631. Laboratory Surveillance of Carbapenem-Resistant Enterobacteriaceae in an Endemic Country, Greece, 2015–2018

Abstract

BackgroundGreece is facing an endemic situation with carbapenem-resistant pathogens in the hospital sector. The Central Public Health Laboratory (CPHL) is the main laboratory for the surveillance of the carbapenem resistance mechanisms, accepting resistant isolates from hospitals on a voluntary basis. The aim of the present study is to evaluate the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) isolated in Greek hospitals the period 2014–2018 and their susceptibility to other antibiotic classes.MethodsA total of 843 CRE isolates (741 Klebsiella spp., 47 Enterobacter spp., 35 Escherichia coli, and 20 others) have been submitted from 36 hospitals throughout the country (Figure 1) to the CPHL. They originated from different clinical specimens (295 urine, 157 blood, and 107 other) or surveillance cultures (185 rectal and 23 pharyngeal swabs) or unknown (n = 76). Carbapenemase genes were detected by PCR targeting blaKPC, blaNDM, blaVIM, and bla OXA-48. Resistance to aminoglycosides and fluoroquinolones was tested with the disk diffusion method according to EUCAST guidelines.ResultsThe isolates were found positive for several carbapenemase genes (Table 1). Overall, KPC-2 (36%) was the predominant carbapenemase, followed by the metalloenzymes NDM (28%) and VIM (18%) while OXA-48 ranked fourth (7%). KPC enzyme was predominant among Klebsiella spp isolates followed by NDM, whereas among Enterobacter, E.coli, and other species, the VIM metalloenzyme predominated. Simultaneous detection of two carbapenemase genes was found in 30 (4%) isolates: 14 blaKPC/blaVIM, 4 blaKPC/blaNDM, 1 blaKPC/blaOXA-48, 5 blaNDM/blaVIM, 5 blaNDM/blaOXA-48, and 1 blaVIM/blaOXA-48. In 63 isolates (7%), the carbapenem resistance was attributed to other mechanisms, mainly production of ESBL or AmpC plus porin loss. In total, 590 (70%) CRE isolates exhibited a multidrug-resistant phenotype being simultaneously resistant to aminoglycosides and fluoroquinolones.ConclusionThe CRE isolates’ diversity, regarding bacterial species, carbapenemase types and combinations and their temporal and spatial distribution mandate a more structured, continuous laboratory surveillance to monitor the ongoing carbapenem and multidrug resistance evolution and inform infection control and public health actions. Disclosures All authors: No reported disclosures