 an EU-project called "APRES - the appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance" started in nine European countries including Austria. One aim of this cross-sectional project is a systematic analysis of antibiotic resistance pattern of two key-bacteria at the community level. The analysis should be the basis for specific regional and national recommendations concerning the antibiotic prescribing behaviour of physicians in primary health care.
In the context of this EU-study we have undertaken a systematic literature review of all scientific papers and also of grey and non-English literature concerning the resistance pattern for the primary care sector in Austria in order to summarize existing facts and knowledge. It was our aim to assess strengths and weaknesses of the resistance situation at the community level described for Austria and to identify the sources and origin of the data published.

Methods

Study selection

A systematic literature review was performed of all available literature published between the 1st of January 2000 and the 31st January 2011. For the review process we followed the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses) statement [18] as it is described in the additional file 1. Three necessary inclusion criteria for the relevant literature were defined: First, the content has to deal with antibiotic resistance. Second, the resistance data have to be sampled in the ambulatory or community sector in humans and third, in Austria. We searched the scientific literature as well as the grey literature.
All types of indexed scientific literature were included. The bacteria included were Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae for the respiratory tract, Escherichia coli, Proteus mirabilis, Klebsiella spp., Staphylococcus saphrophyticus for the urinary tract and Staphylococcus aureus. Literature containing resistance data from the hospital setting only and the literature not describing the origin either from hospital or primary care setting of the samples were excluded. The language of the literature included was English and German.
For the specification of the "grey" literature we used the definition of the Luxembourg Convention on Grey Literature: "Grey literature is that which is produced on all levels of government, academics, business, and industry in print and electronic formats but which is not controlled by commercial publishers." [19] Essentially, grey literature includes documents that have not been formally published in a peer-reviewed indexed format.
The literature search via electronic searches as well as the review process was carried out by two researchers (KH and GW) for the inclusion and exclusion criteria. Disagreement within the review process was resolved by discussion with the fourth author (MM).

Search strategy

The literature search was performed during the period from April 1, 2010 until March 29, 2011.
For the scientific literature the databases and search engines PubMed, Medline and Embase were used. Search terms were the MeSH (Medical Subject Headings) terms "primary health care" OR "ambulatory care" AND "drug Resistance, Bacterial" AND "Austria" which were combined with the search terms "antibiotic resistance" OR "antimicrobial resistance", "primary care" OR "outpatient" OR "general practice" OR "community", in different combinations. According to the terms in English we used the corresponding German terms "Antibiotika", "Resistenzen", "Allgemeinmedizin", "niedergelassener Bereich" and "Österreich". Additionally, manual searches of the references of relevant articles including reviews were performed.
The search strategy for the grey literature was conducted via the search engines Google (http://​www.​google.​at) and Google Scholar (http://​scholar.​google.​at); in addition a systematic search on websites of institutions and organizations dealing with the sampling and determination of bacteria like regional laboratories for infectious diseases, reference centres or organizations that are responsible for public health like the Ministry of Health and linked facilities was performed. The search terms used were the same as for the scientific literature.
The exclusion process for the scientific literature was a three step process. The first step was the rejection of the duplicates, followed by the exclusion due to screening the title and abstract of papers identified; in the third step the papers were excluded by reading the full text of the papers, each of which was independently reviewed for eligibility. The exclusion process for the grey literature was performed as a three step process too by reading the "Google" title of the link and the short description first, followed by reading the full text of the relevant literature.
Finally, we allocated the literature that met all inclusion criteria into a "high quality" group (reports, government documents, recommendations of Austrian Societies, publications not published in an indexed journal) with respect to the method section described in this literature and a "low quality group" (interviews, official invitations, meeting notes) as recommended by Dobbins et al [20]. Only the "high quality" grey literature was included into this review.

Data extraction

The outcome data extracted were: Numbers and characteristics of the included studies, bacteria types described, sampling location in Austria and general antibiotic resistance findings. Further, the sources of the data were documented.

Results

After the rejection of the duplicate papers a total of 82 potential scientific papers were identified of which 9 were excluded on the basis of the year published and 40 were excluded after reading the abstract and title. Further 16 papers were excluded after reading the full text. Most of the papers were excluded because the reported incidence of resistance data was exclusively from the hospital sector in Austria (EARS-Net) or other countries than Austria. Seventeen papers were included into the final review. Figure 1 shows the "PRISMA Flow Diagram" for the scientific literature results [18]. The grey literature search strategy yielded e.g. 3,840 potential relevant links on March, 29 2011 by using the combination of the search terms "Antibiotikaresistenzen" AND "Österreich" AND "niedergelassener Bereich" in Google.at. After the three step review procedure 23 high quality publications remained of which 21 are resistance reports (19 regional reports from different years published between 2002 and 2011 and two national reports of the years 2008 and 2009). Most of the excluded literature enunciated treatment recommendations of infectious diseases for the ambulatory sector by referencing to data from the hospital sector.
Table 1 summarizes the basic characteristics and selected resistance findings of the final 17 scientific papers. Nine [2129] out of the 17 scientific papers describe the resistance pattern of certain bacteria for the ambulatory sector only by referencing to four data sources, the Alexander-Project [22, 27], the PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) surveillance study [21, 23, 25], the ECO-SENS (International Survey of the Antimicrobial Susceptibility of Urinary Pathogens) project [24, 26, 29] and the ARESC (Antimicrobial Resistance Epidemiological Survey on Cystitis) study [28]. Eight of these nine publications describe the resistance situation in Austria before the year 2001. The reported resistance patterns of the analysed bacteria in the other publications are based on isolates from both the hospital and the outpatient sector in different proportions.
Table 1
Basic characteristics and general resistance findings of the final 17 scientific papers (in alphabetical order)
Author
Sampling
setting and report of results
Sampling location
Years of resistance testing
Total no. of isolates (Austria)
Bacteria
Antibiotics
General Resistance findings
Auer et al 2010 [30]
Hospital (2%) and primary health care (98%) - results reported together
Salzburg, Upper Austria, Styria (Austria)
2004-2008
100
ESBL-producing E. coli
FOF, MEL, ETP, NIT, SXT, GEN, CIP
3% FOF, 6% NIT, 15% MEL, 0% ETP, 22% GEN, 73% SXT, 78% CIPa
Badura et al 2007 [37]
Hospital and primary health care- results reported together
Southeast Austria
1997-2006
690,967 collectively
E. coli, S. aureus, Klebsiella spp.
Various for each bacteria
The data show insignificant changes in prevalence of MRSA and vancomycin-resistant enterococci in southeast Austria during the past decade (1997-2006) but an alarming increase of ESBL-producing E. coli isolates in recent years.
Buxbaum et al 2003 [32]
Hospital and primary health care- results reported together
Austria
2001-2002
542
S. pneumoniae,
PEN, TEL, ERY, CLR,
2.2% PEN, 0% TEL, 8.5% ERY, 10.3% CLR, 7% AZM
    
223
S. pyogenes,
same
0% PEN, 0% TEL, 8% ERY, 6.7% CLR, 8.1% AZM
    
183
S. aureus,
same
73.2% PEN, 2.2 TEL, 17% ERY, 16.4% CLR, 16.4% AZM
    
67
H. influenzae
AMP instead of PEN
1.5% AMP, 0% TEL, ERY, CLR, AZM
Canton et al 2002 [21]
Primary health care
25 countries worldwide incl. Austria
1999-2000
25
S.pyogenes,
ERY, LVX, PEN, TEL
No special results for Austria. But compared to the other countries Austria had one of the lowest resistance rates.
    
20
S.aureus
TEL
0% TEL
Cizman 2003 [22]
Primary health care
21 countries in Europe incl. Austria
1997-1999
1997-2000
n/a
H. influenzae,
PEN
The antibiotic resistance rates were set in correlation with the mean national outpatient consumption. Compared to the other countries Austria had a low total outpatient consumption of 13.80 DDD/1000 inhabitants/day in 1997 and a penicillin resistance rate of S. pneumoniae of 12.4%. With the consumption of macrolides Austria was ranked in the middle field with a resistance rate for S. pneumoniae of 11.4%.
     
