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Patrice Nordmann - One of the best experts on this subject based on the ideXlab platform.

  • extended spectrum β lactamase ampc and Carbapenemase Producing Enterobacteriaceae in animals a threat for humans
    Clinical Microbiology and Infection, 2017
    Co-Authors: Jeanyves Madec, Patrice Nordmann, Marissa Haenni, Laurent Poirel
    Abstract:

    There has been a great and long-term concern that extended-spectrum β-lactamase (ESBL)/AmpC- and Carbapenemase-Producing Enterobacteriaceae occurring in animals may constitute a public-health issue. A large number of factors with complex interrelations contribute to the spread of those bacteria among animals and humans. ESBL/AmpC- or Carbapenemase-encoding genes are most often located on mobile genetic elements favouring their dissemination. Some shared reservoirs of ESBL/AmpC or Carbapenemase genes, plasmids or clones have been identified and suggest cross-transmissions. Even though exposure to animals is regarded as a risk factor, evidence for a direct transfer of ESBL/AmpC-Producing bacteria from animals to humans through close contacts is limited. Nonetheless, the size of the commensal ESBL/AmpC reservoir in non-human sources is dramatically rising. This may constitute an indirect risk to public health by increasing the gene pool from which pathogenic bacteria can pick up ESBL/AmpC/Carbapenemase genes. The extent to which food contributes to potential transmission of ESBL/AmpC producers to humans is also not well established. Overall, events leading to the occurrence of ESBL/AmpC- and Carbapenemase-encoding genes in animals seem very much multifactorial. The impact of animal reservoirs on human health still remains debatable and unclear; nonetheless, there are some examples of direct links that have been identified.

  • evaluation of the rapidec carba np and β carba tests for rapid detection of Carbapenemase Producing Enterobacteriaceae
    Diagnostic Microbiology and Infectious Disease, 2017
    Co-Authors: Stefano Mancini, Nicolas Kieffer, Laurent Poirel, Patrice Nordmann
    Abstract:

    The analytical performances of the RAPIDEC CARBA NP® (bioMerieux) and the β-CARBA® (Bio-Rad) tests were evaluated for the rapid detection of any known type of Carbapenemases in Enterobacteriaceae. An international collection of 149 enterobacterial isolates comprising 111 Carbapenemase-Producing Enterobacteriaceae (CPE) and 38 non-Carbapenemase producers was used. CPE included 32 Carbapenemase producers of class A (18 KPC-2, 1 FRI-1, 5 SME and 8 IMI), 33 of class B (13 NDM, 11 VIM and 9 IMP) and 46 of class D (15 OXA-48, 14 OXA-181, 10 OXA-204, 3 OXA-232 and 4 OXA-162). The RAPIDEC CARBA NP® and the β-CARBA® tests were performed in strict accordance to the manufacturer's instructions and results were read within 2 h and 30 min, respectively. RAPIDEC CARBA NP® detected 104/111 CPE isolates compared to 72/111 for the β-CARBA® test. The overall sensitivity and specificity were 93.7% and 100%, respectively, for the RAPIDEC CARBA NP® test, and 64.9% and 90%, respectively, for the β-CARBA® test. The β-CARBA® test failed to detect all the non-KPC class A Carbapenemases (14/14) and most (24/31) of the OXA-48-like producers (OXA-162, OXA-181, OXA-204 and OXA-232), and detected 1/1 OXA-163 and 1/1 OXA-405 as Carbapenemase producers whereas these enzymes are rather defined as non Carbapenemases. RAPIDEC CARBA NP® test exhibited better performances than those of the β-CARBA® test and confirmed to be a reliable tool for the detection of CPE, especially for OXA-48-like producers.

