Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Hajo Grundmann, Corinna Glasner, Barbara Albiger, David M. Aanensen, Chris T. Tomlinson, Arjana Tambić Andrasević, Rafael Cantón, Yehuda Carmeli, Alexander W. Friedrich, Christian G. Giske, Youri Glupczynski, Marek Gniadkowski, David M. Livermore, Patrice Nordmann, Laurent Poirel, Gian M. Rossolini, Harald Seifert, Alkiviadis Vatopoulos, Timothy Walsh, Neil WoodfordDominique L. Monnet, European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Working Group

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Abstract

Background: Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals.

Methods: National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis.

Findings: Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] K pneumoniae and 402 (15%) E coli). 850 (37%) of 2301 K pneumoniae samples and 77 (19%) of 402 E coli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1. 1·3 patients per 10 000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics.

Interpretation: This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Enterobacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks.
Original languageEnglish
Pages (from-to)153–163
Number of pages11
JournalThe Lancet Infectious Diseases
Volume17
Issue number2
Early online date17 Nov 2016
DOIs
Publication statusPublished - Feb 2017

Keywords

  • carbapenemase
  • Klebsiella pneumoniae
  • Escherichia coli
  • Epidemiology
  • Europe
  • Surveillance
  • Public Health

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