S. pneumoniae,
PEN, ERY
 
     
S. pyogenes
ERY
 
Felmingham et al 2002 [23]
Primary health care
25 countries worldwide incl. Austria
1999-2000
57
S. pneumoniae
PEN, ERY
5.3% PEN, 12.3% ERY
Compared to the other countries Austria had one of the lowest resistance rates.
Graninger 2003 [24]
Primary health care
16 European countries incl. Austria and Canada
1999-2000
n/a
E. coli
n/a
The publication highlights the effectiveness of MEL compared to other antibiotics
Hoban et al 2002 [25]
Primary health care
25 countries worldwide incl. Austria
1999-2000
40
19
H.influenzae
M. catarrhalis
n/a
2.5% ß-lactamase +
89.5% ß-lactamase +
Hönigl et al 2010 [33]
Hospital (63%) and primary health care (37%)- results reported together
Southeast Austria
1997-2008
1997: (n = 113) 2008: (n = 218)
S. pneumoniae
PEN, ERY, CLI, TET, SXT, quinolones
1997: 3.5% ERY, 1.8% CLI, 1.8% TET, 7.1% SXT, 0.9% QUIN
2008: 14.7% ERY, 10.6% CLI, 11% TET, 9.2% SXT, 0.5% quinolones
Kahlmeter 2003 [26]
Primary health care
17 countries in Europe incl. Austria
1999-2000
126
E. coli
AMP, AMC, MEC,
CFR, TMP, SUL, SXT, NAL, CIP, NIT, FOF, GEN
Compared to the other 16 European countries Austria had one of the lowest resistance rates for E. coli: 17.5% AMP, 2.4% AMC, 1.6% MEC, 0.8% CFR, 9.5% TMP, 25.4% SUL, 9.5% SXT, 2.4% NAL, 0% CIP, 0.8% NIT, 0% FOF, 0.8% GEN
Kahlmeter et al 2003 [29]
Primary health care
17 countries in Europe including Austria
1999-2000
126
E. coli
AMP, AMC, MEC,
CFR, TMP, SUL, SXT, NAL, CIP, NIT, FOF, GEN
17.5% AMP, 2.4% AMC, 1.6 MEC, 0.8% CFR, 9.5% TMP, 25.4 SUL, 9.5% SXT, 2.4% NAL, 0% CIP, 0.8% NIT, 0% FOF, 0.8 GEN
Krziwanek et al 2008 [35]
Hospital and primary health care- results reported together
Austria
1996-2006
1,439
MRSA
n/a
In Carinthia, 73% of all MRSA belonged to ST228. In the Austrian region "Salzkammergut", the proportion of ST5 increased from 26% in 2004 to 89% in 2006. In eastern Upper Austria and western Lower Austria, the ST8 Austrian clone was predominant.
Krziwanek et al 2009 [36]
Hospital and primary health care- results reported together
Upper Austria
2006-2008
1,098
MRSA
n/a
Out of the 1,098 MRSA samples from humans, 21 were MRSA type ST398 that is usually associated with animals. Most of these 21 patients were farmers (n = 16). Increasing prevalence from 1.3% in 2006 to 2.5% in 2008 shows emergence of MRSA ST398 in humans in Austria.
Prelog et al 2008 [31]
Hospital and primary health care- results reported together
Western Austria
2006
2,042
E. coli
n/a
20 out of the 2,042 E. coli isolates demonstrated alleles encoding CTX-M enzymes belonging to phylogentic group 1.
Schito et al 2000 [27]
Primary health care
14 countries in Europe incl. Austria
1992-1998
185
S. pneumoniae
PEN, ERY
4.8% PEN, 11.4%
    
153
H. influenzae
DOX, SXT, CIP
1.3% DOX, 13.7% SXT, 0.0% CIP
    
n/a
M. catarrhalis
n/a
 
Schito et al 2002 [34]
Hospital and primary health care- results reported together
Italy, Spain, Austria
1999-2000
3,593 collectively in all three countries
S. pneumoniae,
M. catherrralis,
H. influenzae
K. pneumoniae
S. pyogenes,
S. aureus
AMP, AMC, CEC, CXM, CFM, CTB, CPD, AZM, CLR
for all bacteria
The results show a substantial prevalence of macrolide resistance of the bacteria analysed in Italy, Spain and Austria.
Schito et al 2009 [28]
Primary health care
9 European countries including Austria and in addition Brazil
2003-2006
3,018 collectively in all nine countries
E. coli, K. pneumoniae, P. mirabilis, S. saphrophyticus
AMP, AMC, MEC, CFX, NAL, CIP, SXT, NIT, FOF
Mean resistance rates for E.coli between 2003 and 2006 for Austria were e.g.: 48.3% AMP 8.1% NAL and 29.0% SXT. Compared to the other countries Austria with 48.3% resistance against AMP had one of the highest resistance rates; against the other antibiotics one of the lowest rates.
Abbr.: FOF, fosfomycin; MEL, pivmecillinam; ETP, ertapenem; NIT, nitrofurantoin; GEN, gentamicin; SXT, trimethoprim-sulfamethoxazole; CIP, ciprofloxacin; PEN, penicillin; ERY, erythromycin; CLI, clindamycin; TET, tetracycline; AMP, ampicillin; AMC, co-amoxiclav; MEC, mecillinam; CFR, cefadroxil; TMP, trimethoprim; SUL, sulfamethoxazole; NAL, nalidixic acid; DOX, doxycyclin; CXM, cefuroxime; CEC, cefaclor; CFM, cefixime; CTB, ceftibuten; CPD, cefpodoxime; AZM, azithromycin; CLR, clarithromycin; LVX, levofloxacin
n/a: Data not described in the publication
a: Resistance data include intermediate susceptible isolates
Six articles show the resistance pattern of E. coli, ESBL-producing E. coli and other bacteria related to community-acquired uncomplicated urinary tract infections [24, 26, 2831], eight the resistance pattern of the bacteria included for community-acquired respiratory tract infections [2123, 25, 27, 3234], further two are dealing with the MRSA situation in Austria [35, 36] and one article is a "letter to the editor" with an overview of multiple bacteria [37]. No overall conclusion of the current resistance situation in the ambulatory sector in Austria can be gathered out of these different studies due to the differences in sampling settings, inclusion and exclusion criteria of the study population, time periods, bacteria analysed and the methodology used. Moreover, the determination of the resistance rates in Austria was conducted using the CLSI (Clinical and Laboratory Standards Institute) standard. Within this standard there has been a change in the antimicrobial MIC breakpoint in 2008 which means that most data before and after 2008 are not comparable [38].
Tables 2 and 3 summarize the basic characteristics and selected resistance findings of the 23 high quality grey literature documents of which only the isolates from the primary health care sector included into the reports are described. The resistance findings included are contained in several reports and their updates since the year 2008 separately for the ambulatory and the hospital sector. The key-bacteria analysed for the urinary and respiratory tract are the same among the reports. The Austrian resistance reports (AURES) of the years 2008 and 2009 e.g. include the chapter "Resistance report for selected non-invasive microbial pathogens" which summarize the data from the ambulatory sector of several large microbiology laboratories from all over Austria; a change in the resistance pattern of the bacteria included can be observed in certain regions over several years (table 3). While the change in the CLSI standard in 2008 has to be considered for these resistance reports as well the overall resistance situation in the primary care sector in Austria for e.g. E. coli is summarized as following: "The percentage of the ESBL-producing E. coli is with 6% stable over the last two years in the primary care sector. The highest antibiotic resistance rates for E. coli and ESBL-producing E. coli can be seen with fluorochinolones (19%/85%) and trimethoprim/sulfamethoxazole (27%/82%)."[39]
Table 2
Basic characteristics of the 23 high quality grey literature documents
Editor
Title
Sampling
setting and report of the results
Sampling location
Tested bacteria
Years of sampling and resistance testing
Bundesministerium f. Gesundheit Österreich
Österreichischer Resistenzbericht AURES 2009 [39]
Hospitals and primary health care sector - results reported separately
Austria
S. pyogenes, S. Pneumoniae
H.influenzae
E. coli, P. mirabilis,
S. aureus
One year before the publication
 
Österreichischer Resistenzbericht AURES 2008 [61]
    
