Abstract
We report the findings of an active surveillance scheme for detection of asymptomatic carriers with carbapenemase-producing Gram-negative bacteria (CP-GNB) in Romanian hospitals. During a pilot study from December 2014 to May 2015, faecal cultures were screened in three hospitals (two large, one medium-size) for patients newly admitted to selected wards or inpatients transferred from other wards to an intensive-care unit. The study revealed a high prevalence of CP-GNB detected in 22/27 and 28/38 of the carbapenem non-susceptible isolates from Hospitals 1 and 3, respectively. CP-GNB identified through faecal screening included NDM-1-producing Serratia marcescens and Klebsiella pneumoniae, OXA-48-producing K. pneumoniae and OXA-23-producing Acinetobacter baumannii. The distribution of the CP-GNB varied between the hospitals, with NDM-1-producing S. marcescens and K. pneumoniae being prevalent in the north-central part of the country and OXA-23/24-producing A. baumannii, OXA-48-producing K.pneumoniae, Morganella morganii and VIM-2-producing Escherichia coli/Pseudomonas aeruginosa detected in the north-east of the country. Conjugation studies showed that carbapenem resistance was transferable and PCR-based replicon typing identified blaNDM-1 on IncFIIs in S. marcescens and K. pneumoniae from Hospital 1 and blaOXA-48 on IncL plasmids in all Klebsiella spp. isolates from Hospitals 1 and 3. Our findings underline the importance of active surveillance for detection of CP-GNB asymptomatic faecal carriers and suggest a likely endemic spread of CP-GNB in Romania.
Highlights
The worldwide emergence of carbapenemase-producing Gram-negative bacteria (CP-GNB) is widely accepted as a major public health threat that has caused international concern
PCR showed that no extended spectrum beta-lactamases (ESBLs)-resistance determinants had co-transferred with the carbapenem-resistance genes. This pilot study demonstrated a high prevalence of CP-GNB in two of three Romanian hospitals over a six-month period
The distribution of the CP-GNB varied between the two hospitals in which these bacteria were detected: NDM-1-producing S. marcescens and K. pneumoniae were prevalent in Hospital 1, in the north-central part of the country, but were not identified in Hospital 3, in the north-east
Summary
The worldwide emergence of carbapenemase-producing Gram-negative bacteria (CP-GNB) is widely accepted as a major public health threat that has caused international concern. The epidemiology of CP-GNB in Europe varies between northern and southern countries. A European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE) among national experts from 39 European countries in 2013 showed that carbapenemase-producing Enterobacteriaceae (CPE) were continuing to spread in Europe, with Klebsiella pneumoniae carbapenemase (KPC)-producing isolates having the widest distribution and the number of OXA-48-producing isolates continuing to rise [2]. NDM-1-producing isolates are sporadically reported, mainly from the United Kingdom (UK) [2]. The same report found that 30 of the 39 European countries had a dedicated surveillance system for CPE and 22 of the countries had national recommendations or specific guidelines for infection control [2]; Romania does not have such a surveillance system or CPE infection control guidelines
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