Increase in cases of carbapenem-resistant E. coli carrying the blaNDM-5 gene, EU/EEA countries
EU/EEA countries are reporting an increased number of Escherichia coli (E. coli) isolates carrying the blaNDM-5 gene that makes them resistant to carbapenems, antibiotics that are often used as last resort to treat serious E. coli infections.
While in the EU/EEA, carbapenem resistance in E. coli has so far been very low, the results from this study indicate that E. coli strains carrying blaNDM-5 are already established and represent a new threat for EU/EEA countries.
Furthermore, a high proportion of the E. coli isolates carrying blaNDM-5 are also resistant to other groups of antibiotics such as aminoglycosides, fluoroquinolones and trimethoprim-sulfamethoxazole, which further limits the number of options for the treating patients with these E. coli infections, both in healthcare and in the community.
The ECDC report Increase in Escherichia coli isolates carrying blaNDM-5 in the European Union/European Economic Area, 2012–2022 analysed 874 E. coli isolates carrying blaNDM-5, from 13 EU/EEA countries. Despite limited completeness of data, nearly 85% of the isolates with available information on travel and/or hospitalisation were linked to countries outside of the EU/EEA, mainly in Africa and Asia.
While this suggests that travel-related acquisition may be the most likely origin of these E. coli isolates, there are a few examples of clusters of closely related isolates that could potentially be related to within-country transmission.
E. coli carrying blaNDM-5 are spreading rapidly and on a large geographical scale, and there is a risk that the number of cases of carbapenem-resistant E. coli infections will increase in the EU/EEA within a few years. Further spread of E. coli isolates carrying blaNDM-5 within and between EU/EEA countries, particularly within/between healthcare facilities, would increase the health-related and economic burden of E. coli infections in the EU/EEA.
Early detection and control measures need to be further strengthened to mitigate the adverse consequences for patients and healthcare systems.
E. coli are very common bacteria in the gastrointestinal tract, and part of the normal bacterial flora in humans but are also a common cause of severe infections. It is the most frequent cause of bloodstream infections and urinary tract infections in the EU/EEA and is involved in infections of both community and healthcare origin. In addition, it is associated with intra-abdominal infections and can cause neonatal meningitis.
Each year more than 35 000 people die from antimicrobial-resistant infections in the EU/EEA, according to ECDC estimates. The health impact of antimicrobial resistance (AMR) is comparable to that of influenza, tuberculosis and HIV/AIDS combined.