Abt. f. Mikrobiologie,
Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG
Resistenzreport 2009
Zusammenfassung der lokalen Resistenzdaten [62]
The majority of isolates was collected in the primary health care sector but some isolates were collected in hospitals and residencies as well - results reported partly separate since 2009
Salzburg, Upper Austria, Upper Styria (Austria)
S. pyogenes, S. pneumoniae
H. influenzae
E. coli, P. mirabilis,
S. aureus
One year before the publication
 
Resistenzreport 2008
Zusammenfassung der lokalen Resistenzdaten [63]
    
 
Resistenzbericht 2007 [64]
    
 
Resistenzbericht 2006 [65]
    
 
Resistenzbericht 2005 [66]
 
Salzburg (Austria)
  
 
Resistenzbericht 2004 [67]
    
 
Resistenzbericht 2003 [68]
    
 
Resistenzbericht 2002 [69]
    
Institut f. Hygiene, Mikrobiologie und Umweltmed.
Med. Univ. Graz, Labor für Med. Bakteriologie und Mykologie
Resistenzbericht 2010 [70]
Isolates from primary health care (50%) and from secondary and tertiary care sector (50%) - results reported partly separate
Styria (Austria)
S. pyogenes, S. pneumoniae
H. influenzae
E. coli, P. mirabilis,
S. aureus
One year before the publication
 
Resistenzbericht 2009 [71]
    
 
Resistenzbericht 2008 [72]
    
Bakterielles Labor des LKH Leoben
Resistenzbericht 2009 aus dem Einsendegut des Bakt. Labors im LKH Leoben [73]
Hospitals (90%) and primary health care (10%) - results reported partly separate since 2007
Upper Styria (Austria)
S. pyogenes, S. pneumoniae
H. influenzae
E. coli, P. mirabilis,
S. aureus
One year before the publication
 
Resistenzbericht 2007 aus dem Einsendegut des Bakt. Labors im LKH Leoben [74]
    
 
Resistenzbericht 2006 aus dem Einsendegut des Bakt. Labors im LKH Leoben
    
 
Resistenzbericht 2005 aus dem Einsendegut des Bakt. Labors im LKH Leoben [75]
    
 
Resistenzbericht 2004 aus dem Einsendegut des Bakt. Labors im LKH Leoben [76]
    
 
Resistenzbericht 2003 aus dem Einsendegut des Bakt. Labors im LKH Leoben [77]
    
Sekt. Hygiene u. Med. Mikrobiologie u.
Univ. Klinik für Innere Med. I, Klin. Infektiologie u. Immunologie
Med. Univ. Innsbruck
Resistenzbericht 2009. Resistenzverhalten von Bakterien und Pilzen gegen Antibiotika und Antimykotika [78]
Primary, secondary and tertiary health care - results reported separately
Tyrol (Austria)
S. pyogenes, S. pneumoniae
H.influenzae
E. coli, P. mirabilis,
S. aureus
One year before the publication
 
Resistenzbericht 2008. Resistenzverhalten von Bakterien und Pilzen gegen Antibiotika und Antimykotika [79]
    
Hell 2010 [80]
ESBL-producing E.coli in uncomplicated UIT - regional and Austria-wide update and evaluation of treatment options
Primary health care
Austria
ESBL-producing E. coli
2004-2008
Grisold 2011 [81]
Das Antibiogramm: Indikation - Interpretation - Qualität
Hospitals and primary health care sector - results reported separately
Styria (Austria)
ESBL-producing E. coli
n/a
Table 3
Selected resistance findings from the ambulatory sector only of the most up-to-date grey literature included
Location
Pathogen
Tested isolates
Antibiotics
Resistance in %
Additional information
2009 and 2008 AURES [39, 61]Bundesministerium f. Gesundheit Österreich
  
2008
2009
 
2008
2009
2008
2009
Respiratory tract
S. pyogenes
977
1,440
PEN
0
0
  
  
1,436
1,433
macrolides
3.6
3.3
  
  
1,438
1,356
fluoroquinolones
0.7
0.3
  
 
S. pneumoniae
510
454
PEN
0.8
1.8
  
  
510
454
macrolides
14.5
13.4
  
  
506
455
fluoroquinolones
0.8
0.2
  
 
H. influenzae
1,244
1,255
AMP or AMX
9.4
9.6
  
  
1,244
1,255
AMC
0
0.1
  
  
1,244
1,234
fluoroquinolones
0.2
0
  
All locations
S. aureus
2,395
3,970
OXA
2.4
2.1
MRSA
2.4%
MRSA
2.1%
  
2,994
3,746
macrolides
14.5
14.9
  
  
3,045
3,757
CLI
6.9
9.7
  
  
3,277
3,547
SXT
0,8
0.6
  
  
1,633
3,886
fluoroquinolones
3.8
3.6
  
Urinary tract
E coli
8,992
11,218
AMP or AMX
39.8
43.9
ESBL
6.0%
ESBL
6.4%
  
8,985
11,219
AMC
5.8
9.2
  
  
9,088
11,107
cephalosporin 1st
8.5
9.7
  
  
8,992
11,225
SXT
24.6
27.5
  
  
8,992
11,241
fluoroquinolones
15.7
18.8
  
  
8,789
10,738
NIT
2.2
2.7
  
  
4,361
4,893
MEL
12.2
6.8
  
  
5,489
7,799
FOF
1.5
2.3
  
 
P.mirabilis
n/a
n/a
     
Location
Pathogen
Tested isolates
Antibiotics
Resistance in %
Additional information
2010 Medical University Graz, Department for Hygiene and Microbiology [70]
Respiratory tract
S. pyogenes
n/a
     
 
S. pneumoniae
n/a
     
 
H. influenzae
n/a
     
 
S. aureus
444
OXA
2.5
MRSA
2.5%
  
441
SXT
0
  
  
434
CIP
3
  
  
444
ERY
14.9
  
  
444
CLI
13.7
  
Urinary tract
E. coli
3,907
AMX
61.4
ESBL
7.4%
  
3,907
AMC
37.5
  
  
3,902
CFX
6.3
  
  
3,907
TMP
27.6
  
  
3,907
SXT
27.2
  
  
3,881
FOF
0.8
  
  
3,907
CIP
18.5
  
  
3,905
NIT
0.4
  
2009 Laboratory Dr Richter and Dr Mustafa, Section for Microbiology, Salzburg [62]
Respiratory tract
S. pyogenes
n/a
     
 
S. pneumoniae
n/a
     
 
H. influenzae
n/a
     
Skin and soft tissue
S. aureus
938
OXA
3
MRSA
3%
  
938
AMC
3
  
  
938
CFX
3
  
  
938
ERY
13
  
  
938
CLIN
3
  
  
938
SXT
1
  
  
938
MXF
3
  
Urinary tract
E. coli
2,506
AMP
40
ESBL
4%
  
2,506
AMC
6
  
  
2,506
CFX
6
  
  
2,506
SXT
26
  
  
2,499
NIT
1
  
  
2,506
CIP
16
  
  
2,504
FOF
1
  
 
P. mirabilis
n/a
     
2009 Medical University Innsbruck, Section for Hygiene and Medical Microbiology [78]
Respiratory tract
S. pyogenes
187
PEN
0
  
  
187
AZM
5.8
  
  
187
MXF
2.1
  
 
S. pneumoniae
115
PEN
0
  
  
115
AZM
12.1
  
  
115
MXF
0.87
  
 
H. influenzae
76
AMP
25
  
  
76
AMC
0
  
  
76
MXF
0
  
All locations
S. aureus
676
FOX
1.48
MRSA
6%
  
610
AZM
20.9
  
  
610
CLIN
18
  
  
674
SXT
1.03
  
  
609
MXF
1.97
  
Urinary tract
E. coli
3,112
AMP
58
ESBL
9%
  
3,104
AMC
20
  
  
3,101
CFZ
17
  
  
3,112
SXT
33
  
  
3,112
CIP
26
  
  
3,097
MEC
7
  
  
3,111
NIT
7
  
2009 County Hospital Leoben, Bacteriological Laboratory [73]
    
Respiratory tract
S. pyogenes
n/a
     
 
S. pneumoniae
n/a
     
 
H. influenzae
n/a
     
 
S. aureus
141
AMC
1.4
  
  
141
OXA
1.4
  
  
141
CFZ
1.4
  
  
140
CLIN
11.4
  
  
140
ERY
12.1
  
  
140
CIP
0.7
  
Urinary tract
E. coli
310
AMP
41
  
  
310
AMC
10
  
  
310
CFZ
10.0
  
  
309
TMP
29.5
  
  
310
CIP
20,0
  
  
309
NIT
1.9
  
  
27
MEC
11.1
  
 
P. mirabilis
28
AMC
10.7
  
  
28
CFZ
17.9
  
  
28
TMP
53.6
  
  
28
CIP
17.9
  
Hell [80]
        
