Active surveillance scheme in three Romanian hospitals reveals a high prevalence and variety of carbapenamase-producing Gram-negative bacteria: a pilot study, December 2014 to May 2015

Abstract

We report the findings of an active surveillance scheme for detection of asymptomatic carriers with carbapenemase-producing Gram-negative bacteria (CP-GNB) in Romanian hospitals. During a pilot study from December 2014 to May 2015, faecal cultures were screened in three hospitals (two large, one medium-size) for patients newly admitted to selected wards or inpatients transferred from other wards to an intensive-care unit. The study revealed a high prevalence of CP-GNB detected in 22/27 and 28/38 of the carbapenem non-susceptible isolates from Hospitals 1 and 3, respectively. CP-GNB identified through faecal screening included NDM-1-producing Serratia marcescens and Klebsiella pneumoniae, OXA-48-producing K. pneumoniae and OXA-23-producing Acinetobacter baumannii. The distribution of the CP-GNB varied between the hospitals, with NDM-1-producing S. marcescens and K. pneumoniae being prevalent in the north-central part of the country and OXA-23/24-producing A. baumannii, OXA-48-producing K.pneumoniae, Morganella morganii and VIM-2-producing Escherichia coli/Pseudomonas aeruginosa detected in the north-east of the country. Conjugation studies showed that carbapenem resistance was transferable and PCR-based replicon typing identified blaNDM-1 on IncFIIs in S. marcescens and K. pneumoniae from Hospital 1 and blaOXA-48 on IncL plasmids in all Klebsiella spp. isolates from Hospitals 1 and 3. Our findings underline the importance of active surveillance for detection of CP-GNB asymptomatic faecal carriers and suggest a likely endemic spread of CP-GNB in Romania.

OXA-48-Carbapenemase-Producing Klebsiella pneumoniae infections - the first cases diagnosed in Romanian National Institute of Infectious Diseases

“…The MIC value for carbapenems is also higher in OXA-48 producers when an ESBL production is associated. (15) Several articles published in the last years signaled the presence of OXA-48 K. pneumoniae isolates starting with 2010 in patients admitted in hospitals from different cities in Romania (16)(17)(18)(19). We described the first cases of OXA-48 K. pneumoniae infections diagnosed in our hospital.…”

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

“…The majority (239/265 [90.2%]) of OXA-48-positive isolates were found to be K. pneumoniae, E. coli, and E. cloacae, with dissemination to the greatest number of additional species observed among isolates from Turkey, one of the main reservoirs of bla OXA-48 (5,6). A total of 64.9% (172/265) of all OXA-48-positive isolates were collected in countries in which endemic (Turkey), interregional (Belgium, France, Romania, and Spain), or regional (Germany and Italy) spread of OXA-48 was recently reported (25,48,49). An additional 27.5% (73/265) of isolates were collected from multiple medical centers in Russia; though limited information regarding the epidemiology of carbapenemase-producing Enterobacteriaceae is available for this country, presumed interspecies and interpatient spread of bla OXA-48 was reported during a 2-year period in a hospital intensive care unit located in Moscow (50).…”

Resistance and Virulence Features in Carbapenem-resistant Acinetobacter baumannii Community Acquired and Nosocomial Isolates in Romania

“…More recently one study from our department highlights a remarkable mobility for bla OXA-23 -Tn2008 and surrounding structures (identified in plasmid or chromosome of different clones) and also describes for the first time the spread of Tnaph6-carrying pACICU2-like plasmids in A. baumannii in Europe [27]. A pilot study from three Romanian hospitals -Iasi and Targu-Mures (2014-2015) demonstrated the presence of carbapenemases OXA-23, OXA-24/72 in A. baumannii nosocomial isolates [38].…”