Epidemiology of carbapenem-resistant and carbapenemase-producing Enterobacterales in the Netherlands 2017–2019
the Infectious Diseases Surveillance Information System-Antimicrobial Resistance (ISIS-AR) Study Group; The Dutch CPE surveillance Study Group
(2022) Antimicrobial Resistance and Infection Control, volume 11, issue 1
(Article)
Abstract
Background: The Netherlands is currently considered a low endemic country for carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE), experiencing only sporadic hospital outbreaks. This study aims to describe susceptibility to carbapenems and the epidemiology of carbapenemase production in Enterobacterales in the Netherlands in 2017–2019. Methods: Three complementary nationwide surveillance systems
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are in place to monitor carbapenem susceptibility in the Netherlands. Routine antimicrobial susceptibility test results from medical microbiology laboratories were used to study phenotypic susceptibility of Escherichia coli and Klebsiella pneumoniae. Pathogen surveillance (of all Enterobacterales species) and mandatory notifications were used to describe the characteristics of CPE positive isolates and affected persons. Results: The prevalence of isolates with gradient strip test-confirmed elevated meropenem (> 0.25 mg/L) or imipenem (> 1 mg/L) minimum inhibitory concentration (MIC) in the Netherlands was very low in 2017–2019, with percentages of 0.06% in E. coli and 0.49% in K. pneumoniae, and carbapenem resistances of 0.02% and 0.18%, respectively. A total of 895 unique species/carbapenemase-encoding allele combinations of CPE from 764 persons were submitted between 2017 and 2019, with the annual number of submissions increasing slightly each year. Epidemiological data was available for 660 persons. Screening because of presumed colonisation risk was the reason for sampling in 70.0% (462/660) of persons. Hospitalization abroad was the most common risk factor, being identified in 45.9% of persons. Conclusions: Carbapenem resistance of E. coli and K. pneumoniae remains low in the Netherlands. The annual number of CPE isolates slightly increased during the period 2017–2019. Recent hospitalization abroad is the main risk factor for acquisition of CPE.
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Keywords: Carbapenem resistance, Carbapenemase production, E. coli, Enterobacterales, Hospitalization, K. pneumoniae, Risk factors, Surveillance, Travel, Public Health, Environmental and Occupational Health, Microbiology (medical), Infectious Diseases, Pharmacology (medical)
ISSN: 2047-2994
Publisher: BioMed Central Ltd.
Note: Funding Information: We thank the Municipal Health Services for completing the epidemiological data in OSIRIS. Furthermore, we thank Angela de Haan, Fabian Landman, Sandra Witteveen and Marga van Santen-Verheuvel for their efforts in the molecular typing of the isolates submitted to the pathogen surveillance system. Finally, we thank Danielle Boudville for English language review of the manuscript. J.W.T. Cohen Stuart, Noordwest Ziekenhuisgroep, Department of Medical Microbiology, Alkmaar; D.C. Melles, Meander Medical Center, Department of Medical Microbiology, Amersfoort; K. van Dijk, Amsterdam UMC, Universiteit van Amsterdam, Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam; A. Alzubaidy, Atalmedial, Department of Medical Microbiology, Amsterdam; B.F.M. Werdmuller, Public Health Service, Public Health Laboratory, Amsterdam; G.J. Blaauw, Gelre Hospitals, Department of Medical Microbiology and Infection prevention, Apeldoorn; B.M.W. Diederen, Bravis Hospital, Department of Medical Microbiology, Bergen op Zoom. ISIS-AR project team: H.J. Alblas, W. Altorf-van der Kuil, S.M. Bierman, S.C. de Greeff, S.R. Groenendijk, R. Hertroys, E.J. Kuijper, J.C. Monen, D.W. Notermans, W.J. van den Reek, A.F. Schoffelen, A.E. Smilde, C.C.H. Wielders, S.H.S. Woudt, R.E. Zoetigheid, Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven; W. van den Bijllaardt, Microvida Amphia, Laboratory for Microbiology and Infection Control, Breda; E.M. Kraan, IJsselland hospital, Department of Medical Microbiology, Capelle a/d Ijssel; E.E. Mattsson, Reinier