TY - JOUR

T1 - Enterobacterales carrying chromosomal AmpC β-lactamases in Europe (EuESCPM)

T2 - Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020–2022

AU - Boattini, Matteo

AU - Bianco, Gabriele

AU - Llorente, Laura Iglesias

AU - Acero, Laura Alonso

AU - Nunes, Daniel

AU - Seruca, Miguel

AU - Mendes, Vasco Santos

AU - Almeida, André

AU - Bastos, Paulo

AU - Rodríguez-Villodres, Ángel

AU - Gascón, Adelina Gimeno

AU - Halperin, Ana Verónica

AU - Cantón, Rafael

AU - Escartín, Maria Nieves Larrosa

AU - González-López, Juan José

AU - Floch, Pauline

AU - Massip, Clémence

AU - Chainier, Delphine

AU - Barraud, Olivier

AU - Dortet, Laurent

AU - Cuzon, Gaëlle

AU - Zancanaro, Clément

AU - Mizrahi, Assaf

AU - Schade, Rogier

AU - Rasmussen, Asger Nellemann

AU - Schønning, Kristian

AU - Hamprecht, Axel

AU - Schaffarczyk, Lukas

AU - Glöckner, Stefan

AU - Rödel, Jürgen

AU - Kristóf, Katalin

AU - Balonyi, Ágnes

AU - Mancini, Stefano

AU - Quiblier, Chantal

AU - Fasciana, Teresa

AU - Giammanco, Anna

AU - Paglietti, Bianca

AU - Rubino, Salvatore

AU - Budimir, Ana

AU - Bedenić, Branka

AU - Rubic, Zana

AU - Marinović, Jelena

AU - Gartzonika, Konstantina

AU - Christaki, Eirini

AU - Mavromanolaki, Viktoria Eirini

AU - Maraki, Sofia

AU - Yalçın, Tuğba Yanık

AU - Azap, Özlem Kurt

AU - Licker, Monica

AU - Musuroi, Corina

AU - Talapan, Daniela

AU - Vrancianu, Corneliu Ovidiu

AU - Comini, Sara

AU - Zalas-Więcek, Patrycja

AU - Michalska, Anna

AU - Cavallo, Rossana

AU - Melo Cristino, José

AU - Costa, Cristina

N1 - Publisher Copyright: © 2024 The Author(s)

PY - 2024

Y1 - 2024

N2 - Introduction: The ESCPM group (Enterobacter species including Klebsiella aerogenes - formerly Enterobacter aerogenes, Serratia species, Citrobacter freundii complex, Providencia species and Morganella morganii) has not yet been incorporated into systematic surveillance programs. Methods: We conducted a multicentre retrospective observational study analysing all ESCPM strains isolated from blood cultures in 27 European hospitals over a 3-year period (2020–2022). Diagnostic approach, epidemiology, and antimicrobial susceptibility were investigated. Results: Our study comprised 6,774 ESCPM isolates. MALDI-TOF coupled to mass spectrometry was the predominant technique for bacterial identification. Susceptibility to new β-lactam/β-lactamase inhibitor combinations and confirmation of AmpC overproduction were routinely tested in 33.3% and 29.6% of the centres, respectively. The most prevalent species were E. cloacae complex (44.8%) and S. marcescens (22.7%). Overall, third-generation cephalosporins (3GC), combined third- and fourth-generation cephalosporins (3GC + 4GC) and carbapenems resistance phenotypes were observed in 15.7%, 4.6%, and 9.5% of the isolates, respectively. AmpC overproduction was the most prevalent resistance mechanism detected (15.8%). Among carbapenemase-producers, carbapenemase type was provided in 44.4% of the isolates, VIM- (22.9%) and OXA-48-enzyme (16%) being the most frequently detected. E. cloacae complex, K. aerogenes and Providencia species exhibited the most notable cumulative antimicrobial resistance profiles, with the former displaying 3GC, combined 3GC + 4GC and carbapenems resistance phenotypes in 15.2%, 7.4%, and 12.8% of the isolates, respectively. K. aerogenes showed the highest rate of both 3GC resistant phenotype (29.8%) and AmpC overproduction (32.1%), while Providencia species those of both carbapenems resistance phenotype (42.7%) and carbapenemase production (29.4%). ESCPM isolates exhibiting both 3GC and combined 3GC + 4GC resistance phenotypes displayed high susceptibility to ceftazidime/avibactam (98.2% and 95.7%, respectively) and colistin (90.3% and 90.7%, respectively). Colistin emerged as the most active drug against ESCPM species (except those intrinsically resistant) displaying both carbapenems resistance phenotype (85.8%) and carbapenemase production (97.8%). Conclusions: This study presented a current analysis of ESCPM species epidemiology in Europe, providing insights to inform current antibiotic treatments and guide strategies for antimicrobial stewardship and diagnostics.

