SummaryBackground Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it diffi cult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the fi rst structured survey on the occurrence of carbapenemaseproducing Klebsiella pneumoniae and Escherichia coli in European hospitals.

This work further underlines the spread of NDM carbapenemases in A. baumannii, and the spread of the corresponding gene in the Middle East. It also describes the first variant of NDM-1.

A multidrug-resistant Acinetobacter baumannii isolate recovered from a patient hospitalized in Switzerland after a transfer from Serbia produced the NDM-1 carbapenemase. The bla NDM-1 gene was part of a chromosomally located Tn125 composite transposon bracketed by two copies of the same insertion sequence, ISAba125. This transposon was also associated with the acquisition and expression of the bla NDM-2 gene in an A. baumannii isolate in Germany. Tn125 appears to be the main vehicle for dissemination of bla NDM genes in that species.T he carbapenemase NDM-1, initially identified in Escherichia coli and Klebsiella pneumoniae, has been found mostly in enterobacterial species (12,16,17). However, recent reports have described the occurrence of bla NDM genes in Acinetobacter baumannii. Several NDM-1-positive A. baumannii isolates have been identified in India (10), and two NDM-positive A. baumannii isolates have been recovered in Germany, one being from a patient transferred from a Serbian hospital and producing NDM-1 (6), whereas the other produced NDM-2 (one amino acid substitution with respect to NDM-1) and had been recovered from a patient transferred from an Egyptian hospital (isolate ML) (9). Although the Indian subcontinent is considered a reservoir of NDM-1 producers (17), recent reports indicate that at least the Balkan states and the Middle East regions could also be potential reservoirs (13,21).In a recent work, Pfeifer et al. (18) reported that the bla NDM-1 gene identified in A. baumannii isolate 161/07 from Germany (from a patient transferred from Serbia) (6) was located inside a composite transposon bracketed by two copies of insertion sequence ISAba125.A retrospective survey focusing on multidrug-resistant Gramnegative isolates identified several non-clonally related NDM-1-producing isolates from three patients who had been hospitalized in Geneva University Hospitals, Switzerland, from March 2009 to October 2010. One E. coli and one K. pneumoniae isolate were recovered from the same patient, who had been transferred from Serbia (22). In both isolates, the bla NDM-1 gene was identified on the same 150-kb IncA/C-type plasmid (20). Further investigations showed that this patient also carried a multidrug-resistant A. baumannii isolate that had been recovered from rectal swabs.A. baumannii isolate JH was resistant to all ␤-lactams, including carbapenems (MICs of imipenem, ertapenem, doripenem, and meropenem measured by Etest [AB bioMérieux; Solna, Sweden] were all Ͼ32 g/ml) according to the CLSI guidelines (3). It was also resistant to gentamicin, amikacin, chloramphenicol, tetracycline, and fluoroquinolones and remained susceptible to tobramycin and netilmicin, with MICs of colistin, rifampin, and tigecycline being at 0.5, 1, and 1 g/ml, respectively. PCR and sequencing revealed that A. baumannii JH harbored the bla NDM-1 gene. Screening for additional ␤-lactamase genes and for 16S RNA methylase genes as reported previously (1, 23) showed that A. baumannii JH was coharboring another carbapenemase gene, ...

BackgroundCarbapenemase-producing Enterobacteriaceae (CPE) have become a major problem for healthcare systems worldwide. While the first reports from European hospitals described the introduction of CPE from endemic countries, there is now a growing number of reports describing outbreaks of CPE in European hospitals. Here we report an outbreak of Carbapenem-resistant K. pneumoniae in a German University hospital which was in part associated to duodenoscopy.FindingsBetween December 6, 2012 and January 10, 2013, carbapenem-resistant K. pneumoniae (CRKP) was cultured from 12 patients staying on 4 different wards. The amplification of carbapenemase genes by multiplex PCR showed presence of the blaOXA-48 gene. Molecular typing confirmed the identity of all 12 isolates. Reviewing the medical records of CRKP cases revealed that there was a spatial relationship between 6 of the cases which were located on the same wards. The remaining 6 cases were all related to endoscopic retrograde cholangiopancreatography (ERCP) which was performed with the same duodenoscope. The outbreak ended after the endoscope was sent to the manufacturer for maintenance.ConclusionsThough the outbreak strain was also disseminated to patients who did not undergo ERCP and environmental sources or medical personnel also contributed to the outbreak, the gut of colonized patients is the main source for CPE. Therefore, accurate and stringent reprocessing of endoscopic instruments is extremely important, which is especially true for more complex instruments like the duodenoscope (TJF Q180V series) involved in the outbreak described here.

Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) has recently been introduced for bacterial identification. To our knowledge, this is the first study where the Biotyper 2.0 database (Bruker Daltonics) has been applied for bacterial identification in a local strain collection of molecularly defined Staphylococcus aureus. We showed that the accuracy of the Biotyper 2.0-based identification for 602 molecularly defined strains of S. aureus, irrespective of meticillin resistance, was equivalent to that of the molecularly defined reference even at a score cutoff value of 2. Also, 412 isolates of 20 different species of non-S. aureus staphylococci were all correctly identified to species level compared to the molecularly defined reference. Moreover, the MALDI-TOF MS-based S. aureus identification approach was clearly faster than more time-consuming methods such as a molecular identification approach.

Penicillinase testing is required for Staphylococcus aureus isolates with a penicillin MIC of

The new S3 guideline on uncomplicated UTI incorporates a forward-looking approach to the use of antibiotics in treating this common type of infection. It is intended to bring about a sustained improvement in the quality of care.

bDue to the increase in multidrug-resistant Enterobacteriaceae, the interest in older antimicrobial agents, like fosfomycin, has increased. In this study, we used agar dilution for testing susceptibilities to fosfomycin in a collection of 107 carbapenem-nonsusceptible Enterobacteriaceae isolates, of which 80 produced various types of carbapenemases, including KPC, VIM, NDM, and OXA-48. Overall, 78% of the strains had fosfomycin MICs of <32 mg/liter and were thus considered to be susceptible according to the current EUCAST breakpoint. The MIC 50 and MIC 90 were 8 mg/liter and 512 mg/liter, respectively. Escherichia coli strains had significantly lower fosfomycin MICs than the Klebsiella pneumoniae and Enterobacter cloacae strains. Furthermore, comparisons of the susceptibility testing methods, like Etest and disk diffusion, were performed against agar dilution as the reference method. Essential agreement between Etest and agar dilution was 78.9%, and categorical agreement between the two methods was 92.5%, with 20% very major errors and 2.6% major errors. Disk diffusion was studied with 50-g and 200-g fosfomycin disks, but no inhibition zone breakpoint that reduced very major and major errors to an acceptable level was found. Etest and disk diffusion showed poor agreement with fosfomycin agar dilution.