Enterobacterales carrying chromosomal AmpC β-lactamases in Europe (EuESCPM): Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020–2022
2 Hospital Universitario Insular de Gran Canaria [Las Palmas de Gran Canaria, Spain]
3 Serviço de Patologia Clínica, Centro Hospitalar Universitário Lisboa Norte, and Faculdade de Medicina. Universidade de Lisboa
4 Centro Hospitalar Universitário Lisboa Central
5 Chercheur indépendant
6 ISCIII - Instituto de Salud Carlos III [Madrid]
7 Hospital Universitario Ramón y Cajal [Madrid]
8 Vall d'Hebron University Hospital [Barcelona]
9 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
10 CHU Limoges
11 IMVA-HB - Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes
12 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
13 Centre hospitalier Saint-Joseph [Paris]
14 MICALIS - MICrobiologie de l'ALImentation au Service de la Santé
15 Amsterdam UMC - Amsterdam University Medical Centers
16 KUH - Copenhagen University Hospital [Denmark] = Københavns Universitetshospital [Danmark]
17 OFFIS - Carl Von Ossietzky Universität Oldenburg = Carl von Ossietzky University of Oldenburg
18 Universitätsklinikum Jena = Jena University Hospital [Jena, Germany]
19 Faculty of Medicine – Semmelweis University
20 UZH - Universität Zürich [Zürich] = University of Zurich
21 UNIPA - Università degli studi di Palermo - University of Palermo
22 UNISS - Università degli Studi di Sassari = University of Sassari
23 University of Zagreb
24 KBC Split - University Hospital Center Split =
25 University of Ioannina
26 UOC - University of Crete [Heraklion]
27 Bilkent University [Ankara]
28 Başkent University Hospital [Adana, Turkey]
29 UMFT - Victor Babeş University of Medicine and Pharmacy
30 INBI - National Institute for Infectious Diseases “Matei Bals” [Bucharest, Romania]
31 ICUB - Research Institute of the University of Bucharest
32 Operative Unit of Clinical Pathology, Carlo Urbani Hospital, Jesi, Ancona
33 Nicolaus Copernicus University [Toruń]
34 ULISBOA - Universidade de Lisboa = University of Lisbon = Université de Lisbonne [Lisboa]
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Résumé
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.
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