Urinary tract
E. coli
ESBL-producing
100
MEC
11
  
  
100
FOF
3
  
  
100
NIT
1
  
  
100
SXT
73
  
  
100
CIP
78
  
Abbr.: FOF, fosfomycin; MEL, pivmecillinam; NIT, nitrofurantoin; SXT, trimethoprim-sulfamethoxazole; CIP, ciprofloxacin; PEN, penicillin; ERY, erythromycin; CLI, clindamycin; AMP, ampicillin; AMX, amoxicillin; AMC, amoxicillin/clavulanate; MEC, mecillinam; TMP, trimethoprim; SUL, sulfamethoxazole; AZM, azithromycin; CFZ, cefazolin; FOX, cefoxitin; OXA, oxacillin; MXF, moxifloxacin
n/a: Resistance data of isolates from primary care alone not available
All resistance reports included are published in German only and on special websites.

Discussion

This review provides the most comprehensive and up to date information on the pattern of AR at the community level in Austria. This has been achieved by a thorough search of both the scientific and grey literature.
Our analysis shows that the seventeen scientific publications included describe only a small part of the resistance situation in the primary health care sector in Austria (table 1). Half of these publications contain data from the ambulatory sector only but are older than ten years. Moreover, the included scientific literature is very heterogeneous concerning the observed time period, the number and origin of the isolates and the kind of bacteria analysed.
In contrast, the grey literature yields more substantial information on the content of interest (tables 2 and 3). Mainly the "resistance reports" (Resistenzberichte) contain comprehensive and up-to-date resistance data from the ambulatory level. Since 2008, the AURES report in particular is the only source which provides comprehensive, structured and nationwide data on a yearly basis from isolates obtained exclusively at the primary care sector. The resistance situation described can be summarized as rather stable over the last two years. A comparison of the resistance situations can be drawn on a regional and on a national level (table 3). This literature is at the moment the best available source of ambulatory resistance data; however, the data are not covering all regions of Austria. Further, the reports are available in German only, are accessible on certain specific websites only and are not published in indexed journals. Therefore, it is nearly impossible for someone who cannot speak German or is not familiar with the website address to find a comprehensive source of information about the current resistance situation in the primary health care sector in Austria. Moreover, the methodology for the determination of resistance differs between Austrian counties and European countries which, hopefully, will improve due to the EUCAST (European Committee on Antimicrobial Susceptibility Testing) efforts to harmonize the MIC breakpoints for antimicrobial susceptibility testing of bacteria in Europe [40]. This could be an obstacle for comparative studies which are based on systematic literature searches from different countries or for finding adequate sources to describe the status quo in Austria. Unfortunately, the results from the promising international studies (Alexander project and PROTEKT study)[41] of the years 1999 and 2000 that dealt with the resistance pattern of bacteria responsible for community-acquired infections of the respiratory tract have not been translated into regular national or international surveillance systems.
In contrast, comprehensive and current antibiotic resistance data from the hospital sector or outpatient antibiotic consumption data in Austria are easy to find in the scientific literature due to the longstanding partnership of Austria with the EARS-Net and ESAC network. These standardized data were collected nationwide and published regularly [42, 43]. This could be the reason that, at the moment, all recommendations available for the treatment of community-acquired infectious diseases for the primary health care sector still are based on resistance data derived from the hospital sector [44]. Examples are the brochure of the Austrian Antibiotic Stewardship Group (ABS) for the ambulatory sector or the latest expert consensus of the Austrian Society of Infectious Diseases concerning Antibiotic treatment in primary health care [45, 46]. It should be mentioned that first steps towards a resistance-register for non-invasive isolates from the primary health care sector in Austria are already under way. The collection and reporting of non-invasive isolates and their resistances in the regional and the national resistance reports in a structured and systematic way could be the starting point. Also the ABS group is advancing this issue [47, 48].
The strengths of this review are its focus on the outpatient setting in Austria and its comprehensiveness by the inclusion of both the scientific and the grey literature. In fact, for our purpose the data contained in the grey literature prove very valuable in achieving our aim of comprehensiveness and reduces publication and selection bias. It could be speculated that the situation of published literature is similar in other countries as well. However, recent studies have examined the impact of the inclusion of the grey literature in systematic reviews to describe the status quo of a situation in more detail [4951]. Especially, since a Cochrane update was published in 2004 to highlight the importance of widespread literature search strategies for public health interventions including the grey literature for systematic reviews [52] the number of reviews which include grey literature is growing constantly in many health related sectors [5360].
The limitations of this literature review are the reliance on previously published research results. Even more difficult is the reliance on the grey literature found due to the non hierarchic search results with the search engine Google. Moreover, in this review we compared the scientific and the grey literature and draw conclusions on their comprehensiveness and on the public health relevance of their content. Since the scientific papers were independently peer-reviewed and the grey literature was published by organizations without that review process this may affect the methodological quality and therefore, the scientific level of evidence. In addition, it is not possible to directly compare the resistance data described in the scientific and grey literature: in the scientific literature the resistance data are mainly analysed for specific diseases like e.g. uncomplicated urinary tract infections in a defined group of patients, in the grey literature the resistance data reported are the result of all isolates analysed for one specific bacterium regardless of a given disease.

Conclusion

In this review, comprehensive and up-to-date antibiotic resistance data of different pathogens, isolated from the primary care level in Austria, are presented. They could be found mainly in the grey literature, only few are published in peer-reviewed journals. The grey literature, therefore, is a very valuable source of relevant information and might reveal possibilities for further research.
Based on these findings we recommend collecting and publishing also the non-invasive resistance findings on a regular basis in indexed journals like it is done in the EARS-Net and ESAC network.

Acknowledgements and Funding

This work was financially supported in part by the Seventh EU Framework Programme "APRES - The appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance" (grant agreement number 223083).
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

KH and GW performed the literature search; KH performed the extraction of the data and drafted the initial manuscript, GW helped with the extraction of the grey literature data; MM conceptualized the study and helped with data interpretation; PA and MM critically revised the manuscript for important content. All authors read and approved the final manuscript.
Anhänge

