Enterobacterales carrying chromosomal AmpC β-lactamases in Europe (EuESCPM): Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020–2022
- Authors: Boattini M.; Bianco G.; Llorente L.I.; Acero L.A.; Nunes D.; Seruca M.; Mendes V.S.; Almeida A.; Bastos P.; Rodriguez-Villodres A.; Gascon A.G.; Halperin A.V.; Canton R.; Escartin M.N.L.; Gonzalez-Lopez J.J.; Floch P.; Massip C.; Chainier D.; Barraud O.; Dortet L.; Cuzon G.; Zancanaro C.; Mizrahi A.; Schade R.; Rasmussen A.N.; Schonning K.; Hamprecht A.; Schaffarczyk L.; Glockner S.; Rodel J.; Kristof K.; Balonyi A.; Mancini S.; Quiblier C.; Fasciana T.; Giammanco A.; Paglietti B.; Rubino S.; Budimir A.; Bedenic B.; Rubic Z.; Marinovic J.; Gartzonika K.; Christaki E.; Mavromanolaki V.E.; Maraki S.; Yalcin T.Y.; Azap O.K.; Licker M.; Musuroi C.; Talapan D.; Vrancianu C.O.; Comini S.; Zalas-Wiecek P.; Michalska A.; Cavallo R.; Melo Cristino J.; Costa C.
- Publication year: 2024
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/638855
Abstract
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.