4 research outputs found
a pilot study, 2013
Introduction After recognition of European outbreaks of Clostridium difficile
infections (CDIs) associated with the emergence of PCR ribotype 027/NAP1 in
2005, CDI surveillance at country level was encouraged by the European Centre
for Disease Prevention and Control (ECDC) [1]. In 2008, an ECDC-supported
European CDI survey (ECDIS) identified large intercountry variations in
incidence rates and distribution of prevalent PCR ribotypes, with the
outbreak-related PCR ribotype 027 being detected in 5% (range: 0–26) of the
characterised isolates [2]. The surveillance period was limited to one month
and the representation of European hospitals was incomplete; however, this has
been the only European (comprising European Union (EU)/European Economic Area
(EEA) and EU candidate countries) CDI surveillance study. The authors
highlighted the need for national and European surveillance to control CDI.
Yet, European countries were found to have limited capacity for diagnostic
testing, particularly in terms of standard use of optimal methods and absence
of surveillance protocols and a fully validated, standardised and exchangeable
typing system for surveillance and/or outbreak investigation. As of 2011, 14
European countries had implemented national CDI surveillance, with various
methodologies [3]. National surveillance systems have since reported a
decrease in CDI incidence rate and/or prevalence of PCR ribotype 027 in some
European countries [4-8]. However, CDI generally remains poorly controlled in
Europe [9], and PCR ribotype 027 continues to spread in eastern Europe [10-12]
and globally [13]. In 2010, ECDC launched a new project, the European C.
difficile Infection Surveillance Network (ECDIS-Net), to enhance surveillance
of CDI and laboratory capacity to test for CDI in Europe. The goal of ECDIS-
Net was to establish a standardised CDI surveillance protocol suitable for
application all over Europe in order to: (i) estimate the incidence rate and
total infection rate of CDI (including recurrent CDI cases) in European acute
care hospitals; (ii) provide participating hospitals with a standardised tool
to measure and compare their own incidence rates with those observed in other
participating hospitals; (iii) assess adverse outcomes of CDI such as
complications and death; and (iv) describe the epidemiology of CDI concerning
antibiotic susceptibility, PCR ribotypes, presence of tcdA, tcdB and binary
toxins and detect new emerging types at local, national and European level.
The primary objectives of the present study were to: (i) test the pilot
protocol for the surveillance of CDI in European acute care hospitals
developed by ECDIS-Net (methodology, variables and indicators); (ii) assess
the feasibility and workload of collecting the required hospital data, case-
based epidemiological and microbiological data; and (iii) evaluate the quality
of data collected, whether in the presence or absence of existing national CDI
surveillance activities. A secondary aim was to assess the relationship
between patient and microbiological characteristics and in-hospital outcome of
CDI to confirm the added value of collecting detailed epidemiological and
microbiological data on CDI at European level
Standardised surveillance of Clostridium Difficile Infection in European acute care hospitals: A pilot study, 2013
Clostridium difficile infection (CDI) remains poorly controlled in many European countries, of which several have not yet implemented national CDI surveillance. In 2013, experts from the European CDI Surveillance Network project and from the European Centre for Disease Prevention and Control developed a protocol with three options of CDI surveillance for acute care hospitals: a ‘minimal’ option (aggregated hospital data), a ‘light’ option (including patient data for CDI cases) and an ‘enhanced’ option (including microbiological data on the first 10 CDI episodes per hospital). A total of 37 hospitals in 14 European countries tested these options for a three-month period (between 13 May and 1 November 2013). All 37 hospitals successfully completed the minimal surveillance option (for 1,152 patients). Clinical data were submitted for 94% (1,078/1,152) of the patients in the light option; information on CDI origin and outcome was complete for 94% (1,016/1,078) and 98% (294/300) of the patients in the light and enhanced options, respectively. The workload of the options was 1.1, 2.0 and 3.0 person-days per 10,000 hospital discharges, respectively. Enhanced surveillance was tested and was successful in 32 of the hospitals, showing that C. difficile PCR ribotype 027 was predominant (30% (79/267)). This study showed that standardised multicountry surveillance, with the option of integrating clinical and molecular data, is a feasible strategy for monitoring CDI in Europe
ENTEROBACTERIACAE, PRODUCING ESBLS AND METALLO-β-LACTAMASE NDM-1, ISOLATED IN HOSPITALS OF BALTIC REGION COUNTRIES
Abstract. We studied the prevalence of K. pneumoniae and E. coli resistance to extended spectrum cephalosporins and carbapenems, isolated from patients of eight hospitals in St-Petersburg from January to May, 2012. Prevalence of cephalosporin resistant isolates varied in different hospitals: E. coli – from 7,8 to 50%, K. pneumoniae – from 25,4 to 88,4%. Isolates produced extended spectrum beta-lactamases СТХ-М, mainly СТХ-М-1, also СТХ-М-2 and СТХ-М-9. Twenty two carbapenem-resistant K. pneumoniae strains (also resistant to other antimicrobials) were isolated in three hospitals. MALDI-TOF MS showed that carbapenem resistance was caused by carbapenemase. Carbapenemases of all isolates belonged to metallo-β-lactamases according to results of the ROSCO Diagnostica tests. The gene coding production of New Delhi metallo-β-lactamase (blaNDM-1) were detected in all strains. Our data confirmed that the main cephalosporin resistance mechanism of E. coli и K. pneumoniae in Baltic region (including Russia, St-Petersburg) is CTX-M-1 production. For the first time in Russia K. pneumoniae strains producing metallo-β-lactamases NDM-1 were isolated in several hospitals of St-Petersburg
Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study
The members of the European Survey on Carbapenemase-Producing
Enterobacteriaceae, (EuSCAPE) Working Group are: Portugal—Manuela Caniça and Vera ManageiroBACKGROUND: Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals.
METHODS: National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis.
FINDINGS: Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] K pneumoniae and 402 (15%) E coli). 850 (37%) of 2301 K pneumoniae samples and 77 (19%) of 402 E coli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1. 1·3 patients per 10 000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics.
INTERPRETATION: This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Enterobacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks.European Centre for Disease Prevention and Controlinfo:eu-repo/semantics/publishedVersio