  • high prevalence of Carbapenemase Producing Enterobacteriaceae among hospitalized children in luanda angola
    Antimicrobial Agents and Chemotherapy, 2016
    Co-Authors: Nicolas Kieffer, Patrice Nordmann, Marta Airesdesousa, Laurent Poirel
    Abstract:

    This study aimed to evaluate the prevalence of Carbapenemase-Producing Enterobacteriaceae in Luanda, Angola. A total of 157 rectal samples were collected from children visiting a pediatric hospital in Luanda in March 2015. Fifty-seven imipenem-nonsusceptible enterobacterial isolates were recovered, most of which were non-clonally related. The blaOXA-181 (50/57) and blaNDM-1 (7/57) Carbapenemase genes were identified. Notably, OXA-181-Producing Escherichia coli isolates rarely coproduced extended-spectrum β-lactamases and consequently remained susceptible to broad-spectrum cephalosporins. The blaOXA-181 gene was always located on an IncX3 plasmid, while the blaNDM-1 gene was located on either IncFIA or IncA/C plasmids. The study identified a high prevalence of OXA-181 among hospitalized children in Angola.

  • national survey of colistin resistance among Carbapenemase Producing Enterobacteriaceae and outbreak caused by colistin resistant oxa 48 Producing klebsiella pneumoniae france 2014
    Eurosurveillance, 2016
    Co-Authors: Aurelie Jayol, Laurent Poirel, Laurent Dortet, Patrice Nordmann
    Abstract:

    From January 2014 to December 2014, 972 consecutive non-replicate Carbapenemase-Producing Enterobacteriaceae isolates from colonised or infected patients were collected at the Associated French National Reference Centre as part of the French national survey on antimicrobial resistance. It included 577 Klebsiella spp. (59%), 236 Escherichia coli (24%), 108 Enterobacter spp. (11%), 50 Citrobacter spp. (5%), and a single Salmonella spp. isolate (0.1%). Of 561 K. pneumoniae isolates, 35 were found to be resistant to colistin (6.2%). PFGE analysis revealed a clonal outbreak involving 15 K. pneumoniae isolates belonging to sequence type ST11, recovered in a single hospital in the Picardie region in northern France. Those clonally related isolates showed variable levels of resistance to colistin, ranging from 4 to 64 mg/L. They harboured the blaOXA-48 Carbapenemase gene and the blaCTX-M-15 extended-spectrum beta-lactamase gene. Among the 91 Enterobacter cloacae isolates, seven were resistant to colistin and produced different types of Carbapenemases. Surprisingly, none of the E. coli and Citrobacter spp. isolates showed resistance to colistin. This national survey including Carbapenemase-Producing isolates recovered in 2014 reported a high rate of colistin resistance in K. pneumoniae and E. cloacae (6.2% and 7.7%, respectively) in France.

  • evaluation of the rapidec carba np the rapid carb screen and the carba np test for biochemical detection of Carbapenemase Producing Enterobacteriaceae
    Journal of Antimicrobial Chemotherapy, 2015
    Co-Authors: Laurent Dortet, Laurent Poirel, Gaelle Cuzon, Thierry Naas, Aurelie Agathine, Patrice Nordmann
    Abstract:

    OBJECTIVES: The objective of this study was the evaluation of the performance of two commercially available biochemical tests for the rapid detection of Carbapenemase-Producing Enterobacteriaceae compared with a home-made technique. METHODS: A collection of 150 enterobacterial isolates, including 132 isolates with decreased susceptibility to at least one carbapenem molecule, were tested for Carbapenemase activity using the RAPIDEC(®) CARBA NP (bioMerieux), the Rapid CARB Screen(®) (Rosco Diagnostica) and the home-made Carba NP test. This strain collection included 55 non-Carbapenemase producers, 21 KPC producers, 21 NDM producers, 17 VIM producers, 11 IMP producers, 16 OXA-48 producers and 9 OXA-48-like producers (OXA-162, OXA-181, OXA-204, OXA-232 and OXA-244). RESULTS: The RAPIDEC(®) CARBA NP detected all Carbapenemase producers except a single OXA-244 producer. Using the Rapid CARB Screen(®), one KPC-2, two NDM-1, one OXA-48 and five OXA-48 variant producers gave equivocal results and one OXA-244 producer was not detected. Using the Carba NP test, the same OXA-244 producer was not detected and one OXA-181 producer and one OXA-244 producer gave equivocal results. Sensitivity and specificity were 99% (95% CI 94.3%-99.8%) and 100% (95% CI 93.5%-100%), respectively, for the RAPIDEC(®) CARBA NP test, 89.5% (95% CI 81.7%-94.2%) and 70.9% (95% CI 57.9%-81.2%) for the Rapid CARB Screen(®) and 96.8% (95% CI 91.1%-98.9%) and 100% (95% CI 93.5%-100%) for the Carba NP test. The impact of the use of an adequate bacterial inoculum for obtaining the optimal performance with the RAPIDEC(®) CARBA NP was noted. CONCLUSIONS: The RAPIDEC(®) CARBA NP possesses the best performance for rapid and efficient detection of Carbapenemase-Producing Enterobacteriaceae.

