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CP-producing K. pneumoniae, E. coli more prevalent in Mediterranean, Balkan hospitals
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Carbapenemase-producing Klebsiella pneumoniae and Escherichia coli showed substantial discrepancies in prevalence from country to country, a survey of more than 450 European hospitals revealed, with the greatest prevalence occurring in Mediterranean and Balkan countries.
Researchers wrote that the survey showed “encouraging commitment by all participants” for the containment of carbapenemase-producing Enterobacteriaceae infections.
“Few alternative antibiotics remain, and although resistance can extend even to agents still in development or recently approved, public health efforts are beginning to emphasize containment of CPE in populations and health care networks,” Hajo Grundmann, MD, of the department of medical microbiology at the University Medical Center Groningen, Netherlands, and colleagues wrote. “This requires an understanding of the geographical distribution of CPE infections, their population reservoirs and the risk factors for acquisition. However, there is little internationally comparable data.”
Researchers recruited hospitals with diagnostic capacities to collect samples and relay data back to national hospitals for the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE). Four hundred fifty-five hospitals in 36 countries submitted 2,703 isolates of K. pneumoniae and E. coli between Nov. 1, 2013 and April 30, 2014. Twenty-seven European Union states participated, as well as Israel, six EU enlargement countries and two European Economic Area countries. Scotland participated on its own behalf, rather than as part of the United Kingdom.
K. pneumoniae represented the most samples (n = 2,301), while 402 were E. coli. Thirty-seven percent of K. pneumoniae samples (n = 850) and 19% (n = 77) of E. coli samples were carbapenemase producers, researchers reported. Using population-weighted averages, Grundmann and colleagues estimated that the overall prevalence of carbapenemase-producing K. pneumoniae or E. coli infection was 1.3 patients per 10,000 admissions and 2.5 patients per 100,000 hospital patient-days. Researchers described Greece, Spain, Serbia, Italy and Montenegro as “high-incidence countries.”
In an accompanying editorial, Edward J. Feil, of the Milner Centre for Evolution at the University of Bath, U.K., wrote that “the delivery of new classes of antibiotics has all but dried up over the last 40 years,” and that new disease management strategies were “urgently needed.
“The design and validation of such strategies is, however, crucially dependent on sentinel epidemiological data,” Feil wrote. “Crucially, an initial phase of [Grundmann and colleagues’] study focused on capacity building and standardization across multiple national expert laboratories.”
Feil pointed out that all facilities in the study were trained to work to agreed-upon standards.
“The EuSCAPE network has laid much of the groundwork and fostered considerable collaborative spirit; the onus is now on European public health bodies and funding agencies to ensure this momentum is at least maintained, and ideally expanded, for future surveys.” – by Andy Polhamus
Disclosure: Grundmann and Feil report no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.
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