Carbapenem-resistant Gram-negative bacilli in Canada 200910: results from the Canadian Nosocomial Infection Surveillance Program (CNISP)

To investigate the occurrence and molecular mechanisms associated with carbapenemases in carbapenem-resistant Gram-negative isolates from Canadian cases. Twenty hospital sites across Canada submitted isolates for a 1 year period starting 1 September 2009. All Enterobacteriaceae with MICs epsilon 2 mg/L and Acinetobacter baumannii and Pseudomonas aeruginosa with MICs epsilon 16 mg/L of carbapenems were submitted to the National Microbiology Laboratory (NML) where carbapenem MICs were confirmed by Etest and isolates were characterized by PCR for carbapenemase genes, antimicrobial susceptibilities, PFGE and plasmid isolation. A total of 444 isolates (298 P. aeruginosa, 134 Enterobacteriaceae and 12 A. baumannii) were submitted to the NML of which 274 (61.7; 206 P. aeruginosa, 59 Enterobacteriaceae and 9 A. baumannii) met the inclusion criteria as determined by Etest. Carbapenemase genes were identified in 30 isolates: bla(GES-5) (n3; P. aeruginosa), bla(KPC-3) (n7; Enterobacteriaceae), bla(NDM-1) (n2; Enterobacteriaceae), bla(VIM-2) and bla(VIM-4) (n8; P. aeruginosa) bla(SME-2) (n1; Enterobacteriaceae) and bla(OXA-23) (n9; A. baumannii). PFGE identified a cluster in each of Enterobacteriaceae, P. aeruginosa and A. baumannii corresponding to isolates harbouring carbapenemase genes. Three KPC plasmid patterns (IncN and FllA) were identified where indistinguishable plasmid patterns were identified in unrelated clinical isolates. Carbapenemases were rare at the time of this study. Dissemination of carbapenemases was due to both dominant clones and common plasmid backbones.