Carbapenemase Producing Enterobacterales in Romania: Investigating the Origins

Abstract

Carbapenemase-producing Enterobacterales (CPE) have emerged and spread in Romania since 2010. According to the reports of the EuSPACE (European survey of carbapenemase-producing Enterobacteriaceae) the epidemio-logical stage of the CPE expansion in Romania has shifted from sporadic occurrence in 2013 directly to inter-regional spread in 2014-2015. In this study we aimed to provide data from the timeframe when the dissemination of the carbapenemase genes in Romania began, by retrospectively analyzing CPE strains in a tertiary care university hospital. During the period of November 2012 – October 2013 we found 107 CPE (8.78%) out of 1219 non-duplicate Enterobacterales strains. 26 isolates of various Enterobacterales species carried blaNDM-1, 83 Klebsiella pneumoniae strains were positive for blaOXA-48-like and 2 of these co-harboured blaNDM-1. The increased incidence of OXA-48 producing K. pneumoniae was linked to a two-peaked hospital outbreak during February and May 2013. The percentage of 24.3% of NDM-1 producers was alarming due to the diversity of involved species and the higher resistance levels to carbapenems compared with blaOXA-48-like gene carriers. Plasmid replicon typing revealed a great diversity of plasmids in NDM-1-positive strains, belonging to incompatibility groups A/C, FII, FIIk, HI2, L and M. The strong connection between certain plasmid groups and host species suggests that the transfer of broad host-range plasmids through conjugation does not play the main role in the successful spread of blaNDM-1 among Enterobacterales species.

Characterization of Carbapenemase-Producing Klebsiella pneumoniae Isolates from Two Romanian Hospitals Co-Presenting Resistance and Heteroresistance to Colistin

“…The interdependence between KPC-2-producing isolates with FII(K) and IncX3 plasmids and between OXA-48 producers with IncL and IncR plasmids concurs with previous observations made by Becker et al in Germany [ 80 ]. In contrast to a prior study conducted at the same medical institution in Târgu Mureș on strains collected between 2012 and 2013 that demonstrated the presence of the IncR plasmid replicon in five K. pneumoniae NDM-1-positive isolates [ 81 ], our two NDM-1 producers did not harbor this replicon type. Moreover, a significant match between the BC7_BM strain and the reference plasmids suggests the persistence and evolution of a bla NDM plasmid in this geographical area, which was previously named pKOX_NDM1-like by Phan et al [ 82 ].…”

Synergistic Combination of Aztreonam and Ceftazidime–Avibactam—A Promising Defense Strategy against OXA-48 + NDM Klebsiella pneumoniae in Romania

“…Starting in 2010, a few published Romanian studies have signaled the presence of bla OXA-48 and bla NDM Kp isolates in patients admitted to hospitals from different geographic areas. The first study was conducted between November 2013 and April 2014, and it described the local distribution of bla NDM-1, bla OXA-48, and bla OXA-181 in nine hospital isolates from central Romania, whereas the second one showed the distribution of CPE in two hospitals in Bucharest between 2011 and 2012 [ 26 , 27 , 28 , 29 ].…”