Prevalence of carbapenem resistance and carbapenemase production among Enterobacteriaceae isolated from urine in the UK: results of the UK infection-Carbapenem Resistance Evaluation Surveillance Trial (iCREST-UK)

Woodford, Neil; Xu-McCrae, Li; Mushtaq, Shazad; Wu, Houdini H.T.; Ellington, Matthew J.; Lancaster, Owen; Davies, Frances; Donaldson, Hugo; Rao, G. Gopal; Verma, Anita; Wareham, David W.; Ciesielczuk, Holly; Stone, Gregory G.; Irani, Paurus; Bracher, Simon; Hawkey, Peter M.

doi:10.1093/jac/dkx471

Cited by 15 publications

(14 citation statements)

References 8 publications

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“…In Wales, IMP, NDM, VIM, KPC and OXA-48-like (known as the "big five") are the carbapenemases predominantly identified and consistent with those found in the rest of the UK: in particular, IMP, NDM, KPC and OXA-48-like in Enterobacteriales [2] and VIM in Pseudomonas species [3]. Phenotypic assays employing inhibitors for the different enzymes are available for the detection of some carbapenemases.…”

Section: Introductionmentioning

confidence: 58%

Rapid detection of IMP, NDM, VIM, KPC and OXA-48-like carbapenemases from Enterobacteriales and Gram-negative non-fermenter bacteria by real-time PCR and melt-curve analysis

Mentasti

Prime

Sands

et al. 2019

Eur J Clin Microbiol Infect Dis

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Carbapenemase producing microorganisms are increasingly isolated and often associated with treatment failures and outbreaks. The need for reliable and timely detection and/or confirmation of carbapenemase production is paramount, therefore a real-time PCR assay targeting IMP, NDM, VIM, KPC and OXA-48-like carbapenemases was designed and validated. All available allele variants of the above carbepenmases were downloaded from the Beta-Lactamase DataBase (http://bldb.eu/), aligned with Clustal Omega and primers designed using Primer-BLAST. Real-time PCR monoplexes were optimized for the QuantStudio 6-Flex (Applied Biosystems) using the PowerUp SYBR Green Master Mix (Life Technologies) and validated using a panel of 204 characterised strains carrying a wide range of beta-lactamases, sometimes in combination. Melt-curve analysis was used to confirm positive results. The in silico approach allowed primers to be designed in conserved regions of the KPC and NDM alignments, while three primer sets for IMP and two for VIM were necessary to ensure amplification of the different variants. One primer set was designed for OXA-48-like, however it is unlikely to detect all variants. Expected results were obtained for all 204 tested strains, with 100% sensitivity and specificity. Melt-curve analysis showed consistent Tm results for KPC, NDM and OXA-48-like; differences were instead noted for IMP and VIM as likely consequence of higher variability in the PCR target regions. Inhibition was not observed. The assay is rapid, easy to perform and implement. It enables unequivocal detection of IMP, NDM, VIM, KPC and OXA-48-like carbapenemases even when more than one type is present simultaneously.

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Section: Introductionmentioning

confidence: 58%

Rapid detection of IMP, NDM, VIM, KPC and OXA-48-like carbapenemases from Enterobacteriales and Gram-negative non-fermenter bacteria by real-time PCR and melt-curve analysis

Mentasti

Prime

Sands

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…Data regarding important CRE studies in Taiwan and other countries are shown in Table 1 . There were big variations in the rates of CPE among clinical CRE isolates in Taiwan as compared to those from other countries ( Lorenzoni et al, 2017 ; Woodford et al, 2017 ; Laolerd et al, 2018 ). It is notable that persistently high KPC-2 rates (73.9% in 2012, and 61.1% in 2015) and emergence of KPC-17 as well as KPC-34 since 2014 were observed ( Chiu et al, 2018 ).…”

