Journal
LANCET INFECTIOUS DISEASES
Volume 17, Issue 2, Pages 153-163Publisher
ELSEVIER SCI LTD
DOI: 10.1016/S1473-3099(16)30257-2
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Funding
- European Centre for Disease Prevention and Control (ECDC) [ECDC/2012/055]
- MSD
- AstraZeneca
- DaVoltera
- Intercell AG
- Allecra Therapeutics
- BioMerieux SA
- Rempex Pharmaceuticals
- Nariva
- Proteologics
- Liofilchem
- bioMerieux
- groupH
- Merck
- Meiji
- Roche
- Dechra
- Allecra
- Leo
- Nordic
- Pfizer
- Curetis
- Tetraphase
- Achaogen
- Shionogi
- Auspherix
- Discuva
- VenatoRx Wockhardt
- Accelerate
- Centauri
- AOP Orphan
- Melinta
- Accelerate Achaogen
- Alifax
- Angelini ACRAF
- Basilea
- Becton Dickinson
- Biotest
- Cepheid
- Check-points
- Medivir
- Menarini
- Merck/Cubist Novartis
- Rempex/TMCo
- Venatorx
- Zambon
- Elitech
- Nordic Pharma
- Basilea Pharmaceutica International
- FAB Pharma
- Roche Pharma Switzerland
- Medicines Company
- Astella Pharma
- Cubist Pharmaceutical
- Durata Therapeutics
- Gilead Sciences Germany
- Novartis Pharma
- Novartis Pharma Germany
- Pfizer Pharma Germany
- Astellas Pharma Germany
- AstraZeneca Germany
- MSD Sharp
- Dohme Germany
- Department of Health (DH)
- Enigma
- European Centre for Disease Prevention and Control (ECDC)
- Birmingham University
- Diagnostics Inc.
- Roche Ltd
- Momentum Bioscience, Pharmaceuticals, USA
- Bio-Rad, France
- Meiji Seika Pharma Co
- Medical Research Council [MR/P007295/1] Funding Source: researchfish
- MRC [MR/P007295/1] Funding Source: UKRI
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Background Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals. Methods National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis. Findings Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] Kpneurnoniae and 402 (15%) Ecoli). 850 (37%) of 2301 Kpneumoniae samples and 77 (19%) of 402 Ecoli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1.1.3 patients per 10000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics. Interpretation This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Entero-bacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks.
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