Acquisition of carbapenemase-producing Enterobacteriaceae by healthy travellers to India, France, February 2012 to March 2013

Abstract

Healthy travellers to countries where carbapenemases-producing Enterobacteriaceae (CPE) are endemic might be at risk for their acquisition, even without contact with the local healthcare system. Here, we report the acquisition of CPE (two OXA-181, one New Delhi metallo-beta-lactamase 1 (NDM-1)) in three healthy travellers returning from India. The duration of CPE intestinal carriage was less than one month. The results indicate that healthy travellers recently returning from India might be considered as at risk for CPE carriage.

Cross-transmission of Escherichia coli producing OXA-181 in hospitalized patients and failure of carbapenemase detection by commercial and in-house PCR assays

“…It is likely that our index case represented a case of intercontinental transfer of OXA-181-producing E. coli from Ghana to Ireland. Elsewhere, the international transfer of OXA-181-producing CPE has been documented from the Indian subcontinent to France and New Zealand (Ruppé et al, 2014;Williamson et al, 2011).…”

“…The OXA-181 enzyme is reported mainly in Klebsiella pneumoniae and predominantly in Asian and Middle Eastern countries (Balm et al, 2013;Potron et al, 2011;Ruppé et al, 2014;Williamson et al, 2011), although OXA-181-producing E. coli originating from Nigeria and the Comoro Islands have also been reported (Decousser et al, 2015;Walkty et al, 2015). Amongst isolates of E. coli and K. pneumoniae confirmed to have an OXA-48-like carbapenemase by AMRHAI in 2014, 40 % produced OXA-181 or one of its close variants K.…”

Occurrence and features of chromosomally encoded carbapenemases in Gram-negative bacteria in farm animals sampled at slaughterhouse level

“…Carbapenemase-producing bacteria represent an increasing threat to the efficacy of carbapenems such as imipenem, ertapenem or meropenem, that are the drugs of choice in human medicine to treat serious infections due to extended-spectrum β-lactamase (ESBL)-producing strains . Beyond clinical settings, carbapenem-resistant isolates have been detected in the fecal flora of healthy humans (Ruppé et al, 2013;Zurfluh et al, 2015a), the aquatic environment (rivers and lakes) (Zurfluh et al, 2013), vegetables and seafood originating from Asia (Zurfluh et al, 2015b;Morrison and Rubin, 2015). Since carbapenems are not licenced for use in veterinary medicine (at least in Western countries), and a recent survey reported the lack of detection of carbapenemase-producing Enterobacteriaceae among farm animals, the risk of acquisition of such organisms from food producing animals is considered to be low Poirel et al, 2014).…”

The genetic analysis of Enterobacteriaceae plasmids to provide insights into the acquisition and spread of the blaNDM gene

“…gut colonisers (46). Asymptomatic carriers have been recently identified as 'vehicles' for the spread of resistance by commuting internationally, for purposes of medical tourism or personal travel (47)(48)(49). The third intervention is antimicrobial stewardship, which aims to limit the selection and development of antibiotic resistance within health-care facilities and the community, as the over-or misuse of antimicrobials has been theorised to have led to the emergence and dissemination of antimicrobial resistance (50).…”

“…The first is infection control, which contains the spread of MDR organisms from its source (e.g. infected patients) in order to prevent additional infections during an outbreak, especially within health-care facilities where internationally, for purposes of medical tourism or personal travel (47)(48)(49). The third intervention is antimicrobial stewardship, which aims to limit the selection and development of antibiotic resistance within health-care facilities and the community, as the over-or misuse of antimicrobials has been theorised to have led to the emergence and dissemination of antimicrobial resistance (50).…”