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28.04.2016 | Original Article | Ausgabe 7/2016

European Journal of Clinical Microbiology & Infectious Diseases 7/2016

Detection and epidemiology of carbapenemase producing Enterobacteriaceae in the Netherlands in 2013–2014

Zeitschrift:
European Journal of Clinical Microbiology & Infectious Diseases > Ausgabe 7/2016
Autoren:
A. L. M. Vlek, D. Frentz, A. Haenen, H. J. Bootsma, D. W. Notermans, F. N. J. Frakking, S. C. de Greeff, T. Leenstra, ISIS-AR study group
Wichtige Hinweise
Members of the ISIS-AR study group are shown at the end of the manuscript.

Members of the ISIS-AR study group

J.W.T. Cohen Stuart, Department of Medical Microbiology, Medical Center Alkmaar
A.J.L. Weersink, Department of Medical Microbiology, Meander Medical Center Amersfoort
M.L. van Ogtrop, Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis Amsterdam
D.J. Kaersenhout, Department of Medical Microbiology, Slotervaart Hospital / Netherlands Cancer Institute Amsterdam
B.C. van Hees, Department of Medical Microbiology, Gelre Hospitals Apeldoorn
R.G.F. Wintermans, Department of Medical Microbiology, Lievensberg Hospital Bergen op Zoom
J. Alblas, W. Altorf-van der Kuil, D. Frentz, S.C. de Greeff, J. van Heereveld, R. Hertroys, T. Leenstra, J.C. Monen, D.W. Notermans, S.H. Woudt, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
P.H.J. van Keulen, Laboratory for Microbiology and Infection Control, Amphia Hospital Breda
J.A.J.W. Kluytmans, Laboratory for Microbiology and Infection Control, Amphia Hospital Breda
E.M. Kraan, Department of Medical Microbiology, Ijsselland Hospital Capelle a/d Ijssel
E.E. Mattsson, Department of Medical Microbiology, Diagnostic Centre SSDZ Delft
F.W. Sebens, Department of Medical Microbiology, Deventer Hospital Deventer
B. Postma, Department of Medical Microbiology, Slingeland Hospital Doetinchem
H.M.E. Frénay, Department of Medical Microbiology, Albert Schweitzer Hospital Dordrecht
B. Maraha, Department of Medical Microbiology, Albert Schweitzer Hospital Dordrecht
A.J. van Griethuysen, Department of Medical Microbiology, Gelderse Vallei Hospital Ede
A. Halaby, Laboratory of Medical Microbiology and Public Health Enschede
A. Demeulemeester, SHL-groep Etten-Leur
D. Versteeg, Department of Medical Microbiology, Admiraal de Ruyter Hospital Goes
M.G.R. Hendrix, Certe Laboratory for Infectious Diseases Groningen
A. Ott, Certe Laboratory for Infectious Diseases Groningen
B. Diederen, Regional Laboratory of Public Health Haarlem
C. Hol, Department of Medical Microbiology, St Jansdal Hospital Harderwijk
E.I.G.B. de Brauwer, Department of Medical Microbiology, Atrium MC Parkstad Heerlen
F.S. Stals, Department of Medical Microbiology, Atrium MC Parkstad Heerlen
L.J. Bakker, Department of Medical Microbiology, CBSL, Tergooi Hospital Hilversum
J.W. Dorigo-Zetsma, Department of Medical Microbiology, CBSL, Tergooi Hospital Hilversum
J.H. van Zeijl, Centre for Infectious Diseases Friesland Leeuwarden
A.T. Bernards, Department of Medical Microbiology, Leiden University Medical Center Leiden
B.M. de Jongh, Department of Medical Microbiology and Immunology, St Antonius Hospital Nieuwegein
B.J.M. Vlaminckx, Department of Medical Microbiology and Immunology, St Antonius Hospital Nieuwegein
M. Nabuurs-Franssen, Department of Medical Microbiology, Canisius Wilhelmina Hospital Nijmegen
S. Kuipers, Department of Medical Microbiology, Radboud University Medical Center Nijmegen
D.C. Melles, Department of Medical Microbiology, Erasmus University Medical Center Rotterdam
M. van Rijn, Department of Medical Microbiology, Ikazia Hospital Rotterdam
P. de Man, Department of Medical Microbiology, Franciscus Vlietland Hospital Rotterdam
B.G. Moffie, Department of Medical Microbiology, Franciscus Vlietland Hospital Rotterdam
R.W. Brimicombe, Department of Medical Microbiology, Haga Hospital ‘s-Gravenhage
C.L. Jansen, Department of Medical Microbiology, MCH Westeinde Hospital ‘s-Gravenhage
M.A. Leversteijn-van Hall, Department of Medical Microbiology and Infection Control, Alrijne Zorggroep / Bronovo Hospital ‘s-Gravenhage
N. Renders, Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital ‘s-Hertogenbosch
D.W. van Dam, Department of Medical Microbiology and Infection Control, Zuyderland Medical Centre Sittard-Geleen
B.G.A. Hendrickx, Department of Medical Microbiology, ZorgSaam Hospital Terneuzen
A.G.M. Buiting, Department of Medical Microbiology, St. Elisabeth Hospital Tilburg
M.P.D. Deege, Department of Medical Microbiology, Saltro Diagnostic Centre Utrecht
M.B. Ekkelenkamp, Department of Medical Microbiology, University Medical Centre Utrecht
F.N.J. Frakking, Department of Medical Microbiology, University Medical Centre Utrecht
A.L.M. Vlek, Department of Medical Microbiology and Immunology, Diakonessenhuis Utrecht
I. Overdevest, Department of Medical Microbiology, PAMM Veldhoven
A.A. van Zwet, Laboratory for Medical Microbiology and Immunology, Rijnstate Hospital Velp
G.P. Voorn, Department of Medical Microbiology, Zuwe Hofpoort Hospital Woerden
G.J.H.M. Ruijs, Laboratory of Medical Microbiology and Infectious Diseases, Isala Hospital Zwolle
M.J.H.M. Wolfhagen, Laboratory of Medical Microbiology and Infectious Diseases, Isala Hospital Zwolle

