Spread of carbapenems resistant Enterobacteriaceae in South Africa; report from National Antimicrobial Resistance Reference Laboratory

Transcription

1 Spread of carbapenems resistant Enterobacteriaceae in South Africa; report from National Antimicrobial Resistance Reference Laboratory Olga Perovic*, Ashika Singh-Moodley, Samantha Iyaloo 5 th November 15 Antimicrobial Reference Laboratory at NICD and University of Witwatersrand*

2 Introduction The spread of carbapenem-non-susceptible Enterobacteriaceae poses a threat to healthcare and patient safety globally and in South Africa. Since the first case of carbapenemase producing Enterobacteriaceae (NDM1) in a private healthcare facility in Gauteng 2011, the Antimicrobial Resistance Laboratory (AMRL) at the National Institute for Communicable Diseases (NICD) has been receiving carbapenem non-susceptible Enterobacteriaceae clinically significant isolates from public and private health sectors for confirmatory and molecular testing. 2

3 Objectives To analyze CREs trend over 4 years period. To identify the most common organisms effected by presence of CPE genes. To highlight importance of surveillance.

4 Case report form

5 Labortaory methodology Confirmatory identification of organisms was done on VITEK II (biomèrieux, France) and on MALDI-TOF. Antimicrobial susceptibility testing was performed using automated systems the MicroScan Walkaway system (Siemens, USA). The interpretation of susceptibility was done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines 11. DNA was extracted from the phenotypic carbapenem-resistant isolates. The supernatant was harvested and screened for bla NDM, bla KPC, bla OXA-48 and its variants, bla GES, bla IMP and bla VIM using realtime polymerase chain reaction (PCR) (LightCycler 480 II, Roche Applied Science, LightCycler 480 Probes Master kit and the individual LightMix Modular kits (Roche Diagnostics, IN, USA). 5

6 Results A total of 1618 carbapenem non-susceptible isolates from all specimen types were received by the AMRL since We confirmed presence of cabapenemase genes in 1043 (83%) Enterobacteriaceae from total of 1258 isolates. Approximately 12% of patients had more than one specimen with non-susceptible isolates.

7 Distribution of 1258 Enterobacteriaceae

8 Distribution of referral isolates per province Group1 EC FS GA KZ LP NW WC

9 Numbers Number of 1249 isolates from public and private sectors The majority of isolates were received from public hospitals 1025 (82%) Isolates per year Private Public

10 Numbers Ward types at public sector from 1024 patients Ward types ADULT PAED UNK

11 Gender distribution among 1190 patients Female Male

12 Numbers Specimen types Urine and blood were the most common specimens (25% and 28.5%, respectively) Total 1302 Private Public

13 Numbers The most common organisms All rganisms Serratia marcescens Salmonella spp. Providencia rettgeri Proteus mirabilis Morganella morganii Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli Enterobacter cloacae complex Enterobacter cloacae Enterobacter aerogenes Citrobacter freundii

14 KPC OXA-48 Variants IMP OXA-48 NDM GES KPC OXA-48 Variants VIM IMP OXA-48 NDM GES KPC VIM OXA-48 NDM VIM OXA-48 NDM Percentages Confirmed CPEs, 1043 (83%) from total 1258 isolates 50% 45% 40% 35% 30% 31% 25% 20% 15% 12% 14% 10% 5% 0% 0% 0% 0% 0% 3% 1% 1% 0% 2% 3% 5% 0% 0% 4% 8% 4% 9% Confirmed CPEs Confirmed CPEs Confirmed CPEs Confirmed CPEs

15 Numbers Isolates with OXA-48 variants OXA-48 Variants

16 Percenatges Distribution of carbapenemase genes among K. pneumoniae and E. cloacae 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% VIM OXA-48 Variants OXA-48 NDM KPC IMP GES 0% E. cloacae K. pneumo E. cloacae E. cloacae com K. pneumo E. cloacae E. cloacae com K. pneumo E. cloacae K. pneumo The most common organisms

17 Distribution of 274 CPEs per wards 50% 45% 40% 35% 30% 25% 20% 15% VIM OXA-48 Variants OXA-48 NDM KPC IMP GES 10% 5% 0% ADULT ICU PAEDIATRIC OUTPATIENT

18 CPEs in K. pneumoniae 50% Klebsiella pneumoniae was the predominant organism 920 (73%) and carbapenemases were detected in 623 (68%) isolates including 372 (60%) NDM as the most predominate gene with a substantial increase in positivity rate from 46% in 2014 to 71% in % 40% 35% 30% 25% 20% 15% K. pneumo - VIM K. pneumo - OXA-48 Variants K. pneumo - OXA-48 K. pneumo - NDM K. pneumo - KPC K. pneumo - GES 10% 5% 0%

19 Numbers Numbers Scarces clinical information Group1 Group1 Antibiotics use Underlying conditions N U Y Poly. (U) N U Y Poly. (U)

20 Conclusions We presented carbapenem resistant Enterobacteriaceae referred for confirmatory testing and molecular identification of carbapenemases with increasing percentage of CPE cases over 4 years. Real prevalence of the resistance is not established as these were all referral isolates but structured enhanced surveillance is recommended to establish the hospital burden and infection control and prevention measures should be implemented at all healthcare facilities. 20

21 THE END I would like to thank AMRL-CC staff for their support and audience for their attention. 21