First detection of a carbapenemase-producing Enterobacteriaceae in Iceland

We sought to detect and determine the genetic diversity of carbapenemase-producing Enterobacteriaceae (CPE) isolated from clinical specimens in Amman, Jordan. From five hospitals, a total of 2,759 isolates had antimicrobial susceptibilities determined via Vitek II, of which 28 (1%) were carbapenem resistant. Species identifications were determined via matrix-assisted laser desorption ionization time-of-flight mass spectrometry and carbapenemase gene detection via real-time PCR indicated that 23 (82.1%) isolates were Klebsiella pneumoniae (OXA-48-like, n = 7; NDM, n = 14; OXA-48-like and NDM, n = 2), four (14.2%) were Enterobacter cloacae complex (NDM, n = 3 and VIM, n = 1), and one (3.5%) was Escherichia coli (NDM). Sequencing of carbapenemase gene amplicons from a subset of isolates identified bla, bla, and bla alleles. Strain typing detected seven different K. pneumoniae variable number tandem repeat types, consistent with mostly sporadic occurrences along with limited clonal spread. E. cloacae complex isolates were diverse by pulsed-field gel electrophoresis, with a maximum relatedness of 70%. Plasmid restriction fragment length polymorphism (pRFLP) revealed four distinct profiles associated with NDM-encoding plasmids that were positive for replicons of the FII(K)/FIB or FIB incompatibility (Inc) groups via PCR-based replicon typing. OXA-48-encoding IncL/M plasmids differed by two pRFLP bands. The results show diverse CPE produce OXA-48 and NDM-1 enzymes in Jordan and that the carbapenemase genes are distributed on diverse plasmids in Jordanian hospitals, with some limited evidence for related clusters occurring, emphasizing the need for strict infection control measures.

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Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study

Haldorsen

Giske

Hansen

et al. 2018

Journal of Antimicrobial Chemotherapy

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ObjectivesTo examine performance of EUCAST disc diffusion and supplementary MIC methods for detection of Enterobacteriaceae with reduced susceptibility to meropenem using EUCAST screening recommendations.MethodsSixty-one Nordic laboratories delivered data on EUCAST disc diffusion (n = 61), semi-automated meropenem MIC (n = 23; VITEK2, n = 20 and Phoenix, n = 3) and gradient meropenem MIC (n = 58) methods. The strains (n = 27) included the major carbapenemase classes (A, n = 4; B, n = 9; D, n = 6) involved in the global spread of carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE strains (n = 8) covering a range of broth microdilution (BMD) meropenem MICs.ResultsA triplicate Klebsiella variicola (meropenem MIC 0.5 mg/L) harbouring OXA-48 and Escherichia coli ATCC 25922 showed an overall good precision. Meropenem zone diameters below the EUCAST screening cut-off (<27 mm) were reported for strains with MIC ≥1 mg/L (n = 21), irrespective of resistance mechanism. For three strains (MIC = 0.5 mg/L) with OXA-48/-181, eight laboratories provided meropenem zone diameters above the screening cut-off. Very major errors (VMEs) were not observed. The overall distributions of major errors (MEs) and minor errors (mEs) were 9% and 36% (disc diffusion), 26% and 18% (VITEK2) and 7% and 20% (gradient MIC), respectively. Differences in ME and mE distributions between disc diffusion and MIC gradient tests compared with semi-automated methods were significant (P < 0.0001), using BMD MICs as a reference for categorization.ConclusionsThe EUCAST disc diffusion method is a robust method to screen for CPE but isolates with meropenem MICs <1 mg/L pose challenges. The high ME rate in semi-automated methods might deter appropriate use of carbapenems in CPE infections with limited therapeutic options.

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First detection of a carbapenemase-producing Enterobacteriaceae in Iceland

Cited by 3 publications

References 4 publications

Antibiotic resistance monitoring in wastewater in the Nordic countries: A systematic review

Antibiotic resistance monitoring in wastewater in the Nordic countries: A systematic review

Characterization of Carbapenemase-Producing Enterobacteriaceae from Patients in Amman, Jordan

Performance of the EUCAST disc diffusion method and two MIC methods in detection of Enterobacteriaceae with reduced susceptibility to meropenem: the NordicAST CPE study

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