Abstract
From January 2014 to December 2014, 972 consecutive non-replicate carbapenemase-producing Enterobacteriaceae isolates from colonised or infected patients were collected at the Associated French National Reference Centre as part of the French national survey on antimicrobial resistance. It included 577 Klebsiella spp. (59%), 236 Escherichia coli (24%), 108 Enterobacter spp. (11%), 50 Citrobacter spp. (5%), and a single Salmonella spp. isolate (0.1%). Of 561 K. pneumoniae isolates, 35 were found to be resistant to colistin (6.2%). PFGE analysis revealed a clonal outbreak involving 15 K. pneumoniae isolates belonging to sequence type ST11, recovered in a single hospital in the Picardie region in northern France. Those clonally related isolates showed variable levels of resistance to colistin, ranging from 4 to 64 mg/L. They harboured the blaOXA-48 carbapenemase gene and the blaCTX-M-15 extended-spectrum beta-lactamase gene. Among the 91 Enterobacter cloacae isolates, seven were resistant to colistin and produced different types of carbapenemases. Surprisingly, none of the E. coli and Citrobacter spp. isolates showed resistance to colistin. This national survey including carbapenemase-producing isolates recovered in 2014 reported a high rate of colistin resistance in K. pneumoniae and E. cloacae (6.2% and 7.7%, respectively) in France.
Highlights
Carbapenemase-producing Enterobacteriaceae (CPE) resistant to colistin are increasingly reported
Fifteen of the 35 colistinresistant K. pneumoniae isolates were recovered from a single hospital in the Picardie region, northern France (Figure 1)
The clone was of the ST11 type, and was susceptible only to cefoxitin, amikacin and fosfomycin (Table 2)
Summary
Carbapenemase-producing Enterobacteriaceae (CPE) resistant to colistin are increasingly reported. They represent an additional link in the development of pan-drug resistance. The epidemiology of colistin resistance among enterobacterial isolates is currently almost unknown in most parts of the world. The lack of information about the prevalence of colistin resistance among multidrug-resistant enterobacterial isolates derives from several reasons: (i) so far, there has been limited interest in that field, (ii) methods used for determination of colistin susceptibility are not adequate, and (iii) the lack of well-defined breakpoints does not allow precise determination of prevalence. The recent identification of a plasmid-borne polymyxin resistance determinant (MCR-1) raised a very serious concern in that resistance to colistin might widely disseminate [2]
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