Authors’ original submitted files for images

Below are the links to the authors’ original submitted files for images.
Literatur
1.
Zurück zum Zitat Cosgrove SE, Carmeli Y: The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003, 36 (11): 1433-1437. 10.1086/375081.CrossRefPubMed Cosgrove SE, Carmeli Y: The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003, 36 (11): 1433-1437. 10.1086/375081.CrossRefPubMed
2.
Zurück zum Zitat Livermore DM: Bacterial resistance: origins, epidemiology, and impact. Clin Infect Dis. 2003, 36 (Suppl 1): 11-23.CrossRef Livermore DM: Bacterial resistance: origins, epidemiology, and impact. Clin Infect Dis. 2003, 36 (Suppl 1): 11-23.CrossRef
3.
Zurück zum Zitat Levy SB: Antibiotic resistance-the problem intensifies. Adv Drug Deliv Rev. 2005, 57 (10): 1446-1450. 10.1016/j.addr.2005.04.001.CrossRefPubMed Levy SB: Antibiotic resistance-the problem intensifies. Adv Drug Deliv Rev. 2005, 57 (10): 1446-1450. 10.1016/j.addr.2005.04.001.CrossRefPubMed
5.
Zurück zum Zitat Cosgrove SE: The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006, 42 (Suppl 2): S82-89.CrossRefPubMed Cosgrove SE: The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006, 42 (Suppl 2): S82-89.CrossRefPubMed
6.
Zurück zum Zitat Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA: Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrob Agents Chemother. 2009, 54 (1): 109-115.CrossRefPubMedPubMedCentral Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA: Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrob Agents Chemother. 2009, 54 (1): 109-115.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Klugman KP: Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis. 2005, 5 (8): 481-493. 10.1016/S1473-3099(05)70189-4.CrossRefPubMed Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Klugman KP: Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis. 2005, 5 (8): 481-493. 10.1016/S1473-3099(05)70189-4.CrossRefPubMed
8.
Zurück zum Zitat Okeke IN, Klugman KP, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Laxminarayan R: Antimicrobial resistance in developing countries. Part II: strategies for containment. Lancet Infect Dis. 2005, 5 (9): 568-580. 10.1016/S1473-3099(05)70217-6.CrossRefPubMed Okeke IN, Klugman KP, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Laxminarayan R: Antimicrobial resistance in developing countries. Part II: strategies for containment. Lancet Infect Dis. 2005, 5 (9): 568-580. 10.1016/S1473-3099(05)70217-6.CrossRefPubMed
9.
Zurück zum Zitat Smith RD: Assessing the macroeconomic impact of a healthcare problem: the application of computable general equilibrium analysis to antimicrobial resistance. Journal of Health Economics. 2005, 24: 1055-1075. 10.1016/j.jhealeco.2005.02.003.CrossRefPubMed Smith RD: Assessing the macroeconomic impact of a healthcare problem: the application of computable general equilibrium analysis to antimicrobial resistance. Journal of Health Economics. 2005, 24: 1055-1075. 10.1016/j.jhealeco.2005.02.003.CrossRefPubMed
10.
Zurück zum Zitat Mossialos E, Morel CM, Edwards S, Berenson J, Gemmill-Toyama M, Brogan D: Policies and incentives for promoting innovation in antibiotic research. 2010, WHO, Copenhagen Mossialos E, Morel CM, Edwards S, Berenson J, Gemmill-Toyama M, Brogan D: Policies and incentives for promoting innovation in antibiotic research. 2010, WHO, Copenhagen
11.
Zurück zum Zitat Kaplan W, Laing R: Priority medicines for Europe and the World. 2004, WHO, Geneva Kaplan W, Laing R: Priority medicines for Europe and the World. 2004, WHO, Geneva
12.
Zurück zum Zitat Goossens H, Ferech M, Vander Stichele R, Elseviers M: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005, 365 (9459): 579-587.CrossRefPubMed Goossens H, Ferech M, Vander Stichele R, Elseviers M: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005, 365 (9459): 579-587.CrossRefPubMed
13.
Zurück zum Zitat Murray BE: Problems and dilemmas of antimicrobial resistance. Pharmacotherapy. 1992, 12 (6 Pt 2): 86S-93S.PubMed Murray BE: Problems and dilemmas of antimicrobial resistance. Pharmacotherapy. 1992, 12 (6 Pt 2): 86S-93S.PubMed
14.
Zurück zum Zitat Summers AO: Generally overlooked fundamentals of bacterial genetics and ecology. Clin Infect Dis. 2002, 34 (Suppl 3): 85-92.CrossRef Summers AO: Generally overlooked fundamentals of bacterial genetics and ecology. Clin Infect Dis. 2002, 34 (Suppl 3): 85-92.CrossRef
15.
Zurück zum Zitat Bronzwaer SL, Goettsch W, Olsson-Liljequist B, Wale MC, Vatopoulos AC, Sprenger MJ: European Antimicrobial Resistance Surveillance System (EARSS): objectives and organisation. Euro Surveill. 1999, 4 (4): 41-44.PubMed Bronzwaer SL, Goettsch W, Olsson-Liljequist B, Wale MC, Vatopoulos AC, Sprenger MJ: European Antimicrobial Resistance Surveillance System (EARSS): objectives and organisation. Euro Surveill. 1999, 4 (4): 41-44.PubMed
16.
Zurück zum Zitat Vander Stichele RH, Elseviers MM, Ferech M, Blot S, Goossens H: European surveillance of antimicrobial consumption (ESAC): data collection performance and methodological approach. Br J Clin Pharmacol. 2004, 58 (4): 419-428. 10.1111/j.1365-2125.2004.02164.x.CrossRefPubMedPubMedCentral Vander Stichele RH, Elseviers MM, Ferech M, Blot S, Goossens H: European surveillance of antimicrobial consumption (ESAC): data collection performance and methodological approach. Br J Clin Pharmacol. 2004, 58 (4): 419-428. 10.1111/j.1365-2125.2004.02164.x.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Magee JT, Pritchard EL, Fitzgerald KA, Dunstan FD, Howard AJ: Antibiotic prescribing and antibiotic resistance in community practice: retrospective study, 1996-8. BMJ. 1999, 319 (7219): 1239-1240.CrossRefPubMedPubMedCentral Magee JT, Pritchard EL, Fitzgerald KA, Dunstan FD, Howard AJ: Antibiotic prescribing and antibiotic resistance in community practice: retrospective study, 1996-8. BMJ. 1999, 319 (7219): 1239-1240.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009, 339: b2535-10.1136/bmj.b2535.CrossRefPubMedPubMedCentral Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009, 339: b2535-10.1136/bmj.b2535.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Luxembourg Convention on Grey Literature. Perspectives on the Design and Transfer of Scientific and Technical Information. Third Conference on Grey Literature. [http://www.greynet.org/] Luxembourg Convention on Grey Literature. Perspectives on the Design and Transfer of Scientific and Technical Information. Third Conference on Grey Literature. [http://​www.​greynet.​org/​]
20.
Zurück zum Zitat Dobbins M, Robeson P: A Methodology for Searching the Grey Literature for Effectiveness Evidence Syntheses related to Public Health. 2006, The Public Health Agency of Canada Dobbins M, Robeson P: A Methodology for Searching the Grey Literature for Effectiveness Evidence Syntheses related to Public Health. 2006, The Public Health Agency of Canada
21.
Zurück zum Zitat Canton R, Loza E, Morosini MI, Baquero F: Antimicrobial resistance amongst isolates of Streptococcus pyogenes and Staphylococcus aureus in the PROTEKT antimicrobial surveillance programme during 1999-2000. J Antimicrob Chemother. 2002, 50 (Suppl S1): 9-24.CrossRefPubMed Canton R, Loza E, Morosini MI, Baquero F: Antimicrobial resistance amongst isolates of Streptococcus pyogenes and Staphylococcus aureus in the PROTEKT antimicrobial surveillance programme during 1999-2000. J Antimicrob Chemother. 2002, 50 (Suppl S1): 9-24.CrossRefPubMed
22.
Zurück zum Zitat Cizman M: The use and resistance to antibiotics in the community. Int J Antimicrob Agents. 2003, 21 (4): 297-307. 10.1016/S0924-8579(02)00394-1.CrossRefPubMed Cizman M: The use and resistance to antibiotics in the community. Int J Antimicrob Agents. 2003, 21 (4): 297-307. 10.1016/S0924-8579(02)00394-1.CrossRefPubMed
