Increasing proportion of carbapenemase-producing Enterobacteriaceae and emergence of a MCR-1 producer through a multicentric study among hospital-based and private laboratories in Belgium from September to November 2015

Abstract

Carbapenemase-producing Enterobacteriaceae (CPE) strains have been increasingly reported in Belgium. We aimed to determine the proportion of CPE among Enterobacteriaceae isolated from hospitalised patients and community outpatients in Belgium in 2015. For the hospitalised patients, the results were compared to a previous similar survey performed in the same hospitals in 2012. Twenty-four hospital-based and 10 private laboratories collected prospectively 200 non-duplicated Enterobacteriaceae isolates from clinical specimens. All isolates were screened locally by carbapenem disk diffusion using European Committee on Antimicrobial Susceptibility Testing methodology. Putative CPE strains with inhibition zone diameters below the screening breakpoints were referred centrally for confirmation of carbapenemase production. From September to November 2015, we found a proportion of clinical CPE of 0.55% (26/4,705) and of 0.60% (12/1,991) among hospitalised patients and among ambulatory outpatients respectively. Klebsiella pneumoniae (26/38) and OXA-48-like carbapenemase (28/38) were the predominant species and enzyme among CPE. One OXA-48-producing Escherichia coli isolated from a hospital was found carrying plasmid-mediated MCR-1 colistin resistance. Compared with the 2012 survey, we found a significant increased proportion of clinical CPE (0.55% in 2015 vs 0.25% in 2012; p = 0.02) and an increased proportion of hospitals (13/24 in 2015 vs 8/24 in 2012) with at least one CPE detected. The study results confirmed the concerning spread of CPE including a colistin-resistant MCR-1 producer in hospitals and the establishment of CPE in the community in Belgium.

Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016

“…The Greek situation differs greatly from other European countries such as Spain, France, Germany, Turkey, Romania and Belgium, where OXA-48, most often linked with community-onset healthcare associated sources, is the most frequently encountered carbapenemase [26,[28][29][30][31].…”

In Vitro Activity of Ceftazidime-Avibactam and Aztreonam-Avibactam against OXA-48-Carrying Enterobacteriaceae Isolated as Part of the International Network for Optimal Resistance Monitoring (INFORM) Global Surveillance Program from 2012 to 2015

“…It is important to know the local prevalences of OXA-48 and OXA-48-like ␤-lactamases among clinical isolates so that infections caused by isolates with a higher MIC value for a carbapenem, even if the MIC does not cross the threshold of "resistant," should be considered for treatment options other than carbapenems. Therapeutic options available for treating infections caused by carbapenem-resistant Enterobacteriaceae are often limited to older agents, often with impaired safety profiles, such as aminoglycosides, tigecycline, fosfomycin, and polymyxins (8); in this light, recent reports of colistin-resistant OXA-48-producing isolates are very concerning (67)(68)(69)(70). This study also showed an increased incidence of colistin resistance in OXA-48-producing isolates, with 21.3% of the isolates being nonsusceptible to colistin, compared to only 17% for all Enterobacteriaceae.…”

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

“…More recently, plasmid-mediated resistance (mediated by mcr genes) was discovered (292). While the association between mcr genes and carbapenemase production is anecdotal so far (293)(294)(295)(296)(297)(298), the association of these genes with successful mobile genetic elements or clones, together with the use of colistin in veterinary and human medicine leading to increased selection pressure, is a cause for concern. Furthermore, susceptibility testing with colistin is problematic: broth microdilution methods are recommended because diffusion tests are not reliable (66), and semiautomated methods may cause very major errors (as explained at http://www.eucast.org/ast_of_bacteria/ warnings/ [accessed 22 October 2017]).…”