Abstract
IntroductionIn contrast to countries where carbapenemase-producing Enterobacterales (CPE) are endemic, only sporadic cases were reported in Switzerland until 2013. An aggravation of the epidemiological situation in neighbouring European countries indicated the need for a surveillance study in Switzerland.AimWe aimed to describe CPE distributions in Switzerland and identify epidemiological factors associated with changes in incidence.MethodsData on all human CPE isolates from 2013 to 2018 were collected by the Swiss Centre for Antibiotic Resistance (ANRESIS) and analysed for temporal and regional trends by Generalised Poisson regression. Isolates associated with infection or colonisation were included in a primary analysis; a secondary analysis included invasive isolates only. Statistical detection of regional clusters was performed with WHONET/SaTScan.ResultsWe analysed 731 CPE isolates, of which 325 (44.5%) were associated with screenings and 173 (23.7%) with infections. Yearly detection of CPE isolates increased considerably during the study period from 65 to 212. The most frequently isolated species were Klebsiella pneumoniae (54%) and Escherichia coli (28%). The most frequent genotypes were OXA-48 (43%), KPC (21%) and NDM (14%). In contrast to the French-speaking parts of Switzerland (West, Geneva) where OXA-48 were the predominant genotypes (around 60%), KPC was the most frequently detected genotype in the Italian-speaking region (63%). WHONET/SaTScan outbreak detection analysis identified seven clusters in five regions of Switzerland.ConclusionsIn a first continuous surveillance of CPE in Switzerland, we found that the epidemiological situation aggravated nationwide and that regional patterns of CPE genotypes mirrored the situation in neighbouring European countries.
Highlights
In contrast to countries where carbapenemase-producing Enterobacterales (CPE) are endemic, only sporadic cases were reported in Switzerland until2013
Endemicity was reported for Greece and Italy, Verona integron–encoded metalloβ-lactamase (VIM) has been extensively reported in southern Europe, predominantly in Greece, interregional New Delhi metallo-β-lactamase (NDM) spread has been reported in Poland, Romania and Denmark, and OXA-48 is endemic in Turkey and Malta and widespread in some western European countries (Belgium, France, Spain) [8,9]
Control (Swissnoso) published hospital hygiene recommendations in 2017 that specified to perform screenings only for patients who had been hospitalised in foreign countries in the previous 12 months or for individuals with direct contact with CPE carriers [17]
Summary
In contrast to countries where carbapenemase-producing Enterobacterales (CPE) are endemic, only sporadic cases were reported in Switzerland until2013. In contrast to countries where carbapenemase-producing Enterobacterales (CPE) are endemic, only sporadic cases were reported in Switzerland until. There are large differences regarding surveillance activities and reporting of different carbapenemase genotypes in different regions: KPC endemicity was reported for Greece and Italy, VIM has been extensively reported in southern Europe, predominantly in Greece, interregional NDM spread has been reported in Poland, Romania and Denmark, and OXA-48 is endemic in Turkey and Malta and widespread in some western European countries (Belgium, France, Spain) [8,9]. KPC [11] and OXA-48 [12] strains were identified one year later All these reported cases were associated with single occurrences, without evidence of local spread, and were judged as likely introductions via patients from countries with endemic CPE.
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