E Dyakova - One of the best experts on this subject based on the ideXlab platform.

  • isolation demand from Carbapenemase Producing Enterobacteriaceae screening strategies based on a west london hospital network
    Journal of Hospital Infection, 2016
    Co-Authors: Venanzio Vella, Julie V Robotham, Frances Davies, Gabriel Birgand, Eimear Brannigan, E Dyakova, Luke S. P. Moore, Jonathan A. Otter
    Abstract:

    Summary Objective To estimate the isolation demands arising from high-risk specialty-based screening for Carbapenemase-Producing Enterobacteriaceae (CPE), and the potential fraction of CPE burden detected. Methods Clinical specialty groups from three London hospitals were ranked by incidence of carbapenem resistance among Escherichia coli and Klebsiella spp. Contact precaution bed-days were estimated for three screening strategies: Strategy 1, ‘circulation science and renal medicine'; Strategy 2, Strategy 1 plus ‘specialist services'; and Strategy 3, Strategy 2 plus ‘private patients'. Isolation bed occupancy rates and potential CPE detection rates were estimated. Results Of 99,105 admissions to the three hospitals in Financial Year 2014/15, Strategies 1, 2 and 3 would have screened 4371 (4.4%), 7482 (7.6%), and 13,542 (13.7%) patients, respectively. The specialties' isolation bed occupancy rates varied between 3% and 696% depending on strategy, number of consecutive tests, and whether or not pre-emptive isolation had been applied. Expected detection rates of the potential CPE burden in the hospital network would have varied between 17.1% and 47.5%. Conclusions High-risk specialty-based screening has the potential to detect nearly half of the potential CPE burden, and would be more pragmatic than patient-level risk-factor-based screening. Pre-emptive isolation increases isolation requirements substantially. CPE screening strategies need to balance risk and resources.

  • isolation demand from Carbapenemase Producing Enterobacteriaceae screening strategies based on a west london hospital network
    Journal of Hospital Infection, 2016
    Co-Authors: Venanzio Vella, Julie V Robotham, Frances Davies, Gabriel Birgand, Eimear Brannigan, E Dyakova, Luke S. P. Moore, Jonathan A. Otter
    Abstract:

    Summary Objective To estimate the isolation demands arising from high-risk specialty-based screening for Carbapenemase-Producing Enterobacteriaceae (CPE), and the potential fraction of CPE burden detected. Methods Clinical specialty groups from three London hospitals were ranked by incidence of carbapenem resistance among Escherichia coli and Klebsiella spp. Contact precaution bed-days were estimated for three screening strategies: Strategy 1, ‘circulation science and renal medicine'; Strategy 2, Strategy 1 plus ‘specialist services'; and Strategy 3, Strategy 2 plus ‘private patients'. Isolation bed occupancy rates and potential CPE detection rates were estimated. Results Of 99,105 admissions to the three hospitals in Financial Year 2014/15, Strategies 1, 2 and 3 would have screened 4371 (4.4%), 7482 (7.6%), and 13,542 (13.7%) patients, respectively. The specialties' isolation bed occupancy rates varied between 3% and 696% depending on strategy, number of consecutive tests, and whether or not pre-emptive isolation had been applied. Expected detection rates of the potential CPE burden in the hospital network would have varied between 17.1% and 47.5%. Conclusions High-risk specialty-based screening has the potential to detect nearly half of the potential CPE burden, and would be more pragmatic than patient-level risk-factor-based screening. Pre-emptive isolation increases isolation requirements substantially. CPE screening strategies need to balance risk and resources.

Laurent Dortet - One of the best experts on this subject based on the ideXlab platform.

