ECDC warns of rising antibiotic-resistance threat

Nov 17, 2011 (CIDRAP News) – New surveillance data in Europe show a steep rise in the percentage of carbapenem-resistant Klebsiella pneumonia, a drug-resistant issue seen as a growing threat in the United States as well.

The European Centre for Disease Prevention and Control (ECDC) released the data on antibiotic resistance today, along with new risk assessments on carbapenamase-producing Enterobacteriaceae (CPE) and New Delhi metallo-beta-lactamase 1 (NDM-1).

The release coincides with European Antibiotic Awareness Day and the launch of a new European Union strategy to battle antibiotic resistance, according to an ECDC press release. Other countries such as the United States and Canada are also conducting public awareness campaigns this week focusing on antibiotic resistance.

Klebsiella pneumoniae carbapenemase (KPC) is an enzyme that can make bacteria resistant to carbapenem and most other antibiotics. It was first found in K pneumoniae but has spread to other species of the Enterobacteriaceae family. NDM-1 is another resistance enzyme that has been recognized as a growing public health threat.

Some US-based health experts have said that, of the two resistance enzymes, KPC is the bigger concern, having spread to Southern and Western locations after first appearing on the East Coast 6 years ago. However, they warn that NDM-1 bears watching as well.

EU member states are reporting that 15% to nearly 50% of K pneumonia from bloodstream infections are resistant to carbapenems, the major category of last-line antibiotics to treat multi-drug resistant Gram-negative bacterial infections, which are often linked to pneumonia and urinary tract infections in hospitals.

Dr Marc Sprenger, the ECDC's director, said in a press release that the need to curb antibiotic resistance is critical. "Failure to act will mean that treatment options for patients with bloodstream infections, pneumonia, and urinary tract infections in hospitals will be severely limited," he said.

In a report on antibiotic use patterns, the ECDC said most use of antibiotics occurs in the community, but not all resistance to drugs such as carbapenems is linked to use outside hospitals. It noted that up to 50% of all antibiotic use in hospitals is inappropriate.

The ECDC said a risk assessment for CPE released in September follows an increasing number of healthcare facility outbreaks across the EU involving the highly drug-resistant pathogen.  The report said transferring patients between hospitals, and especially between countries, boosts the risk of spreading CPE.

It said lowering the risk will require early rectal screening, added precautions such as disposable gloves and gowns, cohort nursing, and more intensive monitoring of cross-border patients.

In its updated risk assessment for NDM-1, the ECDC said though carbapenemases such as KPC and Verona integron-encoded metallo-beta-lactamase (VIM) are more common in Europe, others such as NDM and OXA-48 are increasing in prevalence.

It said patient mobility is also a risk factor for the transmission of NDM-producing Enterobacteriaceae. It urged better surveillance across the EU and the development of national guidelines on preventing the spread of the resistant organisms.

The ECDC said 13 EU countries have reported 106 NDM-producing Enterobacteriaceae cases through the end of March, an increase of 77 since October 2010.

In other drug-resistance findings, it said that some European countries are reporting a decrease in methicillin-resistant Staphylococcus aureus (MRSA) cases, though one-fourth are reporting that 25% of invasive S aureus infections are MRSA.

"This brings hope that national efforts on infection control and containment of resistance may in some cases slow down the development of resistance," the ECDC said in its report. "Nevertheless, MRSA remains a public health priority, since significantly increasing trend of MRSA was observed in four countries (Italy, Hungary, Germany, and Slovenia)."

See also:

Nov 17 ECDC press release

Sep 13 ECDC CPE risk assessment

Nov 17 ECDC NDM-1 risk assessment

Aug 20, 2010, CIDRAP News story "Experts offer perspective on NDM-1 resistance threat"

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