Molecular and epidemiological characterization of carbapenemase-producing Enterobacteriaceae in Norway, 2007 to 2014

• Published in: PloS one Vol. 12; no. 11; p. e0187832
• Main Authors: Samuelsen, Ørjan, Overballe-Petersen, Søren, Bjørnholt, Jørgen Vildershøj, Brisse, Sylvain, Doumith, Michel, Woodford, Neil, Hopkins, Katie L, Aasnæs, Bettina, Haldorsen, Bjørg, Sundsfjord, Arnfinn
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.11.2017; Public Library of Science (PLoS)
• Subjects: Amdinocillin; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Bacteria; Bacterial Proteins - biosynthesis; Bacteriology; Basale medisinske, odontologiske og veterinærmedisinske fag: 710; Basic medical, dental and veterinary science disciplines: 710; beta-Lactamases - biosynthesis; Biodiversity; Biology; Biology and Life Sciences; Carbapenemase; Cloning; Colistin; Cross Infection - epidemiology; Cross Infection - microbiology; Disease control; Disease Outbreaks; Disease transmission; Dominant species; Drug resistance; E coli; Enterobacteriaceae; Enterobacteriaceae - classification; Enterobacteriaceae - drug effects; Enterobacteriaceae - enzymology; Enterobacteriaceae - genetics; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Enzymes; Epidemics; Epidemiology; Escherichia coli; Gene families; Gene sequencing; Genetic aspects; Genomes; Gram-negative bacteria; Health aspects; Health surveillance; History, 21st Century; Hospitals; Humans; Klebsiella; Klebsiella pneumoniae; Laboratories; Life Sciences; Medical disciplines: 700; Medical ethics; Medical microbiology: 715; Medicine and Health Sciences; Medisinsk mikrobiologi: 715; Medisinske Fag: 700; Microbial Sensitivity Tests; Microbiology and Parasitology; Mortality; Multidrug resistance; Norway - epidemiology; Nosocomial infections; Outbreaks; People and Places; Phenotypes; Phylogeny; Plasmids; Public health; Retrospective Studies; Santé publique et épidémiologie; Travel; Urinary tract; Urine; VDP; Norway; Arctic region
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0187832

The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) is increasing worldwide. Here we present associated patient data and molecular, epidemiological and phenotypic characteristics of all CPE isolates in Norway from 2007 to 2014 confirmed at the Norwegian National Advisory Unit on Detection of Antimicrobial Resistance. All confirmed CPE isolates were characterized pheno- and genotypically, including by whole genome sequencing (WGS). Patient data were reviewed retrospectively. In total 59 CPE isolates were identified from 53 patients. Urine was the dominant clinical sample source (37%) and only 15% of the isolates were obtained from faecal screening. The majority of cases (62%) were directly associated with travel or hospitalization abroad, but both intra-hospital transmission and one inter-hospital outbreak were observed. The number of CPE cases/year was low (2-14 cases/year), but an increasing trend was observed. Klebsiella spp. (n = 38) and E. coli (n = 14) were the dominant species and blaKPC (n = 20), blaNDM (n = 19), blaOXA-48-like (n = 12) and blaVIM (n = 7) were the dominant carbapenemase gene families. The CPE isolates were genetically diverse except for K. pneumoniae where clonal group 258 associated with blaKPC dominated. All isolates were multidrug-resistant and a significant proportion (21%) were resistant to colistin. Interestingly, all blaOXA-48-like, and a large proportion of blaNDM-positive Klebsiella spp. (89%) and E. coli (83%) isolates were susceptible in vitro to mecillinam. Thus, mecillinam could have a role in the treatment of uncomplicated urinary tract infections caused by OXA-48- or NDM-producing E. coli or K. pneumoniae. In conclusion, the impact of CPE in Norway is still limited and mainly associated with travel abroad, reflected in the diversity of clones and carbapenemase genes.