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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