Unveiling Insights into Carbapenem-Resistant Bacteria Surveillance

In the fight against antimicrobial resistance, carbapenemase-producing enterobacterales (CPE) pose a challenge. These bacteria have developed resistance to a broad spectrum of antibiotics, including carbapenems, which are essential antibiotics in the treatment of serious infections. This fact is a major public health concern. Of particular concern is their rapid transmission potential in the healthcare sector. A national surveillance system has been in operation in Luxembourg since 2014. Since then, suspicious strains have been forwarded to the Laboratoire national de santé (LNS), which is recognised as an expert in carbapenemase detection by PCR and extended characterisation by whole genome sequencing. In 2023, the LNS Microbiology Department provided an insight into the development of CPE isolates in Luxembourg since 2014.

A comprehensive analysis of the data collected between 2014 and 2022 sheds light on the evolution of CPE surveillance in Luxembourg. Presented at the interdisciplinary conference on anti-infective chemotherapy (RICAI) on 16 and 17 December 2023 in Paris, this analysis carried out by four members of the LNS Microbiology Department underlines the importance of vigilant surveillance in a context of changing trends.

Trends in CPE isolates

From 2014 to 2022, of the 962 strains analysed, 188 were identified as carbapenemase producers, of which 165 individual patients were affected (with 22 patients having several different strains). The detection of CPE in Luxembourg increased from 14 cases in 2014 to 47 cases in 2022, reflecting the increased screening efforts. Despite this increase, the positivity rate among the strains tested remained relatively constant at around 25% throughout the eight-year period.

Emerging patterns

Significant shifts were observed in the distribution of carbapenemase variants between species and over the years. In particular, the presence of NDM increased from 8% to 34% between 2021 and 2022, with 16 NDM-positive strains identified in 2022. In addition, K. pneumoniae strains carrying both OXA-48 and NDM were detected in wound, urine and anorectal samples during this period.

Implications for surveillance and control

This groundbreaking epidemiological study on carbapenemase-producing Enterobacterales highlights the importance of continuous surveillance and strict infection control protocols to contain the spread of multidrug-resistant organisms. Understanding the evolving epidemiology of CPE is essential for the development of targeted interventions. By staying ahead of emerging trends and taking proactive measures, the LNS Microbiology Department aims to protect public health and combat the threat of antimicrobial resistance.