Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) are increasing globally; here we report on the investigation of CPE in Canada over a 5-year period. Participating acute care facilities across Canada submitted carbapenem-nonsusceptible Enterobacteriaceae from 1 January 2010 to 31 December 2014 to the National Microbiology Laboratory. All CPE were characterized by antimicrobial susceptibilities, pulsed-field gel electrophoresis, multilocus sequence typing, and plasmid restriction fragment length polymorphism analysis and had patient data collected using a standard questionnaire. The 5-year incidence rate of CPE was 0.09 per 10,000 patient days and 0.07 per 1,000 admissions. There were a total of 261 CPE isolated from 238 patients in 58 hospitals during the study period. blaKPC-3 (64.8%) and blaNDM-1 (17.6%) represented the highest proportion of carbapenemase genes detected in Canadian isolates. Patients who had a history of medical attention during international travel accounted for 21% of CPE cases. The hospital 30-day all-cause mortality rate for the 5-year surveillance period was 17.1 per 100 CPE cases. No significant increase in the occurrence of CPE was observed from 2010 to 2014. Nosocomial transmission of CPE, as well as international health care, is driving its persistence within Canada.
Highlights
Gram-negative organisms account for 5 of the top 10 most common bacterial organisms isolated from patients in Canadian hospitals, with Enterobacteriaceae representing 33.8% of isolates [1]
The global dissemination of NDM since its discovery in 2009 [24] and the current emergence of OXA-48-type carbapenemase outside regions where it is endemic since its discovery in 2003 [16] have highlighted the global emergence and dissemination of carbapenemase-producing Enterobacteriaceae (CPE) and the need for surveillance
In spite of increased global incidence of carbapenem-resistant Enterobacteriaceae (CRE), the current study from a national surveillance network in Canada reports a rate of 0.07 CPE/1,000 admissions or 0.09 CPE per 10,000 admissions, with no significant increase over the 5 years
Summary
Gram-negative organisms account for 5 of the top 10 most common bacterial organisms isolated from patients in Canadian hospitals, with Enterobacteriaceae representing 33.8% of isolates [1]. Enterobacteriaceae are implicated in both communityand hospital-acquired infections. Their plasticity and persistence can be attributed to the ease in which they are transferred (contaminated food, water, environmental surfaces, and hand carriage). The increase in carbapenem-resistant Enterobacteriaceae (CRE) is predominantly due to the acquisition of carbapenemase genes residing on mobile genetic elements [2]
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