New genomic surveillance studies reveal circulation of multidrug-resistant Enterobacterales in Europe
Two studies published in Eurosurveillance marking European Antibiotic Awareness Day and World AMR Awareness Week raise the alarm about the spread of bacteria resistant to carbapenems in both healthcare and community settings across Europe.
Escherichia coli lineage with emerging resistance pattern spreads in the community
A data analysis from 17 European Union and European Economic Area (EU/EEA) countries shows an increasing spread of the carbapenem-resistant bacteria Escherichia coli sequence type (ST)131.
Worldwide, E. coli is the pathogen associated with the most deaths attributable to antimicrobial resistance, and the specific type of E. coli ST 131 is frequently associated with multi-drug resistance.
The study analysed epidemiological data of almost 600 E. coli ST131 isolates provided by national reference laboratories from Austria, Belgium, Czechia, Denmark, Finland, France, Hungary, Ireland, Germany, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Portugal, Slovenia and Sweden.
One group of isolates stood out for potential association with urinary tract infections in the community due to the relatively low median age of patients (57 years), a high proportion of female patients and the frequent detection of isolates from urine samples. These data suggest there is a much wider spread of carbapenem-resistant Enterobacterales infections in the community in the EU/EEA. Further spread of carbapenem-resistant E. coli would mean that these antibiotics could no longer be consistently effective for empiric treatment of severe E. coli infections.
Sustained transmission of carbapenem-resistant Providencia stuartii in the healthcare system
One type of carbapenem-resistant Enterobacterales that has been very rare in Europe to date – New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Providencia stuartii – has now been detected in several hospitals in Romania.
Most of the retrieved isolates were related to reported healthcare-associated infections, such as lower respiratory tract infections, bloodstream infections or urinary tract infections.
Given their resistance to several antibiotic classes like penicillins, cephalosporins and carbapenems, 90% of the tested isolates in this study were categorised as multidrug-resistant. The study identified four multi-hospital clusters of such resistant isolates detected over a year. This indicates sustained transmission within Romania’s healthcare system over a longer period.
Comparing this with data from other countries, the study connected the specific lineage of P. stuartii detected in Romania to isolates found in other countries, including Bulgaria, France, Germany, Ireland, the Netherlands, Switzerland, the United Kingdom and the United States.
The combination of sustained transmission in hospitals in Romania and spread internationally point to a high risk of further transmission of NDM-1-producing P. stuartii in healthcare settings. Healthcare facilities should therefore put in place enhanced infection prevention and control measures as soon as cases are detected in their facilities.
Background
Enterobacterales are a group of bacteria (germs) that are a normal part of the human and animal gut but that can also cause infections. Carbapenem-resistant Enterobacterales are multidrug-resistant bacteria, thus resistant to multiple antibiotics, including a last-line group of antibitioics called carbapenems.