23.
Zurück zum Zitat Felmingham D, Reinert RR, Hirakata Y, Rodloff A: Increasing prevalence of antimicrobial resistance among isolates of Streptococcus pneumoniae from the PROTEKT surveillance study, and compatative in vitro activity of the ketolide, telithromycin. J Antimicrob Chemother. 2002, 50 (Suppl S1): 25-37.CrossRefPubMed Felmingham D, Reinert RR, Hirakata Y, Rodloff A: Increasing prevalence of antimicrobial resistance among isolates of Streptococcus pneumoniae from the PROTEKT surveillance study, and compatative in vitro activity of the ketolide, telithromycin. J Antimicrob Chemother. 2002, 50 (Suppl S1): 25-37.CrossRefPubMed
24.
Zurück zum Zitat Graninger W: Pivmecillinam--therapy of choice for lower urinary tract infection. Int J Antimicrob Agents. 2003, 22 (Suppl 2): 73-78.CrossRefPubMed Graninger W: Pivmecillinam--therapy of choice for lower urinary tract infection. Int J Antimicrob Agents. 2003, 22 (Suppl 2): 73-78.CrossRefPubMed
25.
Zurück zum Zitat Hoban D, Felmingham D: The PROTEKT surveillance study: antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections. J Antimicrob Chemother. 2002, 50 (Suppl S1): 49-59.CrossRefPubMed Hoban D, Felmingham D: The PROTEKT surveillance study: antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections. J Antimicrob Chemother. 2002, 50 (Suppl S1): 49-59.CrossRefPubMed
26.
Zurück zum Zitat Kahlmeter G: An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003, 51 (1): 69-76. 10.1093/jac/dkg028.CrossRefPubMed Kahlmeter G: An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003, 51 (1): 69-76. 10.1093/jac/dkg028.CrossRefPubMed
27.
Zurück zum Zitat Schito GC, Debbia EA, Marchese A: The evolving threat of antibiotic resistance in Europe: new data from the Alexander Project. J Antimicrob Chemother. 2000, 46 (Suppl T1): 3-9.CrossRefPubMed Schito GC, Debbia EA, Marchese A: The evolving threat of antibiotic resistance in Europe: new data from the Alexander Project. J Antimicrob Chemother. 2000, 46 (Suppl T1): 3-9.CrossRefPubMed
28.
Zurück zum Zitat Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, Marchese A: The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009, 34 (5): 407-413. 10.1016/j.ijantimicag.2009.04.012.CrossRefPubMed Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, Marchese A: The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009, 34 (5): 407-413. 10.1016/j.ijantimicag.2009.04.012.CrossRefPubMed
29.
Zurück zum Zitat Kahlmeter G, Menday P, Cars O: Non-hospital antimicrobial usage and resistance in community-acquired Escherichia coli urinary tract infection. J Antimicrob Chemother. 2003, 52 (6): 1005-1010. 10.1093/jac/dkg488.CrossRefPubMed Kahlmeter G, Menday P, Cars O: Non-hospital antimicrobial usage and resistance in community-acquired Escherichia coli urinary tract infection. J Antimicrob Chemother. 2003, 52 (6): 1005-1010. 10.1093/jac/dkg488.CrossRefPubMed
30.
Zurück zum Zitat Auer S, Wojna A, Hell M: Oral treatment options for ambulatory patients with urinary tract infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli. Antimicrob Agents Chemother. 2010, 54 (9): 4006-4008. 10.1128/AAC.01760-09.CrossRefPubMedPubMedCentral Auer S, Wojna A, Hell M: Oral treatment options for ambulatory patients with urinary tract infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli. Antimicrob Agents Chemother. 2010, 54 (9): 4006-4008. 10.1128/AAC.01760-09.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Prelog M, Fille M, Prodinger W, Grif K, Brunner A, Wurzner R, Zimmerhackl LB: CTX-M-1-related extended-spectrum beta-lactamases producing Escherichia coli: so far a sporadic event in Western Austria. Infection. 2008, 36 (4): 362-367. 10.1007/s15010-008-7309-7.CrossRefPubMed Prelog M, Fille M, Prodinger W, Grif K, Brunner A, Wurzner R, Zimmerhackl LB: CTX-M-1-related extended-spectrum beta-lactamases producing Escherichia coli: so far a sporadic event in Western Austria. Infection. 2008, 36 (4): 362-367. 10.1007/s15010-008-7309-7.CrossRefPubMed
32.
Zurück zum Zitat Buxbaum A, Forsthuber S, Graninger W, Georgopoulos A: Comparative activity of telithromycin against typical community-acquired respiratory pathogens. J Antimicrob Chemother. 2003, 52 (3): 371-374. 10.1093/jac/dkg359.CrossRefPubMed Buxbaum A, Forsthuber S, Graninger W, Georgopoulos A: Comparative activity of telithromycin against typical community-acquired respiratory pathogens. J Antimicrob Chemother. 2003, 52 (3): 371-374. 10.1093/jac/dkg359.CrossRefPubMed
33.
Zurück zum Zitat Hoenigl M, Fussi P, Feierl G, Wagner-Eibel U, Leitner E, Masoud L, Zarfel G, Marth E, Grisold AJ: Antimicrobial resistance of Streptococcus pneumoniae in Southeast Austria, 1997-2008. Int J Antimicrob Agents. 2010, 36 (1): 24-27. 10.1016/j.ijantimicag.2010.03.001.CrossRefPubMed Hoenigl M, Fussi P, Feierl G, Wagner-Eibel U, Leitner E, Masoud L, Zarfel G, Marth E, Grisold AJ: Antimicrobial resistance of Streptococcus pneumoniae in Southeast Austria, 1997-2008. Int J Antimicrob Agents. 2010, 36 (1): 24-27. 10.1016/j.ijantimicag.2010.03.001.CrossRefPubMed
34.
Zurück zum Zitat Schito GC, Georgopoulos A, Prieto J: Antibacterial activity of oral antibiotics against community-acquired respiratory pathogens from three European countries. J Antimicrob Chemother. 2002, 50 (Suppl): 7-11.CrossRefPubMed Schito GC, Georgopoulos A, Prieto J: Antibacterial activity of oral antibiotics against community-acquired respiratory pathogens from three European countries. J Antimicrob Chemother. 2002, 50 (Suppl): 7-11.CrossRefPubMed
35.
Zurück zum Zitat Krziwanek K, Luger C, Sammer B, Stumvoll S, Stammler M, Sagel U, Witte W, Mittermayer H: MRSA in Austria--an overview. Clin Microbiol Infect. 2008, 14 (3): 250-259. 10.1111/j.1469-0691.2007.01896.x.CrossRefPubMed Krziwanek K, Luger C, Sammer B, Stumvoll S, Stammler M, Sagel U, Witte W, Mittermayer H: MRSA in Austria--an overview. Clin Microbiol Infect. 2008, 14 (3): 250-259. 10.1111/j.1469-0691.2007.01896.x.CrossRefPubMed
36.
Zurück zum Zitat Krziwanek K, Metz-Gercek S, Mittermayer H: Methicillin-Resistant Staphylococcus aureus ST398 from human patients, upper Austria. Emerg Infect Dis. 2009, 15 (5): 766-769. 10.3201/eid1505.080326.CrossRefPubMedPubMedCentral Krziwanek K, Metz-Gercek S, Mittermayer H: Methicillin-Resistant Staphylococcus aureus ST398 from human patients, upper Austria. Emerg Infect Dis. 2009, 15 (5): 766-769. 10.3201/eid1505.080326.CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Badura A, Feierl G, Kessler HH, Grisold A, Masoud L, Wagner-Eibel U, Marth E: Multidrug-resistant bacteria in southeastern Austria. Emerg Infect Dis. 2007, 13 (8): 1256-1257.CrossRefPubMedPubMedCentral Badura A, Feierl G, Kessler HH, Grisold A, Masoud L, Wagner-Eibel U, Marth E: Multidrug-resistant bacteria in southeastern Austria. Emerg Infect Dis. 2007, 13 (8): 1256-1257.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Anderson NL, Bruno LC, Chapin KC, Cullen S, Daly JA, Eusebio R: Consensus Guidelines Developed for Streamlined Quality Control on Commercial Microbial Identification Systems. Clinical and Laboratory Standards Institute. LABMEDICINE. 2008, 39: Anderson NL, Bruno LC, Chapin KC, Cullen S, Daly JA, Eusebio R: Consensus Guidelines Developed for Streamlined Quality Control on Commercial Microbial Identification Systems. Clinical and Laboratory Standards Institute. LABMEDICINE. 2008, 39:
39.
