Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015

Abstract

In 2012, the European Centre for Disease Prevention and Control (ECDC) launched the 'European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE)' project to gain insights into the occurrence and epidemiology of carbapenemase-producing Enterobacteriaceae (CPE), to increase the awareness of the spread of CPE, and to build and enhance the laboratory capacity for diagnosis and surveillance of CPE in Europe. Data collected through a post-EuSCAPE feedback questionnaire in May 2015 documented improvement compared with 2013 in capacity and ability to detect CPE and identify the different carbapenemases genes in the 38 participating countries, thus contributing to their awareness of and knowledge about the spread of CPE. Over the last two years, the epidemiological situation of CPE worsened, in particular with the rapid spread of carbapenem-hydrolysing oxacillinase-48 (OXA-48)- and New Delhi metallo-beta-lactamase (NDM)-producing Enterobacteriaceae. In 2015, 13/38 countries reported inter-regional spread of or an endemic situation for CPE, compared with 6/38 in 2013. Only three countries replied that they had not identified one single case of CPE. The ongoing spread of CPE represents an increasing threat to patient safety in European hospitals, and a majority of countries reacted by establishing national CPE surveillances systems and issuing guidance on control measures for health professionals. However, 14 countries still lacked specific national guidelines for prevention and control of CPE in mid-2015.

Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015

“…via Libya and Italy. A current European Centre for Disease Prevention and Control (ECDC) report showed high prevalence of carbapenem resistance and other antimicrobial resistances in Turkey and Greece in the period from 2013 to 2014 [7][8][9]. On that account, the Robert Koch Institute, Germany, has recommended in October 2015, screening refugees for MDRO on hospital admission in Germany [10].…”

“…Many refugees are coming from countries with high prevalence of multidrug-resistant organisms (MDRO) in hospital and community settings, such as Afghanistan, the Near and Middle East and the North African countries [6]. Additionally, many of the refugees coming from the Near and Middle East have been travelling through countries with high prevalences of MDROs, such as Turkey or Greece [7][8][9], whereas those coming from Africa are travelling via the 'West-Route', i.e. via Libya and Italy.…”

Bloodstream infections in neutropenic cancer patients: A practical update

“…37,[49][50][51] For example, ESBL-producing strains accounted for the 26% of all the E. coli and K. pneumoniae isolates in neutropenic patients in a South Korean study and for approximately 40% in Italian cohorts 36,43,49,52 Carbapenem-resistant gram-negative bacteria Carbapenem-resistance among GN bacteria is rising worldwide, different resistance mechanisms underlie non-susceptibility to this class of b-lactams, and K. pneumoniae, E. coli, P. aeruginosa and A. baumannii are the most affected species. 45,53 In consequence, in many countries, also cancer patients develop carbapenemresistant infections, as demonstrated by a retrospective survey performed in 52 transplant centers in Italy. 54 In fact, in HSCT patients the incidence of carbapenemresistant K. pneumoniae infections showed a 6-fold increase between 2010 and 2013, reaching the rates of 0.5% in autologous transplant and 2.9% in allogeneic transplant settings.…”

“…11,39 However, as demonstrated for carbapenem-resistant Enterobacteriaceae, in many countries with relatively low prevalence of this resistance pattern, interregional spread of resistant strains has occurred. 45 On the other hand, there are still regions where resistant strains are infrequent and the mortality associated with BSIs remains low. 46 Therefore, a continuously updated knowledge of local epidemiology is crucial.…”

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

“…In other areas of the world, class B New Delhi metallob-lactamase (Asia) or class D OXA-48-like carbapenemases (North Africa and Europe) predominate. 9,10 One of the key challenges of controlling the spread of CRE is the fact that CRE-infected patients identified by routine clinical cultures (passive surveillance) represent only a fraction of the patients that harbor CRE. Gastrointestinal colonization is asymptomatic, and colonized patients are reservoirs for transmission.…”