  • a multiplex lateral flow immunoassay for the rapid identification of ndm kpc imp and vim type and oxa 48 like Carbapenemase Producing Enterobacteriaceae
    Journal of Antimicrobial Chemotherapy, 2018
    Co-Authors: Herve Boutal, Laurent Dortet, Sandrine Bernabeu, Anais Vogel, Karine Devilliers, Elodie Creton, Garence Cotellon, Marc Plaisance, Saoussen Oueslati, Agnes B Jousset
    Abstract:

    Objectives: The global spread of Carbapenemase-Producing Enterobacteriaceae represents a substantial challenge in clinical practice and rapid and reliable detection of these organisms is essential. The aim of this study was to develop and validate a lateral flow immunoassay (Carba5) for the detection of the five main Carbapenemases (KPC-, NDM-, VIM- and IMP-type and OXA-48-like). Methods: Carba5 was retrospectively and prospectively evaluated using 296 enterobacterial isolates from agar culture. An isolated colony was suspended in extraction buffer and then loaded on the manufactured Carba5. Results: All 185 isolates expressing a Carbapenemase related to one of the Carba5 targets were correctly and unambiguously detected in <15 min. All other isolates gave negative results except those Producing OXA-163 and OXA-405, which are considered low-activity Carbapenemases. No cross-reaction was observed with non-targeted Carbapenemases, ESBLs, AmpCs or oxacillinases (OXA-1, -2, -9 and -10). Overall, this assay reached 100% sensitivity and 95.3% (retrospectively) to 100% (prospectively) specificity. Conclusions: Carba5 is efficient, rapid and easy to implement in the routine workflow of a clinical microbiology laboratory for confirmation of the five main Carbapenemases encountered in Enterobacteriaceae.

  • a multiplex lateral flow immunoassay for the rapid identification of ndm kpc imp and vim type and oxa 48 like Carbapenemase Producing Enterobacteriaceae
    Journal of Antimicrobial Chemotherapy, 2018
    Co-Authors: Herve Boutal, Laurent Dortet, Sandrine Bernabeu, Anais Vogel, Karine Devilliers, Elodie Creton, Garence Cotellon, Marc Plaisance, Saoussen Oueslati, Agnes B Jousset
    Abstract:

    Objectives The global spread of Carbapenemase-Producing Enterobacteriaceae represents a substantial challenge in clinical practice and rapid and reliable detection of these organisms is essential. The aim of this study was to develop and validate a lateral flow immunoassay (Carba5) for the detection of the five main Carbapenemases (KPC-, NDM-, VIM- and IMP-type and OXA-48-like).

  • national survey of colistin resistance among Carbapenemase Producing Enterobacteriaceae and outbreak caused by colistin resistant oxa 48 Producing klebsiella pneumoniae france 2014
    Eurosurveillance, 2016
    Co-Authors: Aurelie Jayol, Laurent Poirel, Laurent Dortet, Patrice Nordmann
    Abstract:

    From January 2014 to December 2014, 972 consecutive non-replicate Carbapenemase-Producing Enterobacteriaceae isolates from colonised or infected patients were collected at the Associated French National Reference Centre as part of the French national survey on antimicrobial resistance. It included 577 Klebsiella spp. (59%), 236 Escherichia coli (24%), 108 Enterobacter spp. (11%), 50 Citrobacter spp. (5%), and a single Salmonella spp. isolate (0.1%). Of 561 K. pneumoniae isolates, 35 were found to be resistant to colistin (6.2%). PFGE analysis revealed a clonal outbreak involving 15 K. pneumoniae isolates belonging to sequence type ST11, recovered in a single hospital in the Picardie region in northern France. Those clonally related isolates showed variable levels of resistance to colistin, ranging from 4 to 64 mg/L. They harboured the blaOXA-48 Carbapenemase gene and the blaCTX-M-15 extended-spectrum beta-lactamase gene. Among the 91 Enterobacter cloacae isolates, seven were resistant to colistin and produced different types of Carbapenemases. Surprisingly, none of the E. coli and Citrobacter spp. isolates showed resistance to colistin. This national survey including Carbapenemase-Producing isolates recovered in 2014 reported a high rate of colistin resistance in K. pneumoniae and E. cloacae (6.2% and 7.7%, respectively) in France.

