Browsing by Author "Vatopoulos, A."
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- Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national expertsPublication . Grundmann, H.; Livermore, D.M.; Giske, C.G.; Canton, R.; Rossolini, G.M.; Campos, J.; Vatopoulos, A.; Gniadkowski, M.; Toth, A.; Pfeifer, Y.; Jarlier, V.; Carmeli, Y.; CNSE Working Group
- Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national expertsPublication . Grundmann, H.; Livermore, D. M.; Giske, C. G.; Canton, R.; Rossolini, G. M.; Campos, J.; Vatopoulos, A.; Gniadkowski, M.; Toth, A.; Pfeifer, Y.; Jarlier, V.; Carmeli, Y.; The CNSE Working GroupThe emergence and global spread of carbapenemase-producing Enterobacteriaceae is of great concern to health services worldwide. These bacteria are often resistant to all beta-lactam antibiotics and frequently co-resistant to most other antibiotics, leaving very few treatment options. The epidemiology is compounded by the diversity of carbapenem-hydrolysing enzymes and the ability of their genes to spread between different bacterial species. Difficulties are also encountered by laboratories when trying to detect carbapenemase production during routine diagnostic procedures due to an often heterogeneous expression of resistance. Some of the resistance genes are associated with successful clonal lineages which have a selective advantage in those hospitals where antimicrobial use is high and opportunities for transmission exist; others are more often associated with transmissible plasmids. A genetically distinct strain of Klebsiella pneumoniae sequence type (ST) 258 harbouring the K. pneumoniae carbapenemases (KPC) has been causing epidemics of national and international proportions. It follows the pathways of patient referrals, causing hospital outbreaks along the way. Simultaneously, diverse strains harbouring New Delhi metallo-beta-lactamase (NDM-1) are repeatedly being imported into Europe, commonly via patients with prior medical exposure in the Indian subcontinent. Since the nature and scale of carbapenem-non-susceptible Entrobacteriaceae as a threat to hospital patients in Europe remains unclear, a consultation of experts from 31 countries set out to identify the gaps in diagnostic and response capacity, to index the magnitude of carbapenem-non-susceptibility across Europe using a novel five-level staging system, and to provide elements of a strategy to combat this public health issue in a concerted manner.
- Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational studyPublication . Grundmann, Hajo; Glasner, Corinna; Albiger, Barbara; Aanensen, David M.; Tomlinson, Chris T.; Andrasević, Arjana Tambić; Cantón, Rafael; Carmeli, Yehuda; Friedrich, Alexander W.; Giske, Christian G.; Glupczynski, Youri; Gniadkowski, Marek; Livermore, David M.; Nordmann, Patrice; Poirel, Laurent; Rossolini, Gian M.; Seifert, Harald; Vatopoulos, Alkiviadis; Walsh, Timothy; Woodford, Neil; Monnet, Dominique L.; EuSCAPE Working Group; Koraqi, A..; Lacej, D.; Apfalter, P.; Hartl, R.; Glupczynski, Y.; Huang, T.D.; Strateva, T; Marteva-Proevska, Y.; Tambic, Andrasevic A.; Butic, I.; Pieridou-Bagatzouni, D.; Maikanti-Charalampous, P.; Hrabak, J.; Zemlickova, H.; Hammerum, A.; Jakobsen, L.; Ivanova, M.; Pavelkovich, A.; Jalava, J.; Österblad, M.; Dortet, L.; Vaux, S.; Kaase, M.; Gatermann, S.G.; Vatopoulos, A.; Tryfinopoulou, K.; Tóth, A.; Jánvári, L.; Boo, T.W.; McGrath, E.; Carmeli, Y.; Adler, A.; Pantosti, A.; Monaco, M.; Raka, L.; Kurti, A.; Balode, A.; Saule, M.; Miciuleviciene, J.; Mierauskaite, A.; Perrin -Weniger, M.; Reichert, P.; Nestorova, N.; Debattista, S.; Mijovic, G.; Lopicic, M.; Samuelsen, Ø.; Haldorsen, B.J.; Żabicka, D.; Literacka, E.; Caniça, M.; Manageiro, V.; Kaftandzieva, A.; Trajkovska-Dokic, E.; Damian, M.; Lixandru, B.; Jelesic, Z.; Trudic, A.; Niks, M.; Schreterova, E.; Pirs, M.; Cerar, T.; Oteo, J.; Aracil, B.; Giske, C.; Sjöström, K.; Gür, D.; Cakar, A.; Woodford, N.; Hopkins, K.; Wiuff, C.; Brown, D.J.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.