de Graaf Groep, Department of Medical Microbiology, Delft; J.M. da Silva, Deventer Hospital, Department of Medical Microbiology, Deventer; E. de Jong, Slingeland Hospital, Department of Medical Microbiology, Doetinchem; B. Maraha, Albert Schweitzer Hospital, Department of Medical Microbiology, Dordrecht; A.J. van Griethuysen, Gelderse Vallei Hospital, Department of Medical Microbiology, Ede; G.J. van Asselt, SHL-Groep, Etten-Leur; A. Demeulemeester, SHL-Groep, Etten-Leur; B.B. Wintermans, Admiraal De Ruyter Hospital, Department of Medical Microbiology, Goes; M. van Trijp, Groene Hart Hospital, Department of Medical Microbiology and Infection Prevention, Gouda; A. Ott, Certe, Department of Medical Microbiology, Groningen; J. Sinnige, Regional Laboratory of Public Health, Haarlem; D.C. Melles, St Jansdal Hospital, Department of Medical Microbiology, Harderwijk; W. Silvis, Laboratory of Medical Microbiology and Public Health, Hengelo; L.J. Bakker, CBSL, Tergooi Hospital, Department of Medical Microbiology, Hilversum; J.W. Dorigo-Zetsma, CBSL, Tergooi Hospital, Department of Medical Microbiology, Hilversum; K. Waar, Izore Centre for Infectious Diseases Friesland, Leeuwarden; A.T. Bernards, Leiden University Medical Center, Department of Medical Microbiology, Leiden; M.A. Leversteijn-van Hall, Alrijne Hospital, Department of Medical Microbiology, Leiden-Leiderdorp; E. Schaftenaar, St Antonius Hospital, Department of Medical Microbiology and Immunology, Nieuwegein; M.H. Nabuurs-Franssen, Canisius Wilhelmina Hospital, Department of Medical Microbiology and Infectious Diseases, Nijmegen; H. Wertheim, Radboud University Medical Center, Department of Medical Microbiology, Nijmegen; B.M.W. Diederen, Bravis Hospital, Department of Medical Microbiology, Roosendaal; L. Bode, Erasmus University Medical Center, Department of Medical Microbiology, Rotterdam; M. van Rijn, Ikazia Hospital, Department of Medical Microbiology, Rotterdam; S. Dinant, Maasstad Hospital, Department of Medical Microbiology, Rotterdam; O. Pontesilli, Maasstad Hospital, Department of Medical Microbiology, Rotterdam; D.S.Y. Ong, Franciscus Gasthuis and Vlietland, Department of Medical Microbiology and Infection Control, Rotterdam; M. Wong, Haga Hospital, Department of Medical Microbiology, 's-Gravenhage; A.E. Muller, MCH Westeinde Hospital, Department of Medical Microbiology, 's-Gravenhage; N.H. Renders, Jeroen Bosch Hospital, Department of Medical Microbiology and Infection Control, 's-Hertogenbosch; R.G. Bentvelsen, Microvida ZorgSaam, Terneuzen; A.G.M. Buiting, St. Elisabeth Hospital, Department of Medical Microbiology, Tilburg; A.L.M. Vlek, Diakonessenhuis, Department of Medical Microbiology and Immunology, Utrecht; A.J. Stam, Saltro Diagnostic Centre, Department of Medical Microbiology, Utrecht; A. Troelstra, University Medical Center Utrecht, Department of Medical Microbiology, Utrecht; I.T.M.A. Overdevest, PAMM, Department of Medical Microbiology, Veldhoven; M.P.A. van Meer, Rijnstate Hospital, Laboratory for Medical Microbiology and Immunology, Velp; C. Oliveira dos Santos, Isala Hospital, Laboratory of Medical Microbiology and Infectious Diseases, Zwolle; M.J.H.M. Wolfhagen, Isala Hospital, Laboratory of Medical Microbiology and Infectious Diseases, Zwolle. A. Maijer-Reuwer, ADRZ medisch centrum, Department of Medical Microbiology, Goes; M.A. Leversteijn-van Hall, Alrijne Hospital, Department of Medical Microbiology, Leiden; W. van den Bijllaardt, Amphia Hospital, Microvida Laboratory for Microbiology, Breda; I.J.B. Spijkerman, Amsterdam UMC—location AMC, Department of Medical Microbiology, Amsterdam; K. van Dijk, Amsterdam UMC—location Vumc, Department of Medical Microbiology and Infection Control, Amsterdam; T. Halaby, Analytical Diagnostic Center N.V. Curaçao, Department of Medical Microbiology, Willemstad (Curaçao); B. Zwart, Atalmedial, Department of Medical Microbiology, Amsterdam; B.M.W. Diederen, Bravis Hospital/ZorgSaam Hospital Zeeuws-Vlaanderen, Department of Medical Microbiology, Roosendaal/Terneuzen; A. Voss, Canisius Wilhelmina Hospital, Department of Medical Microbiology and Infectious Diseases, Nijmegen; J.W. Dorigo-Zetsma, CBSL, Department