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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. FUNDING:European Centre for Disease Prevention and Control.

Original publication

DOI

10.1016/s1473-3099(16)30257-2

Type

Journal article

Journal

The Lancet. Infectious diseases

Publication Date

02/2017

Volume

17

Pages

153 - 163

Addresses

Department of Infection Prevention and Hospital Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Netherlands. Electronic address: hajo.grundmann@uniklinik-freiburg.de.

Keywords

European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Working Group, Humans, Escherichia coli, Klebsiella pneumoniae, Escherichia coli Infections, Klebsiella Infections, beta-Lactamases, Bacterial Proteins, Anti-Bacterial Agents, Prevalence, Prospective Studies, Drug Resistance, Microbial, Europe, Surveys and Questionnaires