Section: Prevalence and Mortality Rates Of Carbapenemase-producing Enmentioning

confidence: 88%

Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects

et al. 2018

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Carbapenem-resistant Enterobacteriaceae (CRE), a major resistance concern emerging during the last decade because of significantly compromising the efficacy of carbapenem agents, has currently become an important focus of infection control. Many investigations have shown a high association of CRE infections with high case-fatality rates. In Taiwan, a few surveys observed that a significant proportion (29–47%) of the CR-Klebsiella pneumoniae isolates harbored a plasmidic allele encoding K. pneumoniae carbapenemases (KPC, especially KPC-2). A significant increase in the number of oxacillinase (OXA)-48-like carbapenemases among CR-K. pneumoniae isolates was observed between 2012 and 2015. By striking contrast, isolates of CR-Escherichia coli and CR-Enterobacter species in Taiwan had a much lower percentage of carbapenemase production than CR-K. pneumoniae isolates. This differs from isolates found in China as well as in the India subcontinent. Apart from the hospital setting, CRE was also cultured from the inpatients from communities or long-term care facilities (LTCF). Therefore, implementation of regular CRE screening of LTCF residents, strict disinfectant use in nursing homes and hospital settings, and appropriate control of antibiotic prescriptions is suggested to alleviate the spread of clinical CRE isolates in Taiwan. Although there are some promising new antibiotics against CRE, such as ceftazidime-avibactam, meropenem-vaborbactam, aztreonam-avibactam and cefiderocol, these agents are not available in Taiwan currently. Therefore, in order to effectively decrease case-fatality rates among patients with the infections owing to carbapenemase-producing CRE isolates, combination antibiotic schemes, including colistin (or amikacin) and/or tigecycline in combination with an anti-pseudomonal carbapenem agent, remain the mainstay for treating clinical CRE infections.

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“…Especially OXA-48-like enzymes are weak carbapenemases and the strains having bla OXA-48-like genes can have very low carbapenem MICs. However, also these kinds of strains seem to be very rare [8,19,20].…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012–2018

Räisänen

Lyytikäinen

Kauranen

et al. 2020

Eur J Clin Microbiol Infect Dis

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Carbapenemase-producing Enterobacterales (CPE) pose an increasing threat to patient safety and healthcare systems globally. We present molecular epidemiology of CPE in Finland during 2012-2018 with detailed characteristics of CPE strains causing clusters during the same time period. All Finnish clinical microbiology laboratories send Enterobacterales isolates with reduced susceptibility to carbapenems or isolates producing carbapenemase to the reference laboratory for further characterization by whole genome sequencing (WGS). In total, 231 CPE strains from 202 patients were identified during 2012-2018. Of the strains, 59% were found by screening and 32% from clinical specimens, the latter were most commonly urine. Travel and/or hospitalization history abroad was reported for 108/171 strains (63%). The most common species were Klebsiella pneumoniae (45%), Escherichia coli (40%), and Citrobacter freundii (6%), and the most common carbapenemase genes bla NDM-like (35%), bla OXA-48-like (33%), and bla KPC-like (31%). During 2012-2018, the annual number of CPE strains increased from 9 to 70 and different sequence types from 7 to 33, and bla OXA-48-like genes became the most prevalent. Of the clusters, 3/8 were linked to traveling or hospitalization abroad and 5/8 were caused by K. pneumoniae clone clonal complex 258. Most of the clusters were caused by K. pneumoniae producing KPC. High variety among different sequence types indicates that majority of CPE cases detected in Finland are likely imported from foreign countries. Nearly one-third of the cases are not found by screening suggesting that there is hidden transmission occurring in the healthcare settings.

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Prevalence of carbapenem resistance and carbapenemase production among Enterobacteriaceae isolated from urine in the UK: results of the UK infection-Carbapenem Resistance Evaluation Surveillance Trial (iCREST-UK)

Cited by 15 publications

References 8 publications

Rapid detection of IMP, NDM, VIM, KPC and OXA-48-like carbapenemases from Enterobacteriales and Gram-negative non-fermenter bacteria by real-time PCR and melt-curve analysis

Rapid detection of IMP, NDM, VIM, KPC and OXA-48-like carbapenemases from Enterobacteriales and Gram-negative non-fermenter bacteria by real-time PCR and melt-curve analysis

Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012–2018

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