  • improvement of the xpert carba r kit for the detection of Carbapenemase Producing Enterobacteriaceae
    Antimicrobial Agents and Chemotherapy, 2016
    Co-Authors: Laurent Dortet, Mathieu Fusaro, Thierry Naas
    Abstract:

    The Xpert Carba-R kit, version 2 (v2), which has been improved for the efficient detection of blaOXA-181 and blaOXA-232 genes, was tested on a collection of 150 well-characterized enterobacterial isolates that had a reduced susceptibility to carbapenems. The performance of the Xpert Carba-R v2 was high, as it was able to detect the five major Carbapenemases (NDM, VIM, IMP, KPC, and OXA-48). Thus, it is now well adapted to the Carbapenemase-Producing Enterobacteriaceae epidemiology of many countries worldwide.

  • prospective evaluation of an algorithm for the phenotypic screening of Carbapenemase Producing Enterobacteriaceae
    Journal of Antimicrobial Chemotherapy, 2016
    Co-Authors: Laurent Dortet, Gaelle Cuzon, Patrick Plesiat, Thierry Naas
    Abstract:

    OBJECTIVES The objective of this study was to assess the performance of an algorithm based on the disc diffusion method for the screening of Carbapenemase-Producing Enterobacteriaceae (CPE) referred to the French National Reference Centre for Antibiotic Resistance. METHODS From April to June 2014, all isolates of Enterobacteriaceae referred to the French National Reference Centre for Antibiotic Resistance were included. The inhibition zone diameters of imipenem, ticarcillin/clavulanate and temocillin using EUCAST disc diffusion methodology were recorded. All isolates were subjected to the algorithm proposed by the Antibiogram Committee of the French Society of Microbiology (CA-SFM) for the screening of Carbapenemase producers. Phenotypic, biochemical and molecular detection of Carbapenemases was performed for all isolates. RESULTS A total of 621 consecutive enterobacterial isolates with decreased susceptibility to carbapenems were tested. They included 213 CPE [OXA-48-like (n = 183), NDM (n = 22), VIM (n = 3), KPC (n = 3) and OXA-48-like + NDM (n = 2)] and 408 non-Carbapenemase producers. The CA-SFM algorithm combining cut-off values of 15 mm, 15 mm and 22 mm for ticarcillin/clavulanate, temocillin and imipenem, respectively, perfectly detected 204 isolates (32.8%) as non-Carbapenemase producers, leading to a negative predictive value of 100% for this algorithm. CONCLUSIONS Implementation of the CA-SFM algorithm in clinical microbiology laboratories may avoid additional testing for CPE in one-third of the enterobacterial isolates with decreased susceptibility to carbapenems.

Mary K Hayden - One of the best experts on this subject based on the ideXlab platform.

  • prevention of colonization and infection by klebsiella pneumoniae Carbapenemase Producing Enterobacteriaceae in long term acute care hospitals
    Clinical Infectious Diseases, 2015
    Co-Authors: Mary K Hayden, Karen Lolans, Donald Blom, Rosie D Lyles, Shayna Weiner, Nicholas M Moore, Louis Fogg, David Henry, Caroline Thurlow, Monica K Sikka
    Abstract:

    Background. Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae (hereafter “KPC”) are an increasing threat to healthcare institutions. Long-term acute-care hospitals (LTACHs) have especially high prevalence of KPC. Methods. Using a stepped-wedge design, we tested whether a bundled intervention (screening patients for KPC rectal colonization upon admission and every other week; contact isolation and geographic separation of KPCpositive patients in ward cohorts or single rooms; bathing all patients daily with chlorhexidine gluconate; and healthcare-workereducation and adherence monitoring) would reduce colonization and infection due to KPC in4LTACHs with high endemic KPC prevalence. The study was conducted between 1 February 2010 and 30 June 2013; 3894 patients were enrolled during the preintervention period (lasting from 16 to 29 months), and 2951 patients were enrolled during the intervention period (lasting from 12 to 19 months). Results. KPC colonization prevalence was stable during preintervention (average, 45.8%; 95% confidence interval [CI], 42.1%–49.5%), declined early during intervention, then reached a plateau (34.3%; 95% CI, 32.4%–36.2%; P< .001 for exponential decline). During intervention, KPC admission prevalence remained high (average, 20.6%, 95% CI, 19.1%–22.3%). The incidence rate of KPC colonization fell during intervention, from 4 to 2 acquisitions per 100 patient-weeks (P= .004 for linear decline). Compared to preintervention, average rates of clinical outcomes declined during intervention: KPC in any clinical culture (3.7 to 2.5/1000 patient-days; P= .001), KPC bacteremia (0.9 to 0.4/1000 patient-days; P= .008), all-cause bacteremia (11.2 to 7.6/1000 patient-days; P= .006) and blood culture contamination (4.9 to 2.3/1000 patient-days; P= .03). Conclusions. A bundled intervention was associated with clinically important and statistically significant reductions in KPC colonization, KPC infection, all-cause bacteremia, and blood culture contamination in a high-risk LTACH population.