Zurück zum Zitat Apfalter P, Allerberger F, Fluch G, Oegger G: Resistenzbericht Österreich. AURES 2009. Antibiotikaresistenz und Verbrauch antimikrobieller Substanzen in Österreich. 2010, Bundesministerium für Gesundheit, Wien Apfalter P, Allerberger F, Fluch G, Oegger G: Resistenzbericht Österreich. AURES 2009. Antibiotikaresistenz und Verbrauch antimikrobieller Substanzen in Österreich. 2010, Bundesministerium für Gesundheit, Wien
40.
Zurück zum Zitat Kahlmeter G, Brown DF, Goldstein FW, MacGowan AP, Mouton JW, Osterlund A, Rodloff A, Steinbakk M, Urbaskova P, Vatopoulos A: European harmonization of MIC breakpoints for antimicrobial susceptibility testing of bacteria. J Antimicrob Chemother. 2003, 52 (2): 145-148. 10.1093/jac/dkg312.CrossRefPubMed Kahlmeter G, Brown DF, Goldstein FW, MacGowan AP, Mouton JW, Osterlund A, Rodloff A, Steinbakk M, Urbaskova P, Vatopoulos A: European harmonization of MIC breakpoints for antimicrobial susceptibility testing of bacteria. J Antimicrob Chemother. 2003, 52 (2): 145-148. 10.1093/jac/dkg312.CrossRefPubMed
41.
Zurück zum Zitat Felmingham D, Gruneberg RN: A multicentre collaborative study of the antimicrobial susceptibility of community-acquired, lower respiratory tract pathogens 1992-1993: the Alexander Project. J Antimicrob Chemother. 1996, 38 (Suppl A): 1-57.CrossRefPubMed Felmingham D, Gruneberg RN: A multicentre collaborative study of the antimicrobial susceptibility of community-acquired, lower respiratory tract pathogens 1992-1993: the Alexander Project. J Antimicrob Chemother. 1996, 38 (Suppl A): 1-57.CrossRefPubMed
44.
Zurück zum Zitat Metz-Gercek S, Maieron A, Strauss R, Wieninger P, Apfalter P, Mittermayer H: Ten years of antibiotic consumption in ambulatory care: trends in prescribing practice and antibiotic resistance in Austria. BMC Infect Dis. 2009, 9: 61-10.1186/1471-2334-9-61.CrossRefPubMedPubMedCentral Metz-Gercek S, Maieron A, Strauss R, Wieninger P, Apfalter P, Mittermayer H: Ten years of antibiotic consumption in ambulatory care: trends in prescribing practice and antibiotic resistance in Austria. BMC Infect Dis. 2009, 9: 61-10.1186/1471-2334-9-61.CrossRefPubMedPubMedCentral
45.
Zurück zum Zitat Allerberger F, Apfalter P, Burgmann H, Gareis R, Janata O, Krause R, Lechner A, Mittermayer H, Wechsler-Fördös A: ABSantibioticstewardship im Niedergelassenen Bereich. Diagnose und Therapie von Infektionskrankheiten. 2010, ABSGROUP GmbH, Wien Allerberger F, Apfalter P, Burgmann H, Gareis R, Janata O, Krause R, Lechner A, Mittermayer H, Wechsler-Fördös A: ABSantibioticstewardship im Niedergelassenen Bereich. Diagnose und Therapie von Infektionskrankheiten. 2010, ABSGROUP GmbH, Wien
46.
Zurück zum Zitat Österreichische Gesellschaft für Infektionserkrankungen: Antiinfektiva - Behandlung von Infektionen. Arznei & Vernunft. 2010 Österreichische Gesellschaft für Infektionserkrankungen: Antiinfektiva - Behandlung von Infektionen. Arznei & Vernunft. 2010
47.
Zurück zum Zitat Allerberger F, Frank A, Gareis R: Antibiotic stewardship through the EU project "ABS International". Wien Klin Wochenschr. 2008, 120 (9-10): 256-263. 10.1007/s00508-008-0966-9.CrossRefPubMed Allerberger F, Frank A, Gareis R: Antibiotic stewardship through the EU project "ABS International". Wien Klin Wochenschr. 2008, 120 (9-10): 256-263. 10.1007/s00508-008-0966-9.CrossRefPubMed
48.
Zurück zum Zitat Allerberger F, Gareis R, Jindrak V, Struelens MJ: Antibiotic stewardship implementation in the EU: the way forward. Expert Rev Anti Infect Ther. 2009, 7 (10): 1175-1183. 10.1586/eri.09.96.CrossRefPubMed Allerberger F, Gareis R, Jindrak V, Struelens MJ: Antibiotic stewardship implementation in the EU: the way forward. Expert Rev Anti Infect Ther. 2009, 7 (10): 1175-1183. 10.1586/eri.09.96.CrossRefPubMed
49.
Zurück zum Zitat Conn VS, Valentine JC, Cooper HM, Rantz MJ: Grey literature in meta-analyses. Nurs Res. 2003, 52 (4): 256-261. 10.1097/00006199-200307000-00008.CrossRefPubMed Conn VS, Valentine JC, Cooper HM, Rantz MJ: Grey literature in meta-analyses. Nurs Res. 2003, 52 (4): 256-261. 10.1097/00006199-200307000-00008.CrossRefPubMed
50.
Zurück zum Zitat Helmer D, Savoie I, Green C, Kazanjian A: Evidence-based practice: extending the search to find material for the systematic review. Bull Med Libr Assoc. 2001, 89 (4): 346-352.PubMedPubMedCentral Helmer D, Savoie I, Green C, Kazanjian A: Evidence-based practice: extending the search to find material for the systematic review. Bull Med Libr Assoc. 2001, 89 (4): 346-352.PubMedPubMedCentral
51.
Zurück zum Zitat McAuley L, Pham B, Tugwell P, Moher D: Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses?. Lancet. 2000, 356 (9237): 1228-1231. 10.1016/S0140-6736(00)02786-0.CrossRefPubMed McAuley L, Pham B, Tugwell P, Moher D: Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses?. Lancet. 2000, 356 (9237): 1228-1231. 10.1016/S0140-6736(00)02786-0.CrossRefPubMed
52.
Zurück zum Zitat Howes F, Doyle J, Jackson N, Waters E: Evidence-based public health: The importance of finding 'difficult to locate' public health and health promotion intervention studies for systematic reviews. J Public Health (Oxf). 2004, 26 (1): 101-104. 10.1093/pubmed/fdh119.CrossRef Howes F, Doyle J, Jackson N, Waters E: Evidence-based public health: The importance of finding 'difficult to locate' public health and health promotion intervention studies for systematic reviews. J Public Health (Oxf). 2004, 26 (1): 101-104. 10.1093/pubmed/fdh119.CrossRef
53.
Zurück zum Zitat Hartling L, McAlister FA, Rowe BH, Ezekowitz J, Friesen C, Klassen TP: Challenges in systematic reviews of therapeutic devices and procedures. Ann Intern Med. 2005, 142 (12 Pt 2): 1100-1111.CrossRefPubMed Hartling L, McAlister FA, Rowe BH, Ezekowitz J, Friesen C, Klassen TP: Challenges in systematic reviews of therapeutic devices and procedures. Ann Intern Med. 2005, 142 (12 Pt 2): 1100-1111.CrossRefPubMed
54.
Zurück zum Zitat Blackhall K: Finding studies for inclusion in systematic reviews of interventions for injury prevention the importance of grey and unpublished literature. Inj Prev. 2007, 13 (5): 359-10.1136/ip.2007.017020.CrossRefPubMedPubMedCentral Blackhall K: Finding studies for inclusion in systematic reviews of interventions for injury prevention the importance of grey and unpublished literature. Inj Prev. 2007, 13 (5): 359-10.1136/ip.2007.017020.CrossRefPubMedPubMedCentral
55.
Zurück zum Zitat Hopewell S, McDonald S, Clarke M, Egger M: Grey literature in meta-analyses of randomized trials of health care interventions. Cochrane Database Syst Rev. 2007, MR000010-2 Hopewell S, McDonald S, Clarke M, Egger M: Grey literature in meta-analyses of randomized trials of health care interventions. Cochrane Database Syst Rev. 2007, MR000010-2
56.
Zurück zum Zitat Christensen H, Griffiths KM, Gulliver A: Plenty of activity but little outcome data: a review of the "grey literature" on primary care anxiety and depression programs in Australia. Med J Aust. 2008, 188 (12 Suppl): S103-106.PubMed Christensen H, Griffiths KM, Gulliver A: Plenty of activity but little outcome data: a review of the "grey literature" on primary care anxiety and depression programs in Australia. Med J Aust. 2008, 188 (12 Suppl): S103-106.PubMed
57.
Zurück zum Zitat Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P: Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res. 2008, 8: 247-10.1186/1472-6963-8-247.CrossRefPubMedPubMedCentral Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P: Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res. 2008, 8: 247-10.1186/1472-6963-8-247.CrossRefPubMedPubMedCentral
58.
Zurück zum Zitat Zechmeister I, Kilian R, McDaid D: Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations. BMC Public Health. 2008, 8: 20-10.1186/1471-2458-8-20.CrossRefPubMedPubMedCentral Zechmeister I, Kilian R, McDaid D: Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations. BMC Public Health. 2008, 8: 20-10.1186/1471-2458-8-20.CrossRefPubMedPubMedCentral
