First report of emergence of OXA-48 carbapenemase-producing Enterobacteriaceae in Singapore: Proactive or reactive infection control strategy?

Marimuthu, Kalisvar; Teo, Jeanette; Fong, Poh Bee; Chin, Jani Ong Hui; Qi, K J; Lye, David C.; Ping, Angela Chow Li; Krishnan, Prabha; Peng, Brenda Ang Sze

doi:10.1016/j.ajic.2014.01.021

Cited by 8 publications

(6 citation statements)

References 7 publications

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“…Currently, Enterobacterales with bla OXA-48 have a truly global distribution, and reports of imported and nonimported cases have described from all continents except Antarctica, including the Americas (e.g., Colombia [100] and Mexico [91]), various European and North American countries (69), Sub-Saharan Africa (e.g., Tanzania [101], South Africa [97], and Senegal [60]), Asia (e.g., Japan [102], Singapore [103], Taiwan [104], and Malaysia [105]), Oceania (e.g., New Zealand [106]), and the Caribbean islands (107).…”

Section: Geographical Distribution Of Oxa-48mentioning

confidence: 99%

The Global Ascendency of OXA-48-Type Carbapenemases

et al. 2019

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SUMMARY Surveillance studies have shown that OXA-48-like carbapenemases are the most common carbapenemases in Enterobacterales in certain regions of the world and are being introduced on a regular basis into regions of nonendemicity, where they are responsible for nosocomial outbreaks. OXA-48, OXA-181, OXA-232, OXA-204, OXA-162, and OXA-244, in that order, are the most common enzymes identified among the OXA-48-like carbapenemase group. OXA-48 is associated with different Tn1999 variants on IncL plasmids and is endemic in North Africa and the Middle East. OXA-162 and OXA-244 are derivatives of OXA-48 and are present in Europe. OXA-181 and OXA-232 are associated with ISEcp1, Tn2013 on ColE2, and IncX3 types of plasmids and are endemic in the Indian subcontinent (e.g., India, Bangladesh, Pakistan, and Sri Lanka) and certain sub-Saharan African countries. Overall, clonal dissemination plays a minor role in the spread of OXA-48-like carbapenemases, but certain high-risk clones (e.g., Klebsiella pneumoniae sequence type 147 [ST147], ST307, ST15, and ST14 and Escherichia coli ST38 and ST410) have been associated with the global dispersion of OXA-48, OXA-181, OXA-232, and OXA-204. Chromosomal integration of blaOXA-48 within Tn6237 occurred among E. coli ST38 isolates, especially in the United Kingdom. The detection of Enterobacterales with OXA-48-like enzymes using phenotypic methods has improved recently but remains challenging for clinical laboratories in regions of nonendemicity. Identification of the specific type of OXA-48-like enzyme requires sequencing of the corresponding genes. Bacteria (especially K. pneumoniae and E. coli) with blaOXA-48, blaOXA-181, and blaOXA-232 are emerging in different parts of the world and are most likely underreported due to problems with the laboratory detection of these enzymes. The medical community should be aware of the looming threat that is posed by bacteria with OXA-48-like carbapenemases.

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Section: Geographical Distribution Of Oxa-48mentioning

confidence: 99%

The Global Ascendency of OXA-48-Type Carbapenemases

et al. 2019

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“…Four bla KPC-2 -positive K. pneumoniae isolates were identified in patients from two different hospitals in Singapore the following year [ 19 ]. More recently, bla OXA-48-like -producers have also been described [ 20 ]. Uncommon carbapenemases such as bla IMI-1 and bla OXA-232 have been detected in Enterobacter cloacae and K. pneumonia , respectively [ 21 , 22 ].…”

Section: Epidemiologymentioning

confidence: 99%

Carbapenem Resistance in Gram-Negative Bacteria: The Not-So-Little Problem in the Little Red Dot

et al. 2016

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Singapore is an international travel and medical hub and faces a genuine threat for import and dissemination of bacteria with broad-spectrum resistance. In this review, we described the current landscape and management of carbapenem resistance in Gram-negative bacteria (GNB) in Singapore. Notably, the number of carbapenem-resistant Enterobacteriaceae has exponentially increased in the past two years. Resistance is largely mediated by a variety of mechanisms. Polymyxin resistance has also emerged. Interestingly, two Escherichia coli isolates with plasmid-mediated mcr-1 genes have been detected. Evidently, surveillance and infection control becomes critical in the local setting where resistance is commonly related to plasmid-mediated mechanisms, such as carbapenemases. Combination antibiotic therapy has been proposed as a last-resort strategy in the treatment of extensively drug-resistant (XDR) GNB infections, and is widely adopted in Singapore. The diversity of carbapenemases encountered, however, presents complexities in both carbapenemase detection and the selection of optimal antibiotic combinations. One unique strategy introduced in Singapore is a prospective in vitro combination testing service, which aids physicians in the selection of individualized combinations. The outcome of this treatment strategy has been promising. Unlike countries with a predominant carbapenemase type, Singapore has to adopt management strategies which accounts for diversity in resistance mechanisms.

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“…Additionally, mortality associated with CRE infections is reported to be between 40% and 50% 1 . At Tan Tock Seng Hospital (TTSH), a 1,500-bed teaching hospital in Singapore, we have been practicing a mixture of proactive infection control strategies (eg, screening patients with travel history to CRE endemic countries) and reactive infection control strategies (eg, contact tracing once CRE is identified from clinical cultures) since 2010 2 . However, these activities have not stemmed the rising trend of CP-CREs, particularly the New Delhi metallo-β-lactamase (NDM-1)–producing Enterobacteriaceae .…”

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confidence: 99%

“…1 At Tan Tock Seng Hospital (TTSH), a 1,500-bed teaching hospital in Singapore, we have been practicing a mixture of proactive infection control strategies (eg, screening patients with travel history to CRE endemic countries) and reactive infection control strategies (eg, contact tracing once CRE is identified from clinical cultures) since 2010. 2 However, these activities have not stemmed the rising trend of CP-CREs, particularly the New Delhi metallo-β-lactamase (NDM-1)-producing Enterobacteriaceae. The situation became more pressing in 2013 when a large tertiary care hospital in Singapore witnessed a significant increase in Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae.…”

mentioning

confidence: 99%