Rapid emergence of carbapenemase-producing Enterobacteriaceae isolates in Belgium

Huang, Te-Din; Bogaerts, Pierre; Berhin, Catherine; Jans, Béatrice; Deplano, Ariane; Denis, Olivier; Glupczynski, Youri

doi:10.2807/ese.16.26.19900-en

Cited by 20 publications

(17 citation statements)

References 7 publications

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“…These results clearly confirm the trends observed in the national surveillance programme showing that K. pneumoniae was by far the most encountered CPE species and OXA-48 the most frequent carbapenemase in Belgium. 4,5 All PCR-negative CNSE isolates did not hydrolyse imipenem by the Carba NP assay, thus excluding the expression of carbapenemases not targeted (or not detected) by our multiplex PCR assay. Resistance to b-lactams, including carbapenems, among these non-CPE strains presumably resulted from AmpC hyperproduction (n¼85, including 8 ESBL positive), ESBL production (n¼ 17) and other b-lactamases (n¼ 10) in association with impaired permeability due to porin deficiency.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and mechanisms of resistance to carbapenems in Enterobacteriaceae isolates from 24 hospitals in Belgium

Berhin

Bogaerts

Caddrobi

et al. 2013

Journal of Antimicrobial Chemotherapy

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Objectives: To determine the point prevalence of carbapenem-non-susceptible Enterobacteriaceae (CNSE) and carbapenemase-producing Enterobacteriaceae (CPE) isolates among hospitalized patients in Belgium.Methods: Twenty-four hospital-based laboratories prospectively collected 200 non-duplicated Enterobacteriaceae isolates from clinical specimens of hospitalized patients over a 2 month period. All isolates were screened locally for decreased susceptibility to carbapenem drugs using a disc diffusion method according to CLSI interpretative criteria. CNSE strains were referred centrally for confirmation of carbapenemase by phenotypic and molecular testing.Results: From February to April 2012, 158 of the 4564 screened Enterobacteriaceae isolates were categorized as non-susceptible to carbapenems, resulting in a point prevalence of CNSE of 3.5% (95% CI: 2.9% -4.2%; range per centre: 0.5% -8.5%). Of the 125 referred CNSE isolates, 11 Klebsiella pneumoniae isolates [OXA-48 (n¼ 7), KPC type (n¼ 3) and NDM type (n¼ 1)], 1 OXA-48-positive Escherichia coli isolate and 1 KPC-positive Klebsiella oxytoca isolate were detected in eight hospitals. None of the 72 carbapenem-non-susceptible Enterobacter spp. isolates were confirmed as CPE. The minimal estimated point prevalence of CPE isolates was 0.28% (13/ 4564; 95% CI: 0.13% -0.44%) overall (range per centre: 0%-1.5%).Conclusions: Despite the overall low prevalence of CNSE found in this study, the detection of CPE isolates in one-third of the participating centres raises concerns and highly suggests the spread and establishment of CPE in Belgian hospitals.

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Section: Resultsmentioning

confidence: 99%

“…3,4 In Belgium, a rapid increase in the number of CPE has been observed since 2010. 5 The present cross-sectional survey aimed to estimate the prevalence of carbapenem-non-susceptible Enterobacteriaceae (CNSE) isolates and CPE isolates collected in Belgian hospitals.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and mechanisms of resistance to carbapenems in Enterobacteriaceae isolates from 24 hospitals in Belgium

Berhin

Bogaerts

Caddrobi

et al. 2013

Journal of Antimicrobial Chemotherapy

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“…Many of these cases were no longer related to travel abroad nor healthcare associated, thereby suggesting the rapid autochthonous spread of CPE strains in Belgium. 6 Nevertheless, we should remain alert with respect to the potential importance of travellers as an at risk group as demonstrated by the results of the recent VOYAG-R study. 7 Between February 2012 and March 2013, the authors of this study examined the risk factors for acquisition of CPE and ESBLE among 574 travellers, back from travel in a foreign country (America: n5183 travellers, Africa: n5195, and the Middle East and Southeast Asia: n5196, including 57 having travelled in India).…”

Section: Introductionmentioning

confidence: 99%

Infection due to travel-related carbapenemase-producingEnterobacteriaceae, a largely underestimated phenomenon in Belgium

Jans

Huang

Bauraing

et al. 2015

Acta Clinica Belgica

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Background: Carbapenemase-producing Enterobacteriaceae (CPE) are emerging worldwide, representing a major threat for public health. Early CPE detection is crucial in order to prevent infections and the development of reservoirs/outbreaks in hospitals. In 2008, most of the CPE strains reported in Belgium were imported from patients repatriated from abroad. Actually, this is no longer the case. Objectives and methods: A surveillance was set up in Belgian hospitals (2012) in order to explore the epidemiology and determinants of CPE, including the link with international travel/hospitalization. The present article describes travel-related CPE reported in Belgium. Different other potential sources for importation of CPE are discussed. Results: Only 12% of all CPE cases reported in Belgium (2012Belgium ( -2013 were travel related (with/without hospitalization). This is undoubtedly an underestimation (missing travel data: 36%), considering the increasing tourism, the immigration from endemic countries, the growing number of foreign patients using scheduled medical care in Belgium, and the medical repatriations from foreign hospitals. The free movement of persons and services (European Union) contributes to an increase in foreign healthcare workers (HCW) in Belgian hospitals. Residents from nursing homes located at the country borders can be another potential source of dissemination of CPE between countries. Moreover, the high population density in Belgium can increase the risk for CPE-dissemination. Urban areas in Belgium may cumulate these potential risk factors for import/dissemination of CPE. Conclusions: Ideally, travel history data should be obtained from hospital hygiene teams, not from the microbiological laboratory. Patients who received medical care abroad (whatever the country) should be screened for CPE at admission.

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“…However, they do not respond to the cited work by Jefferson [3] that ''the data on the seasonal influenza are similarly weak and the estimates of disease frequency, mortality, and case fatality are vague. Consequently, the effectiveness of seasonal influenza vaccination campaigns and of antiviral medications is more than questionable [3]''.…”

mentioning

confidence: 59%

Re: Nicoll A, Sprenger M. Learning lessons from the 2009 pandemic: putting infections in their proper place. Eur J Epidemiol 2011; 26:191–194

Keil

Schönhöfer²,

Spelsberg³

2011

Eur J Epidemiol

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Rapid emergence of carbapenemase-producing Enterobacteriaceae isolates in Belgium

Cited by 20 publications

References 7 publications

Prevalence and mechanisms of resistance to carbapenems in Enterobacteriaceae isolates from 24 hospitals in Belgium

Prevalence and mechanisms of resistance to carbapenems in Enterobacteriaceae isolates from 24 hospitals in Belgium

Infection due to travel-related carbapenemase-producingEnterobacteriaceae, a largely underestimated phenomenon in Belgium

Re: Nicoll A, Sprenger M. Learning lessons from the 2009 pandemic: putting infections in their proper place. Eur J Epidemiol 2011; 26:191–194

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