59.
Zurück zum Zitat Borschmann R, Hogg J, Phillips R, Moran P: Measuring self-harm in adults: A systematic review. Eur Psychiatry. 2011 Borschmann R, Hogg J, Phillips R, Moran P: Measuring self-harm in adults: A systematic review. Eur Psychiatry. 2011
60.
Zurück zum Zitat Bisits Bullen PA: The positive deviance/hearth approach to reducing child malnutrition: systematic review. Trop Med Int Health. 2011 Bisits Bullen PA: The positive deviance/hearth approach to reducing child malnutrition: systematic review. Trop Med Int Health. 2011
61.
Zurück zum Zitat Mittermayer H, Metz-Gercek S, Allerberger F: Resistenzbericht Österreich. AURES 2008. Antibiotikaresistenz und Verbrauch antimikrobieller Substanzen in Österreich. 2009, Bundesministerium für Gesundheit, Wien Mittermayer H, Metz-Gercek S, Allerberger F: Resistenzbericht Österreich. AURES 2008. Antibiotikaresistenz und Verbrauch antimikrobieller Substanzen in Österreich. 2009, Bundesministerium für Gesundheit, Wien
62.
Zurück zum Zitat Wojna A: Resistenzreport 2009. Zusammenfassung der lokalen Resistenzdaten. 2010, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzreport 2009. Zusammenfassung der lokalen Resistenzdaten. 2010, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
63.
Zurück zum Zitat Wojna A: Resistenzreport 2008. Zusammenfassung der lokalen Resistenzdaten. 2009, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzreport 2008. Zusammenfassung der lokalen Resistenzdaten. 2009, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
64.
Zurück zum Zitat Wojna A: Resistenzbericht 2007. 2008, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzbericht 2007. 2008, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
65.
Zurück zum Zitat Wojna A: Resistenzbericht 2006. 2007, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzbericht 2006. 2007, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
66.
Zurück zum Zitat Wojna A: Resistenzbericht 2005. 2006, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzbericht 2005. 2006, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
67.
Zurück zum Zitat Wojna A: Resistenzbericht 2004. 2005, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzbericht 2004. 2005, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
68.
Zurück zum Zitat Wojna A: Resistenzbericht 2003. 2004, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzbericht 2003. 2004, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
69.
Zurück zum Zitat Wojna A: Resistenzbericht 2002. 2003, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg Wojna A: Resistenzbericht 2002. 2003, Abt. f. Mikrobiologie, Med.-chem. Labor Dr. Mustafa, Labor Dr. Richter OG, Salzburg
70.
Zurück zum Zitat Feierl G, Buzina W, Masoud-Landgraf L: Resistenzbericht 2010. 2011, Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Labor für Medizinische Bakteriologie und Mykologie, Graz Feierl G, Buzina W, Masoud-Landgraf L: Resistenzbericht 2010. 2011, Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Labor für Medizinische Bakteriologie und Mykologie, Graz
71.
Zurück zum Zitat Feierl G, Buzina W: Resistenzbericht 2009. 2010, Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Labor für Medizinische Bakteriologie und Mykologie, Graz Feierl G, Buzina W: Resistenzbericht 2009. 2010, Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Labor für Medizinische Bakteriologie und Mykologie, Graz
72.
Zurück zum Zitat Feierl G, Buzina W: Resistenzbericht 2008. 2009, Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Labor für Medizinische Bakteriologie und Mykologie, Graz Feierl G, Buzina W: Resistenzbericht 2008. 2009, Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Labor für Medizinische Bakteriologie und Mykologie, Graz
73.
Zurück zum Zitat Prein K, Fürpass T: Resistenzbericht 2009 aus dem Einsendegut des Bakt. Labors im LKH Leoben. 2010, LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben Prein K, Fürpass T: Resistenzbericht 2009 aus dem Einsendegut des Bakt. Labors im LKH Leoben. 2010, LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben
74.
Zurück zum Zitat Prein K, Fürpass T: Resistenzbericht 2007 aus dem Einsendegut des Bakt. Labors im LKH Leoben. 2008, LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben Prein K, Fürpass T: Resistenzbericht 2007 aus dem Einsendegut des Bakt. Labors im LKH Leoben. 2008, LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben
75.
Zurück zum Zitat Prein K: Resistenzbericht 2005 aus dem Einsendegut des Bakt. Labors im LKH Leoben. 206, LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben Prein K: Resistenzbericht 2005 aus dem Einsendegut des Bakt. Labors im LKH Leoben. 206, LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben
76.
Zurück zum Zitat Prein K: Resistenzbericht 2004 aus dem Einsendegut des Bakt. 2005, Labors im LKH Leoben. LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben Prein K: Resistenzbericht 2004 aus dem Einsendegut des Bakt. 2005, Labors im LKH Leoben. LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben
77.
Zurück zum Zitat Prein K: Resistenzbericht 2003 aus dem Einsendegut des Bakt. 2004, Labors im LKH Leoben. LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben Prein K: Resistenzbericht 2003 aus dem Einsendegut des Bakt. 2004, Labors im LKH Leoben. LKH Leoben, Pathologisches Institut, Bakteriologisches Labor, Leoben
78.
Zurück zum Zitat Fille M, Hausdorfer J, Weiss G, Lass-Flörl C: Resistenzbericht 2009. Resistenzverhalten von Bakterien und Pilzen gegen Antibiotika und Antimykotika. 2010, Sektion Hygiene und Medizinische Mikrobiologie und Universitätsklinik für Innere Medizin I, Klinische Infektiologie und Immunologie, Medizinische Universität Innsbruck, Innsbruck Fille M, Hausdorfer J, Weiss G, Lass-Flörl C: Resistenzbericht 2009. Resistenzverhalten von Bakterien und Pilzen gegen Antibiotika und Antimykotika. 2010, Sektion Hygiene und Medizinische Mikrobiologie und Universitätsklinik für Innere Medizin I, Klinische Infektiologie und Immunologie, Medizinische Universität Innsbruck, Innsbruck
79.
Zurück zum Zitat Fille M, Hausdorfer J, Weiss G, Lass-Flörl C: Resistenzbericht 2008. Resistenzverhalten von Bakterien und Pilzen gegen Antibiotika und Antimykotika. 2009, Sektion Hygiene und Medizinische Mikrobiologie und Universitätsklinik für Innere Medizin I, Klinische Infektiologie und Immunologie, Medizinische Universität Innsbruck, Innsbruck Fille M, Hausdorfer J, Weiss G, Lass-Flörl C: Resistenzbericht 2008. Resistenzverhalten von Bakterien und Pilzen gegen Antibiotika und Antimykotika. 2009, Sektion Hygiene und Medizinische Mikrobiologie und Universitätsklinik für Innere Medizin I, Klinische Infektiologie und Immunologie, Medizinische Universität Innsbruck, Innsbruck
80.
Zurück zum Zitat Hell M: ESBL-producing E.coli in uncomplicated UIT - regional and Austria-wide update and evaluation of treatment options. Hyg Med. 2010, 35 (1&2): 26-31. Hell M: ESBL-producing E.coli in uncomplicated UIT - regional and Austria-wide update and evaluation of treatment options. Hyg Med. 2010, 35 (1&2): 26-31.
Metadaten
Titel
Antibiotic resistance in primary care in Austria - a systematic review of scientific and grey literature
verfasst von
Kathryn Hoffmann
Gernot Wagner
Petra Apfalter
Manfred Maier
Publikationsdatum
01.12.2011
Verlag
BioMed Central
Erschienen in
BMC Infectious Diseases / Ausgabe 1/2011
Elektronische ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-11-330

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