  • the effectiveness of routine daily chlorhexidine gluconate bathing in reducing klebsiella pneumoniae Carbapenemase Producing Enterobacteriaceae skin burden among long term acute care hospital patients
    Infection Control and Hospital Epidemiology, 2014
    Co-Authors: Michael Y Lin, Karen Lolans, Donald Blom, Rosie D Lyles, Shayna Weiner, Kavya B Poluru, Nicholas M Moore, David W Hines, Robert A Weinstein, Mary K Hayden
    Abstract:

    We evaluated the effectiveness of daily chlorhexidine gluconate (CHG) bathing in decreasing skin carriage of Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae (KPC) among long-term acute care hospital patients. CHG bathing reduced KPC skin colonization, particularly when CHG skin concentrations greater than or equal to 128 μ g/mL were achieved.

  • emergence and rapid regional spread of klebsiella pneumoniae Carbapenemase Producing Enterobacteriaceae
    Clinical Infectious Diseases, 2011
    Co-Authors: Silvia L Munozprice, Karen Lolans, Robert A Weinstein, Mary K Hayden, Bala Hota, Prevention Epicenter Program
    Abstract:

    UNLABELLED: Exposure network analysis and molecular epidemiologic methods were used to analyze the emergence and regional spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae over a 1-year period. Although 40 patients and 26 health care facilities were affected, 1 long-term acute care hospital played a critical role in the convergence of patients at high risk, amplification by cross-infection, and dissemination of these multidrug-resistant bacteria. BACKGROUND: Klebsiella pneumoniae Carbapenemase (KPC)-Producing Enterobacteriaceae are an emerging antibiotic resistance threat with demonstrated epidemic potential. METHODS: We conducted an outbreak investigation of KPC-Producing Enterobacteriaceae among patients of acute and long-term acute care hospitals (LTACHs) in 4 adjacent counties in Indiana and Illinois from 1 January 2008 through 31 December 2008 (cases). The study used traditional and molecular epidemiologic methods and an adaptation of social network analysis ("exposure network analysis"). RESULTS: Clinical records for 40 (95%) of 42 patients were available. Patients were mostly older with multiple comorbid conditions. Eleven patients (27.5%) died during the index hospitalization or were discharged to hospice; 23 (57.5%) were discharged to a nursing home, and 4 (10.0%) were discharged to home. One LTACH (LTACH-A) was central to the regional outbreak: 24 (60%) of 40 cases were linked to LTACH-A, and at least 10 patients (25%) acquired KPC there. Of 16 cases not linked to LTACH-A, 12 (75%) were linked to 3 nursing homes. Only 4 patients (10%) definitely acquired KPC during an acute care hospital stay. Molecular typing revealed the 31 available KPC-positive K. pneumoniae isolates to be similar and to cluster with epidemic multilocus sequence type 258; 2 KPC-positive Escherichia coli isolates were unique. CONCLUSIONS: We observed extensive transfer of KPC-positive patients throughout the exposure network of 14 acute care hospitals, 2 LTACHs, and 10 nursing homes. Although few cases were identified at most institutions, many facilities were affected. Successful control of KPC-Producing Enterobacteriaceae will require a coordinated, regional effort among acute and long-term health care facilities and public health departments.

Laurent Poirel - One of the best experts on this subject based on the ideXlab platform.

