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Epidemiology of Carbapenem Resistance Determinants Identified in Meropenem-Nonsusceptible Collected as Part of a Global Surveillance Program, 2012 to 2017. | LitMetric

AI Article Synopsis

  • A study analyzed 81,781 bacterial isolates from 39 countries between 2012 and 2017 to determine the global incidence of carbapenem-resistant Enterobacteriaceae (CRE), revealing that 3.3% of isolates were resistant to meropenem, with regional variations from 1.4% to 5.3%.
  • Klebsiella pneumoniae was the primary source of resistance, accounting for 76.7% of the meropenem-nonsusceptible isolates, with the majority carrying various types of carbapenemases, including KPC and metallo-β-lactamases.
  • The incidence of meropenem resistance increased from 2.7% to 3.

Article Abstract

To estimate the incidence of carbapenem-resistant (CRE), a global collection of 81,781 surveillance isolates of collected from patients in 39 countries in five geographic regions from 2012 to 2017 was studied. Overall, 3.3% of isolates were meropenem-nonsusceptible (MIC ≥2 μg/ml), ranging from 1.4% (North America) to 5.3% (Latin America) of isolates by region. Klebsiella pneumoniae accounted for the largest number of meropenem-nonsusceptible isolates (76.7%). The majority of meropenem-nonsusceptible carried KPC-type carbapenemases (47.4%), metallo-β-lactamases (MBLs; 20.6%) or OXA-48-like β-lactamases (19.0%). Forty-three carbapenemase sequence variants (8 KPC-type, 4 GES-type, 7 OXA-48-like, 5 NDM-type, 7 IMP-type, and 12 VIM-type) were detected, with KPC-2, KPC-3, OXA-48, NDM-1, IMP-4, and VIM-1 identified as the most common variants of each carbapenemase type. The resistance mechanisms responsible for meropenem-nonsusceptibility varied by region. A total of 67.3% of all carbapenemase-positive isolates identified carried at least one additional plasmid-mediated or intrinsic chromosomally encoded extended-spectrum β-lactamase, AmpC β-lactamase, or carbapenemase. The overall percentage of meropenem-nonsusceptible increased from 2.7% in 2012 to 2014 to 3.8% in 2015 to 2017. This increase could be attributed to the increasing proportion of carbapenemase-positive isolates that was observed, most notably among isolates carrying NDM-type MBLs in Asia/South Pacific, Europe, and Latin America; OXA-48-like carbapenemases in Europe, Middle East/Africa, and Asia/South Pacific; VIM-type MBLs in Europe; and KPC-type carbapenemases in Latin America. Ongoing CRE surveillance combined with a global antimicrobial stewardship strategy, sensitive clinical laboratory detection methods, and adherence to infection control practices will be needed to interrupt the spread of CRE.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218680PMC
http://dx.doi.org/10.1128/AAC.02000-20DOI Listing

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