Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae , 2010 to 2014

Abstract

Carbapenemase-producing Enterobacteriaceae (CPE) are increasing globally; here we report on the investigation of CPE in Canada over a 5-year period. Participating acute care facilities across Canada submitted carbapenem-nonsusceptible Enterobacteriaceae from 1 January 2010 to 31 December 2014 to the National Microbiology Laboratory. All CPE were characterized by antimicrobial susceptibilities, pulsed-field gel electrophoresis, multilocus sequence typing, and plasmid restriction fragment length polymorphism analysis and had patient data collected using a standard questionnaire. The 5-year incidence rate of CPE was 0.09 per 10,000 patient days and 0.07 per 1,000 admissions. There were a total of 261 CPE isolated from 238 patients in 58 hospitals during the study period. blaKPC-3 (64.8%) and blaNDM-1 (17.6%) represented the highest proportion of carbapenemase genes detected in Canadian isolates. Patients who had a history of medical attention during international travel accounted for 21% of CPE cases. The hospital 30-day all-cause mortality rate for the 5-year surveillance period was 17.1 per 100 CPE cases. No significant increase in the occurrence of CPE was observed from 2010 to 2014. Nosocomial transmission of CPE, as well as international health care, is driving its persistence within Canada.

Diverse Mechanisms of Resistance in Carbapenem-Resistant Enterobacteriaceae at a Health Care System in Silicon Valley, California

“…The CP-CRE rate of 38.7% among all CRE at our institution is comparable to 47.9% reported for metropolitan areas in 7 U.S. states, including Oregon and Colorado, but much lower than 81.7% reported by an academic health system in Los Angeles (31). Unlike all other North American institutions where KPC predominates as the most common carbapenemase among CP-CRE isolates (7, 29, 31–33), at our institution CP-CRE were evenly caused by KPC (20.8%), OXA-48 like (25.0%), NDM (20.8%), and SME (20.8%), and less commonly by IMP (8.3%) and VIM (4.2%). The reason for non-predominance of KPC at our health system may be in part due to the geographic location of our institution in the Silicon Valley where high-tech industry draws people from major cities around the globe where different plasmid-encoded carbapenemases are endemic.…”

Enterobacter cloacae Complex Isolates Harboring bla NMC-A or bla IMI -Type Class A Carbapenemase Genes on Novel Chromosomal Integrative Elements and Plasmids

“…Results from the Canadian Nosocomial Infection Surveillance Program showed only four NMC-A/IMI-type producers isolated in participating acute care hospitals between 2010 and 2014 (20). One limitation of that study, however, is that isolates were submitted voluntarily and NMC-A/IMI prevalence may be underestimated.…”

Plasmid evolution in carbapenemase‐producing Enterobacteriaceae: a review

“…Additionally, GES‐5 has been described in Pseudomonas spp. and Enterobacteriaceae , and has been widely reported in South America, with a few reports in Canada, the Czech Republic, Turkey, Portugal, South Africa, and South Korea . Other GES variants are also reported, although rarely …”

“…KPC‐2 was commonly associated with multiple STs, but ST258 was the most prevalent in the United States. The IncF groups dominate in the spread of KPC‐2 and KPC‐3 in the United States and other countries, including Australia, Canada, China, Italy, Romania, and Spain Only one study has reported on IncF groups in KPC‐3 in Portugal and Romania . Few occurrences were also reported in other countries, including the United States, Mexico, and Spain.…”