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

Räisänen, Kati; Lyytikäinen, Outi; Kauranen, Jari; Tarkka, Eveliina; Forsblom-Helander, Benita; Grönroos, Juha O.; Vuento, Risto; Arifulla, Dinah; Sarvikivi, Emmi; Toura, Saija; Jalava, Jari

doi:10.1007/s10096-020-03885-w

Cited by 18 publications

(9 citation statements)

References 19 publications

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“…Hospitalization abroad during the preceding two months was the main risk factor for CPE in the Netherlands. This finding was also observed in many (mainly Northern European) countries [ 19 , 20 , 23 ]. Turkey and Morocco were the most frequently reported countries, which is not surprising since the majority of Dutch citizens with a migration background originate from these countries [ 25 ] and might still often visit relatives there.…”

Section: Discussionsupporting

confidence: 72%

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

Wielders

Schouls

Woudt

et al. 2022

Antimicrob Resist Infect Control

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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.

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Section: Discussionsupporting

confidence: 72%

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

Wielders

Schouls

Woudt

et al. 2022

Antimicrob Resist Infect Control

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“…About 70% of the individuals infected with Carba-GNB in 2012 were travelers returning from foreign countries, mostly from Asia or southern Europe ( Räisänen et al, 2020 ). Among the most frequent clinical bla CARBA gene types ( Supplementary Figure S1 ), bla KPC is endemic in the United States, bla NDM is endemic in South Asia, and bla OXA-48 is endemic in South Asia and northern Africa ( Nordmann and Poirel, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical cases of bla NDM type of infection increased rapidly after the year 2011 and bla KPC types of infection after 2015 ( Supplementary Figure S1 ). The first clinical isolates of bla KPC in Finland were reported in 2009 and were reported each year between 2012 and 2018 ( Räisänen et al, 2020 ). The clinically reported bla CARBA genes bla NDM , bla OXA-48 , bla OXA-181 , bla VIM , and bla NMC-A during the year 2011–2012 were not detected in wastewater.…”

Section: Discussionmentioning

confidence: 99%

Wastewater Surveillance Detected Carbapenemase Enzymes in Clinically Relevant Gram-Negative Bacteria in Helsinki, Finland; 2011–2012

et al. 2022

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Antimicrobial resistance profiling of pathogens helps to identify the emergence of rare or new resistance threats and prioritize possible actions to be taken against them. The analysis of wastewater (WW) can reveal the circulation of antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARG) among the catchment communities. Here, we analyzed WW influent samples to determine the prevalence of carbapenemase genes-carrying Gram-negative bacteria (Carba-GNB) in Helsinki, Finland. This study set important historical reference points from the very early stage of the carbapenemase era, during the period 2011–2012. A total of 405 bacterial isolates grown on CHROMagarKPC (n = 195) and CHROMagarESBL (n = 210) from WW influent samples were collected between October 2011 and August 2012 and were analyzed. The bacterial DNA from the isolates was extracted, and the prevalence of carbapenemases genes blaKPC, blaNDM, blaGES, blaOXA-48, blaIMP, blaIMI, and blaVIM were screened with multiplexed PCR. All carbapenemase-positive isolates were identified taxonomically to species or genus level with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The nucleic acid extraction was successful for 399 isolates, of which 59 (14.8%) were found to carry carbapenemase genes. A total of 89.8% of the carbapenemase positive isolates (53 out of 59) were obtained from CHROMagarKPC plates and only 10.2% (six out of 59) were obtained from CHROMagar ESBL plates. Among the Carba-GNB isolates, 86.4% were blaGES (51 out of 59), 10.2% were blaKPC (six out of 59), and 3.4% were blaVIM (two out of 59). The most common carba-gene, blaGES, was carried by 10 different bacterial species, including Aeromonas spp., Enterobacter spp., and Kluyvera spp.; the blaKPC gene was carried by Escherichia coli, Klebsiella pneumoniae, and Kluyvera cryocescens; and the blaVIM gene was carried by Aeromonas hydrophila/caviae and Citrobacter amalonaticus. This study emphasizes that wastewater surveillance (WWS) can be an additional tool for monitoring antimicrobial resistance (AMR) at the population level.

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“…Moreover, the two hospitals, J and K, both part of the University Central Hospital of the capital of Finland, showed the highest sum of relative abundance of the seven carbapenemase genes among all HWW samples in this study. These results are somewhat surprising as, to date, Finland is known as one of the countries with the lowest level of bacterial resistance in Europe and globally 53 and the carbapenemase-producing strains detected in Finnish hospitals are relatively rare and typically associated with international travel or hospitalization 54 .…”

Section: Discussionmentioning

confidence: 98%

Metagenomic analysis of the abundance and composition of antibiotic resistance genes in hospital wastewater in Benin, Burkina Faso, and Finland

Markkanen

Haukka

Pärnänen

et al. 2021

Preprint

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Antimicrobial resistance (AMR) is one of the greatest global threats to human health, but substantial gaps in AMR data exist in West African countries. To obtain in-depth data, we explored the presence of antimicrobial resistance genes (ARGs) in the hospital wastewaters (HWW) of nine hospitals in Benin and Burkina Faso and, for comparison, of four hospitals in Finland. The highest total relative abundance of ARGs in HWWs was observed in Benin and the lowest in Finland. HWW resistomes were more similar to each other in Benin and Burkina Faso than in Finland. Different clinically relevant carbapenemases were detected in varying abundances, especially in HWWs from Burkina Faso and Finland. The most widespread carbapenemase gene in the Beninese hospitals, blaGES, was also found in water used for handwashing. blaNDM was present in the HWW of one Beninese hospital and was also detected in the stools of a hospitalized patient. Mobile colistin ARGs were detected in the HWWs of all the three studied countries, with mcr-5 variants being the most common. These and other mcr genes were observed in very high abundance in treated wastewater released into rivers in Burkina Faso. In Benin, only little is done to treat wastewaters, including HWWs. The results provide evidence for public health decision-makers in Benin and Burkina Faso for the dire need to increase wastewater treatment capacity, with particular attention to HWWs.SynopsisMetagenomic analysis of HWWs revealed high abundances of ARGs and their potential transmission to other environments in Benin and Burkina Faso.

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

Cited by 18 publications

References 19 publications

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

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

Wastewater Surveillance Detected Carbapenemase Enzymes in Clinically Relevant Gram-Negative Bacteria in Helsinki, Finland; 2011–2012

Metagenomic analysis of the abundance and composition of antibiotic resistance genes in hospital wastewater in Benin, Burkina Faso, and Finland

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