Carbapenemase-producing Enterobacteriaceae circulating in the Reunion Island, a French territory in the Southwest Indian Ocean

Abstract

Background: The spread of carbapenemase-producing Enterobacteriaceae (CPE) in the Southwest Indian Ocean area (SIOA) is poorly documented. Reunion Island is a French overseas territory located close to Madagascar and connected with Southern Africa, Indian sub-continent and Europe, with several weekly flights. Here we report the results of the CPE surveillance program in Reunion Island over a six-year period. Methods: All CPE were collected between January 2011 and December 2016. Demographics and clinical data of the carrier patients were collected. We determined their susceptibility to antimicrobials, identified the carbapenemases and ESBL by PCR and sequencing, and explored their genetic relationship using pulsed-field gel electrophoresis and multi-locus sequence typing. Results: A total of 61 CPEs isolated from 53 patients were retrieved in 6 public or private laboratories of the island. We found that 69.8% of CPE patients were linked to a foreign country of SIOA and that almost half of CPE cases (47.2%) reached the island through a medical evacuation. The annual number of CPE cases strongly increased over the studied period (one case in 2011 vs. 21 cases in 2016). A proportion of 17.5% of CPE isolates were nonsusceptible to colistin. bla NDM was the most frequent carbapenemase (79.4%), followed by bla IMI (11.1%), and bla IMP-10 (4.8%). Autochtonous CPE cases (30.2%) harboured CPE isolates belonging to a polyclonal population. Conclusions: Because the hospital of Reunion Island is the only reference healthcare setting of the SIOA, we can reasonably estimate that its CPE epidemiology reflects that of this area. Mauritius was the main provider of foreign CPE cases (35.5%). We also showed that autochthonous isolates of CPEs are mostly polyclonal, thus unrelated to cross-transmission. This demonstrates the local spread of carbapenemase-encoding genes (i.e. bla NDM) in a polyclonal bacterial population and raises fears that Reunion Island could contribute to the influx of NDMcarbapenemase producers into the French mainland territory.

Tigecycline susceptibility among multi-drug resistant bacteria: A 7-year retrospective study

“…In this study, 57% of the carbapenemase-producing strains were sensitive to tigecycline. The rates found are close to those reported by a study conducted in Reunion Island, a French territory in the Southwest Indian Ocean, which found a susceptibility rate of 67% to tigecycline of CPE strains [11]. A study conducted in Tunisia in a major burns unit found that for CPE, the lowest resistance rates were recorded for tigecycline (43%) and fosfomycin (33%).…”

Dominant Carbapenemase-Encoding Plasmids in Clinical Enterobacterales Isolates and Hypervirulent Klebsiella pneumoniae, Singapore

“…Our results showed that pKPC2 was the most prevalent carbapenemase-encoding plasmid among the clinical Enterobacterales isolates in CaPES. These plasmids are largely found in K. pneumoniae, E. coli, and E. cloacae, which also were the most prevalent carbapenemase-encoding plasmid-harboring species reported in other surveillance studies (31,32), showing that those are major reservoirs. Although KPC-2 has been documented on diverse plasmids and is known to undergo frequent recombination events (33), we uncovered a single plasmid that moves as a discrete and intact unit among diverse strains and species.…”

Comprehensive analysis of antimicrobial resistance in the Southwest Indian Ocean: focus on WHO critical and high priority pathogens

“…In the same year, a patient returning from Mauritius was found to be carrying a carbapenemase-producing K. pneumoniae isolate with the bla NDM-1 and bla OXA-181 genes ( 18 ). From 2011 to 2016, 61 Enterobacterales from 53 patients on Reunion Island were identified to have carbapenem resistance ( 19 ). Among them, 13 E. coli belonging to eight STs (ST10, ST12, ST167, ST349, ST354, ST405, ST410, ST1284) were recovered.…”