  • extended spectrum β lactamase ampc and Carbapenemase Producing Enterobacteriaceae in animals a threat for humans
    Clinical Microbiology and Infection, 2017
    Co-Authors: Jeanyves Madec, Patrice Nordmann, Marissa Haenni, Laurent Poirel
    Abstract:

    There has been a great and long-term concern that extended-spectrum β-lactamase (ESBL)/AmpC- and Carbapenemase-Producing Enterobacteriaceae occurring in animals may constitute a public-health issue. A large number of factors with complex interrelations contribute to the spread of those bacteria among animals and humans. ESBL/AmpC- or Carbapenemase-encoding genes are most often located on mobile genetic elements favouring their dissemination. Some shared reservoirs of ESBL/AmpC or Carbapenemase genes, plasmids or clones have been identified and suggest cross-transmissions. Even though exposure to animals is regarded as a risk factor, evidence for a direct transfer of ESBL/AmpC-Producing bacteria from animals to humans through close contacts is limited. Nonetheless, the size of the commensal ESBL/AmpC reservoir in non-human sources is dramatically rising. This may constitute an indirect risk to public health by increasing the gene pool from which pathogenic bacteria can pick up ESBL/AmpC/Carbapenemase genes. The extent to which food contributes to potential transmission of ESBL/AmpC producers to humans is also not well established. Overall, events leading to the occurrence of ESBL/AmpC- and Carbapenemase-encoding genes in animals seem very much multifactorial. The impact of animal reservoirs on human health still remains debatable and unclear; nonetheless, there are some examples of direct links that have been identified.

  • evaluation of the rapidec carba np and β carba tests for rapid detection of Carbapenemase Producing Enterobacteriaceae
    Diagnostic Microbiology and Infectious Disease, 2017
    Co-Authors: Stefano Mancini, Nicolas Kieffer, Laurent Poirel, Patrice Nordmann
    Abstract:

    The analytical performances of the RAPIDEC CARBA NP® (bioMerieux) and the β-CARBA® (Bio-Rad) tests were evaluated for the rapid detection of any known type of Carbapenemases in Enterobacteriaceae. An international collection of 149 enterobacterial isolates comprising 111 Carbapenemase-Producing Enterobacteriaceae (CPE) and 38 non-Carbapenemase producers was used. CPE included 32 Carbapenemase producers of class A (18 KPC-2, 1 FRI-1, 5 SME and 8 IMI), 33 of class B (13 NDM, 11 VIM and 9 IMP) and 46 of class D (15 OXA-48, 14 OXA-181, 10 OXA-204, 3 OXA-232 and 4 OXA-162). The RAPIDEC CARBA NP® and the β-CARBA® tests were performed in strict accordance to the manufacturer's instructions and results were read within 2 h and 30 min, respectively. RAPIDEC CARBA NP® detected 104/111 CPE isolates compared to 72/111 for the β-CARBA® test. The overall sensitivity and specificity were 93.7% and 100%, respectively, for the RAPIDEC CARBA NP® test, and 64.9% and 90%, respectively, for the β-CARBA® test. The β-CARBA® test failed to detect all the non-KPC class A Carbapenemases (14/14) and most (24/31) of the OXA-48-like producers (OXA-162, OXA-181, OXA-204 and OXA-232), and detected 1/1 OXA-163 and 1/1 OXA-405 as Carbapenemase producers whereas these enzymes are rather defined as non Carbapenemases. RAPIDEC CARBA NP® test exhibited better performances than those of the β-CARBA® test and confirmed to be a reliable tool for the detection of CPE, especially for OXA-48-like producers.

  • high prevalence of Carbapenemase Producing Enterobacteriaceae among hospitalized children in luanda angola
    Antimicrobial Agents and Chemotherapy, 2016
    Co-Authors: Nicolas Kieffer, Patrice Nordmann, Marta Airesdesousa, Laurent Poirel
    Abstract:

    This study aimed to evaluate the prevalence of Carbapenemase-Producing Enterobacteriaceae in Luanda, Angola. A total of 157 rectal samples were collected from children visiting a pediatric hospital in Luanda in March 2015. Fifty-seven imipenem-nonsusceptible enterobacterial isolates were recovered, most of which were non-clonally related. The blaOXA-181 (50/57) and blaNDM-1 (7/57) Carbapenemase genes were identified. Notably, OXA-181-Producing Escherichia coli isolates rarely coproduced extended-spectrum β-lactamases and consequently remained susceptible to broad-spectrum cephalosporins. The blaOXA-181 gene was always located on an IncX3 plasmid, while the blaNDM-1 gene was located on either IncFIA or IncA/C plasmids. The study identified a high prevalence of OXA-181 among hospitalized children in Angola.

