Epidemiology of carbapenem-resistant and carbapenemase-producing Enterobacterales in the Netherlands 2017–2019

Abstract

Background The Netherlands is currently considered a low endemic country for carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE), experiencing only sporadic hospital outbreaks. This study aims to describe susceptibility to carbapenems and the epidemiology of carbapenemase production in Enterobacterales in the Netherlands in 2017–2019. Methods Three complementary nationwide surveillance systems are in place to monitor carbapenem susceptibility in the Netherlands. Routine antimicrobial susceptibility test results from medical microbiology laboratories were used to study phenotypic susceptibility of Escherichia coli and Klebsiella pneumoniae. Pathogen surveillance (of all Enterobacterales species) and mandatory notifications were used to describe the characteristics of CPE positive isolates and affected persons. Results The prevalence of isolates with gradient strip test-confirmed elevated meropenem (> 0.25 mg/L) or imipenem (> 1 mg/L) minimum inhibitory concentration (MIC) in the Netherlands was very low in 2017–2019, with percentages of 0.06% in E. coli and 0.49% in K. pneumoniae, and carbapenem resistances of 0.02% and 0.18%, respectively. A total of 895 unique species/carbapenemase-encoding allele combinations of CPE from 764 persons were submitted between 2017 and 2019, with the annual number of submissions increasing slightly each year. Epidemiological data was available for 660 persons. Screening because of presumed colonisation risk was the reason for sampling in 70.0% (462/660) of persons. Hospitalization abroad was the most common risk factor, being identified in 45.9% of persons. Conclusions Carbapenem resistance of E. coli and K. pneumoniae remains low in the Netherlands. The annual number of CPE isolates slightly increased during the period 2017–2019. Recent hospitalization abroad is the main risk factor for acquisition of CPE.

Multidrug-resistant organisms in patients from Ukraine in the Netherlands, March to August 2022

“…In the Netherlands, a risk factor for acquisition of MDRO is recent hospitalisation abroad [1,4]. We a Based on the notifications in the national mandatory notification system.…”

“…Adding the two extra patients without submitted isolate, the total number of patients was 58. Isolates were characterised phenotypically (matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-ToF), carbapenem inactivation method and Etest for meropenem) [ 2 , 9 ] and genetically (whole genome (wg) sequencing, multilocus sequence typing (MLST) and wgMLST) [ 10 ], and metadata were collected during submission for CPPA, CRAB and MRSA, or through the national mandatory notification system for CPE [ 1 , 4 ]. Isolates and notifications were considered Ukraine-associated when the epidemiological questionnaire indicated that the patient had recently been hospitalised in Ukraine (< 2 months ago for > 24 h) or had contact with a Ukrainian hospital or visited Ukraine < 1 year before sampling.…”

“…In the Netherlands, a risk factor for acquisition of MDRO is recent hospitalisation abroad [ 1 , 4 ]. We included a figure on mandatory CPE notifications from 2019 to 2022 in Supplementary Figure S1 .…”

“…The Netherlands is a country with a low prevalence of multidrug-resistant organisms (MDRO), including carbapenemase-producing Enterobacterales (CPE), carbapenemase-producing Pseudomonas aeruginosa (CPPA), carbapenem-resistant Acinetobacter baumannii complex (CRAB) and meticillinresistant Staphylococcus aureus (MRSA) [1][2][3][4]. Active MDRO screening and infection prevention measures (e.g.…”

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

“…Interestingly, identification of CRE from Japan is still scarce with 0.5% meropenem resistance in K. pneumoniae [ 24 ]. Similarly, much lower CR among E. coli (0.02%) and K. pneumoniae (0.18%) reported from Netherlands [ 81 ]. On the other hand, variable range of imipenem resistance in P. aeruginosa was observed worldwide, including in China (33.2%), India (29.6%), Japan (8.0%), Italy (28.5%), Turkey (43.3%), Ukraine (54.7%), United States (21.4%) and Kuwait (44.7%) [ 82 ].…”