Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals High In Vitro Susceptibility to Colistin and Meropenem

Abstract

hospitals (about 40,000 hospital beds) prospectively collected nonduplicate Enterobacteriaceae using the screening cutoff recommended by EUCAST. Carbapenemase characterization was performed by phenotypic methods and confirmed by PCR and sequencing. Multilocus sequencing types (MLST) were determined for Klebsiella pneumoniae and Escherichia coli. A total of 702 Enterobacteriaceae isolates met the inclusion criteria; 379 (54%) were CPE. OXA-48 (71.5%) and VIM-1 (25.3%) were the most frequent carbapenemases, and K. pneumoniae (74.4%), Enterobacter cloacae (10.3%), and E. coli (8.4%) were the species most affected. Susceptibility to colistin, amikacin, and meropenem was 95.5%, 81.3%, and 74.7%, respectively. The most prevalent sequence types (STs) were ST11 and ST405 for K. pneumoniae and ST131 for E. coli. Forty-five (54.1%) of the hospitals had at least one CPE case. For K. pneumoniae, ST11/OXA-48, ST15/OXA-48, ST405/ OXA-48, and ST11/VIM-1 were detected in two or more Spanish provinces. ST11 isolates carried four carbapenemases (VIM-1, OXA-48, KPC-2, and OXA-245), but ST405 isolates carried OXA-48 only. A wide interregional spread of CPE in Spain was observed, mainly due to a few successful clones of OXA-48-producing K. pneumoniae (e.g., ST11 and ST405). The dissemination of OXA-48-producing E. coli is a new finding of public health concern. According to the susceptibilities determined in vitro, most of the CPE (94.5%) had three or more options for antibiotic treatment. C arbapenemase-producing Enterobacteriaceae (CPE), mainly Klebsiella pneumoniae, are an emerging threat to public and individual health worldwide. These microorganisms are often resistant to almost all available antibiotics (1, 2), so there are few alternative treatment options. The most common carbapenemases are KPC (class A); VIM, IMP, and NDM (class B); and the OXA-48 types (class D). However, the extent to which health care systems have been affected and the carbapenemase types that are predominant differ substantially from country to country (3).A multicenter study performed in Spain in 2009 revealed 43 (0.04%) cases of CPE, which were mostly VIM-1 and IMP-22 (4). After that, we reported a rapid increase in the number of cases of CPE, mainly OXA-48-producing K. pneumoniae, in this country from 2010 to 2012 (5-7).Because previous studies (5, 6) were based on voluntary reports without taking into account key important issues, in this paper, we present data on the impact of CPE as obtained from a prospective, multicenter, and population-based study. We show that carbapenemase production in this country is widely and irregularly distributed; however, the rates of susceptibility to meropenem and colistin were still high.(The preliminary results of this study were presented in part at the 24th European Congress of Clinical Microbiology and Infectious Diseases Annual Meeting, 10 to 13 May 2014 in Barcelona, Spain,).

Molecular Characterization of Escherichia coli Strains Isolated from Retail Meat That Harbor bla CTX-M and fosA3 Genes

“…Since virulent organisms causing infections are mainly known to belong to group B2, and to a lesser extent to group D, whereas most commensal strains belong to groups B1 and A (38), our data indicate that most of the transferable isolates tested in this study belonged to commensal strains. This finding is therefore consistent with previous reports in that commensal E. coli strains in food animals were likely to be a reservoir of ESBL genes (24) and to play a role in dissemination of such resistance (41). Various other reports also showed that ST156 was detected in water and animals (42)(43)(44).…”

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

“…ST11 with bla OXA-48 has recently been identified in Spain (67). Other STs also belonging to CC258 with bla KPC have been reported in Colombia (ST512), Italy (ST512), Israel (ST512), Spain (ST512), Brazil (ST340), and Greece (ST340) (18,68).…”

“…This global ST has also been associated with bla NDM (70) and bla OXA-181 (71) in various countries, including Switzerland, Iraq, Canada, the United Kingdom, India, and Italy. ST14, ST25, and ST340 with bla NDM-1 have been identified in India, Kenya, and Oman (72), and ST405 with OXA-48 has been identified in Spain (67).…”

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

“…CPE have been implicated in hospital outbreaks and have the propensity to spread (or disseminate their plasmids) rapidly at local, regional, and international levels. [10][11][12][13][14][15] We provide comprehensive survey results on the occurrence of carbapenemase-producing K pneumoniae and E coli between Nov, 2013, and April, 2014, from 455 hospitals in 34 European countries plus Turkey and Israel, together serving more than 270 million citizens out of a total population of 600 million. During the course of this investigation, NELs successfully expanded their capacity and adjusted workfl ows to accommodate new diagnostic tests.…”