Abstract
The emergence and spread of carbapenemase-producing Enterobacteriaceae (CPE) represent a major public health concern because these bacteria are usually extensively resistant to most antibiotics. In order to evaluate their dissemination in Quebec, a surveillance program was introduced in 2010. We report the molecular and epidemiological profiles of CPE isolates collected. Between August 2010 and December 2012, a total of 742 non-duplicate isolates non-susceptible to carbapenems were analysed. AmpC β-lactamase and metallo-β-lactamase production were detected by Etest and carbapenemase production by the modified Hodge test (MHT). Antibiotic susceptibility profiles were determined using broth microdilution or Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC) strains was analyzed by pulsed-field gel electrophoresis (PFGE). The presence of genes encoding carbapenemases as well as other β-lactamases was detected using PCR. Of the 742 isolates tested, 169 (22.8%) were CPE. Of these 169 isolates, 151 (89.3%) harboured a bla KPC gene while the remaining isolates carried bla SME (n = 9), bla OXA-48 (n = 5), bla NDM (n = 3), and bla NMC (n = 1) genes. Among the 93 KPC strains presenting with a unique pattern (unique PFGE pattern and/or unique antibiotics susceptibility profile), 99% were resistant to ertapenem, 95% to imipenem, 87% to meropenem, 97% to aztreonam, 31% to colistin and 2% to tigecycline. In 19 patients, 2 to 5 KPC strains from different species or with a different PFGE pattern were isolated. CPE strains were present in the province of Quebec with the majority of strains harbouring KPC. Alternately, SME, OXA-48 and NMC containing strains were rarely found.
Highlights
Carbapenems are bactericidal antibiotics of the β-lactam family
The emergence of carbapenemase-producing Enterobacteriaceae (CPE) is a major health concern because these bacteria are resistant to multiple classes of antibiotics that can lead to therapeutic failure [1]
Enterobacteriaceae harbouring carbapenemases belong to one of three classes according to the Ambler classification system [2]: class A serine β-lactamases (i.e. Klebsiella pneumoniae carbapenemase [KPC], Serratia marcescens enzyme [SME], not metalloenzyme carbapenemase [NMC]), class B metallo-β-lactamase (i.e. New Delhi metallo-beta-lactamase [NDM]) and the class D oxacillinase
Summary
Carbapenems (i.e. ertapenem, meropenem, imipenem, doripenem) are bactericidal antibiotics of the β-lactam family. The emergence of carbapenemase-producing Enterobacteriaceae (CPE) is a major health concern because these bacteria are resistant to multiple classes of antibiotics that can lead to therapeutic failure [1]. Carbapenem resistance has been associated with different mechanisms including carbapenemase production, overexpression of chromosomal AmpC and porin mutations or ESBL production combined to porin mutations. Carbapenemase genes are known to have chromosomal or plasmid localization [2]. Bacterial transmission of carbapenemase genes is related to the transfer of mobile genetic elements such as plasmids or transposons [2] thereby facilitating outbreaks
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