  • national survey of colistin resistance among Carbapenemase Producing Enterobacteriaceae and outbreak caused by colistin resistant oxa 48 Producing klebsiella pneumoniae france 2014
    Eurosurveillance, 2016
    Co-Authors: Aurelie Jayol, Laurent Poirel, Laurent Dortet, Patrice Nordmann
    Abstract:

    From January 2014 to December 2014, 972 consecutive non-replicate Carbapenemase-Producing Enterobacteriaceae isolates from colonised or infected patients were collected at the Associated French National Reference Centre as part of the French national survey on antimicrobial resistance. It included 577 Klebsiella spp. (59%), 236 Escherichia coli (24%), 108 Enterobacter spp. (11%), 50 Citrobacter spp. (5%), and a single Salmonella spp. isolate (0.1%). Of 561 K. pneumoniae isolates, 35 were found to be resistant to colistin (6.2%). PFGE analysis revealed a clonal outbreak involving 15 K. pneumoniae isolates belonging to sequence type ST11, recovered in a single hospital in the Picardie region in northern France. Those clonally related isolates showed variable levels of resistance to colistin, ranging from 4 to 64 mg/L. They harboured the blaOXA-48 Carbapenemase gene and the blaCTX-M-15 extended-spectrum beta-lactamase gene. Among the 91 Enterobacter cloacae isolates, seven were resistant to colistin and produced different types of Carbapenemases. Surprisingly, none of the E. coli and Citrobacter spp. isolates showed resistance to colistin. This national survey including Carbapenemase-Producing isolates recovered in 2014 reported a high rate of colistin resistance in K. pneumoniae and E. cloacae (6.2% and 7.7%, respectively) in France.

  • evaluation of the rapidec carba np the rapid carb screen and the carba np test for biochemical detection of Carbapenemase Producing Enterobacteriaceae
    Journal of Antimicrobial Chemotherapy, 2015
    Co-Authors: Laurent Dortet, Laurent Poirel, Gaelle Cuzon, Thierry Naas, Aurelie Agathine, Patrice Nordmann
    Abstract:

    OBJECTIVES: The objective of this study was the evaluation of the performance of two commercially available biochemical tests for the rapid detection of Carbapenemase-Producing Enterobacteriaceae compared with a home-made technique. METHODS: A collection of 150 enterobacterial isolates, including 132 isolates with decreased susceptibility to at least one carbapenem molecule, were tested for Carbapenemase activity using the RAPIDEC(®) CARBA NP (bioMerieux), the Rapid CARB Screen(®) (Rosco Diagnostica) and the home-made Carba NP test. This strain collection included 55 non-Carbapenemase producers, 21 KPC producers, 21 NDM producers, 17 VIM producers, 11 IMP producers, 16 OXA-48 producers and 9 OXA-48-like producers (OXA-162, OXA-181, OXA-204, OXA-232 and OXA-244). RESULTS: The RAPIDEC(®) CARBA NP detected all Carbapenemase producers except a single OXA-244 producer. Using the Rapid CARB Screen(®), one KPC-2, two NDM-1, one OXA-48 and five OXA-48 variant producers gave equivocal results and one OXA-244 producer was not detected. Using the Carba NP test, the same OXA-244 producer was not detected and one OXA-181 producer and one OXA-244 producer gave equivocal results. Sensitivity and specificity were 99% (95% CI 94.3%-99.8%) and 100% (95% CI 93.5%-100%), respectively, for the RAPIDEC(®) CARBA NP test, 89.5% (95% CI 81.7%-94.2%) and 70.9% (95% CI 57.9%-81.2%) for the Rapid CARB Screen(®) and 96.8% (95% CI 91.1%-98.9%) and 100% (95% CI 93.5%-100%) for the Carba NP test. The impact of the use of an adequate bacterial inoculum for obtaining the optimal performance with the RAPIDEC(®) CARBA NP was noted. CONCLUSIONS: The RAPIDEC(®) CARBA NP possesses the best performance for rapid and efficient detection of Carbapenemase-Producing Enterobacteriaceae.