Abstract
The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) is increasing worldwide. Here we present associated patient data and molecular, epidemiological and phenotypic characteristics of all CPE isolates in Norway from 2007 to 2014 confirmed at the Norwegian National Advisory Unit on Detection of Antimicrobial Resistance. All confirmed CPE isolates were characterized pheno- and genotypically, including by whole genome sequencing (WGS). Patient data were reviewed retrospectively. In total 59 CPE isolates were identified from 53 patients. Urine was the dominant clinical sample source (37%) and only 15% of the isolates were obtained from faecal screening. The majority of cases (62%) were directly associated with travel or hospitalization abroad, but both intra-hospital transmission and one inter-hospital outbreak were observed. The number of CPE cases/year was low (2–14 cases/year), but an increasing trend was observed. Klebsiella spp. (n = 38) and E. coli (n = 14) were the dominant species and blaKPC (n = 20), blaNDM (n = 19), blaOXA-48-like (n = 12) and blaVIM (n = 7) were the dominant carbapenemase gene families. The CPE isolates were genetically diverse except for K. pneumoniae where clonal group 258 associated with blaKPC dominated. All isolates were multidrug-resistant and a significant proportion (21%) were resistant to colistin. Interestingly, all blaOXA-48-like, and a large proportion of blaNDM-positive Klebsiella spp. (89%) and E. coli (83%) isolates were susceptible in vitro to mecillinam. Thus, mecillinam could have a role in the treatment of uncomplicated urinary tract infections caused by OXA-48- or NDM-producing E. coli or K. pneumoniae. In conclusion, the impact of CPE in Norway is still limited and mainly associated with travel abroad, reflected in the diversity of clones and carbapenemase genes.
Highlights
Carbapenemase-producing Enterobacteriaceae (CPE) have emerged as a global public health concern during the last two decades [1, 2]
Of the 53 patients, four had multiple CPE isolates belonging to different species or different sequence type (ST)
A third had blaNDM-1-positive E. coli and E. cloacae complex isolates identified in two different specimens within a one-month period
Summary
Carbapenemase-producing Enterobacteriaceae (CPE) have emerged as a global public health concern during the last two decades [1, 2]. CPE isolates are usually multidrug-resistant (MDR) or even extensively- or pandrug-resistant (XDR/PDR), resulting in limited antibiotic treatment options [1, 3, 4]. Due to the lack of effective therapy, CPE infections have been associated with high mortality rates [5, 6]. Colistin and various combination regimens are generally used for treatment of CPE infections. High rates of colistin resistance among CPE have been observed in certain regions [7, 8]. Colistin resistance is often mutation-based, plasmid-mediated colistin resistance has been described [9,10,11,12,13,14], and observed in CPE isolates [11, 15,16,17]
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