Abstract

Laboratory detection of carbapenemase-producing Enterobacteriaceae (CPE) is complicated. Screening with MIC values below clinical breakpoints followed by genotypic confirmation is recommended. We evaluated the application of recommended CPE screening and confirmation methods and provide an overview of CPE epidemiology in E. coli and K. pneumoniae in the Netherlands. Data on E. coli and K. pneumoniae isolates with elevated meropenem (>0.25 mg/L) and/or imipenem (>1 mg/L) MIC values in 2013–2014 were selected from the Infectious Disease Surveillance Information System for Antibiotic Resistance. Laboratories were requested to provide additional results of any confirmatory testing performed. Confirmation of elevated carbapenem MIC values using gradient testing was performed in 59.8 % of eligible isolates. Confirmatory testing showed elevated MIC values in 8 % of E. coli and 32 % of K. pneumoniae isolates. The overall proportion of confirmed non-susceptible E. coli and K. pneumoniae was 0.01 % and 0.16 %, respectively. Genotypic confirmation was performed in 61.0 % of isolates with confirmed elevated carbapenem MIC values. A carbapenemase gene was identified in 47 % of E. coli and 65 % of K. pneumoniae isolates. OXA-48, NDM and KPC were the most frequently found carbapenemase genes. The majority (62 %) of CPE isolates was detected through targeted screening. CPE are a rare finding in the Netherlands. Adherence to the national guideline is suboptimal and differs between laboratories, implying a risk of inadequate CPE detection. Since accurate identification of CPE is the first step in prevention of CPE spread, successful implementation of guidelines for testing and reporting of CPE is essential.

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