AB - Introduction: The ESCPM group (Enterobacter species including Klebsiella aerogenes - formerly Enterobacter aerogenes, Serratia species, Citrobacter freundii complex, Providencia species and Morganella morganii) has not yet been incorporated into systematic surveillance programs. Methods: We conducted a multicentre retrospective observational study analysing all ESCPM strains isolated from blood cultures in 27 European hospitals over a 3-year period (2020–2022). Diagnostic approach, epidemiology, and antimicrobial susceptibility were investigated. Results: Our study comprised 6,774 ESCPM isolates. MALDI-TOF coupled to mass spectrometry was the predominant technique for bacterial identification. Susceptibility to new β-lactam/β-lactamase inhibitor combinations and confirmation of AmpC overproduction were routinely tested in 33.3% and 29.6% of the centres, respectively. The most prevalent species were E. cloacae complex (44.8%) and S. marcescens (22.7%). Overall, third-generation cephalosporins (3GC), combined third- and fourth-generation cephalosporins (3GC + 4GC) and carbapenems resistance phenotypes were observed in 15.7%, 4.6%, and 9.5% of the isolates, respectively. AmpC overproduction was the most prevalent resistance mechanism detected (15.8%). Among carbapenemase-producers, carbapenemase type was provided in 44.4% of the isolates, VIM- (22.9%) and OXA-48-enzyme (16%) being the most frequently detected. E. cloacae complex, K. aerogenes and Providencia species exhibited the most notable cumulative antimicrobial resistance profiles, with the former displaying 3GC, combined 3GC + 4GC and carbapenems resistance phenotypes in 15.2%, 7.4%, and 12.8% of the isolates, respectively. K. aerogenes showed the highest rate of both 3GC resistant phenotype (29.8%) and AmpC overproduction (32.1%), while Providencia species those of both carbapenems resistance phenotype (42.7%) and carbapenemase production (29.4%). ESCPM isolates exhibiting both 3GC and combined 3GC + 4GC resistance phenotypes displayed high susceptibility to ceftazidime/avibactam (98.2% and 95.7%, respectively) and colistin (90.3% and 90.7%, respectively). Colistin emerged as the most active drug against ESCPM species (except those intrinsically resistant) displaying both carbapenems resistance phenotype (85.8%) and carbapenemase production (97.8%). Conclusions: This study presented a current analysis of ESCPM species epidemiology in Europe, providing insights to inform current antibiotic treatments and guide strategies for antimicrobial stewardship and diagnostics.

KW - AmpC β-lactamase

KW - Antimicrobial resistance

KW - Blood culture

KW - COVID-19

KW - Enterobacterales

KW - Sepsis

U2 - 10.1016/j.ijantimicag.2024.107115

DO - 10.1016/j.ijantimicag.2024.107115

M3 - Journal article

C2 - 38367844

AN - SCOPUS:85187958432

VL - 63

JO - International Journal of Antimicrobial Agents

JF - International Journal of Antimicrobial Agents

SN - 0924-8579

IS - 5

M1 - 107115

ER -