of Medical Microbiology, Hilversum; A. Ott, Certe, Department of Medical Microbiology, Groningen; J.H. Oudbier, Comicro, Department of Medical Microbiology, Hoorn; M. van der Vusse, Deventer Hospital, Department of Medical Microbiology, Deventer; A.L.M. Vlek, Diakonessenhuis, Department of Medical Microbiology and Immunology, Utrecht; A.G.M. Buiting, Elisabeth-TweeSteden (ETZ) Hospital, Department of Medical Microbiology and Immunology, Tilburg; L. Bode, Erasmus University Medical Center, Department of Medical Microbiology, Rotterdam; S. Paltansing, Franciscus Gasthuis & Vlietland, Department of Medical Microbiology and Infection Control, Rotterdam; A.J. van Griethuysen, Gelderse Vallei Hospital, Department of Medical Microbiology, Ede; M. den Reijer, Gelre Hospitals, Department of Medical Microbiology and Infection prevention, Apeldoorn; M. van Trijp, Groene Hart Hospital, Department of Medical Microbiology and Infection Prevention, Gouda; M. Wong, Haga Hospital, Department of Medical Microbiology, 's-Gravenhage; A.E. Muller, HMC Westeinde Hospital, Department of Medical Microbiology, 's-Gravenhage; M.P.M. van der Linden, IJsselland Hospital, Department of Medical Microbiology, Capelle a/d IJssel; M. van Rijn, Ikazia Hospital, Department of Medical Microbiology, Rotterdam; M.J.H.M. Wolfhagen, Isala Hospital, Laboratory of Medical Microbiology and Infectious Diseases, Zwolle; K. Waar, Izore Centre for Infectious Diseases Friesland, Department of Medical Microbiology, Leeuwarden; E. Kolwijck, Jeroen Bosch Hospital, Department of Medical Microbiology and Infection Control, 's-Hertogenbosch; N. al Naiemi, LabMicTA, Regional Laboratory of Microbiology Twente Achterhoek, Hengelo; T. Schulin, Laurentius Hospital, Department of Medical Microbiology, Roermond; M. Damen, Maasstad Hospital, Department of Medical Microbiology, Rotterdam; S. Dinant, Maasstad Hospital, Department of Medical Microbiology, Rotterdam; S.P. van Mens, Maastricht University Medical Centre, Department of Medical Microbiology, Maastricht; D.C. Melles, Meander Medical Center, Department of Medical Microbiology, Amersfoort; J.W.T. Cohen Stuart, Noordwest Ziekenhuisgroep, Department of Medical Microbiology, Alkmaar; M.L. van Ogtrop, Onze Lieve Vrouwe Gasthuis, Department of Medical Microbiology, Amsterdam; I.T.M.A. Overdevest, PAMM, Department of Medical Microbiology, Veldhoven; A.P. van Dam, Amsterdam Health Service, Public Health Laboratory, Amsterdam; H. Wertheim, Radboud University Medical Center, Department of Medical Microbiology, Nijmegen; B. Maraha, Albert Schweitzer Hospital, Department of Medical Microbiology, Dordrecht; J.C. Sinnige, Regional Laboratory of Public Health, Department of Medical Microbiology, Haarlem; E.E. Mattsson, Reinier de Graaf Groep, Department of Medical Microbiology, Delft; R.W. Bosboom, Rijnstate Hospital, Laboratory for Medical Microbiology and Immunology, Velp; A. Stam, Saltro Diagnostic Centre, Department of Medical Microbiology, Utrecht; E. de Jong, Slingeland Hospital, Department of Medical Microbiology, Doetinchem; N. Roescher, St Antonius Hospital, Department of Medical Microbiology and Immunology, Nieuwegein; E. Heikens, St Jansdal Hospital, Department of Medical Microbiology, Harderwijk; R. Steingrover, St. Maarten Laboratory Services, Department of Medical Microbiology, Cay Hill (St. Maarten); A. Troelstra, University Medical Center Utrecht, Department of Medical Microbiology, Utrecht; E. Bathoorn, University of Groningen, Department of Medical Microbiology, Groningen; T.A.M. Trienekens, VieCuri Medical Center, Department of Medical Microbiology, Venlo; D.W. van Dam, Zuyderland Medical Centre, Department of Medical Microbiology and Infection Control, Sittard-Geleen; E.I.G.B. de Brauwer, Zuyderland Medical Centre, Department of Medical Microbiology and Infection Control, Heerlen; F.S. Stals, Zuyderland Medical Centre, Department of Medical Microbiology and Infection Control, Heerlen. Funding Information: This work was performed as part of the regular activities of the RIVM, financed by the Ministry of Health, Welfare and Sport. Publisher Copyright: © 2022, The Author(s).
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