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Patients seeking treatment in hospital or other health care facilities can be particularly vulnerable to infections they acquire during their stay, especially if the infections are difficult to treat because they are resistant to commonly used drugs. For example, Carbapenem-resistant Enterobacterales (CRE) are known to particularly affect hospitalized patients. Two studies published in Eurosurveillance marking World AMR Awareness Week from 18 to 22 November 2024, analyzed new data on the spread of such CRE, namely Escherichia coli sequence type (ST)131 producing various carbapenemases and New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Providencia stuartii to inform potential public health action.
Escherichia coli lineage with emerging resistance pattern spreads in the community In a rapid communication , Kohlenberg and collaborators assessed genomic and epidemiological data from 17 EU/EEA countries and observed an emergence of Escherichia coli that produces carbapenemases. Worldwide, E. coli is the pathogen associated with most deaths attributable to antimicrobial resistance and the specific type of E.
coli that the authors investigated in their study (ST 131) has been detected across the world and is frequently associated with multidrug-resistance. Kohlenberg and collaborators analyzed the sequencing and 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.
Detection of E. coli ST131 isolates producing carbapenemases increased over time. One group of isolates stood out for potential association with urinary tract infections in the community inferred from the relatively low median age of patients (57 years), a high proportion of female patients and the frequent detection of isolates from urine samples.
The authors note that "community-acquired urinary tract infections might only represent the tip of the iceberg in terms of patient colonization in the community." While Kohlenberg and team acknowledge they did not analyze a random population of E. coli ST131 but pre-selected isolates from the reference laboratories which probably resulted in an isolate collection with a higher likelihood for co-carriage of other resistance markers, they argue that the results of their study across 17 EU/EEA countries "sends another warning about the worsening epidemiological carbapenemase-producing Enterobacterales situation in the EU/EEA.
Further spread of E. coli carrying carbapenemase genes would mean that carbapenems could no longer be consistently effective for empiric treatment of severe E. coli infections.
" Sustained transmission of carbapenem-resistant Providencia stuartii in the health care system One type of CRE which has been very rare in Europe thus far—New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Providencia stuartii—has now been detected in several hospitals in Romania. In their genomic investigation, Linkevicius and team looked at how NDM-1-producing P. stuartii is spreading in hospitals with the aim to generate timely information to control any further transmission.
In their study , the authors analyzed 74 P. stuartii samples they received from six hospitals across Romania. Most (n=72/74) of the retrieved isolates were related to a reported infection among patients, such as lower respiratory tract bloodstream or urinary tract infections.
The authors categorized the majority of the infections as health care-associated, i.e. the patients acquired them in a hospital or other health care setting.
Given their resistance to several antibiotic classes like penicillins, cephalosporins and carbapenems, 90% of the tested isolates in this study were categorized as multidrug-resistant. In their investigation, Linkevicius and team identified four multi-hospital clusters of such resistant isolates detected over a year. This indicates sustained transmission within the Romanian health care system over a longer period.
Putting their study results into international context by comparing with data from other countries, the authors could also connect the specific lineage of P. stuartii detected in Romania to isolates found in other countries, i.e.
Bulgaria, France, Germany, Ireland, the Netherlands, Switzerland, the United Kingdom and the United States of America. They conclude that "sustained transmission in hospitals in Romania and the international spread point to high risk of further transmission of NDM-1-producing P. stuartii in health care settings.
Enhanced infection prevention and control measures should be put in place as soon as cases are detected in health care facilities ." More information: Anke Kohlenberg et al. Emergence of Escherichia coli ST131 carrying carbapenemase genes, European Union/European Economic Area, August 2012 to May 2024, Eurosurveillance (2024).
DOI: 10.2807/1560-7917.ES.
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2400727 Marius Linkevicius et al. Genomic surveillance detects interregional spread of New Delhi metallo-beta-lactamase-1-producing Providencia stuartii in hospitals, Romania, December 2021 to September 2023, Eurosurveillance (2024). DOI: 10.
2807/1560-7917.ES.2024.
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