European survey on antibiotic resistance in hospitals
Multidrug-resistant Enterobacteriaceae shown in a petri dish
An international team of scientists and clinicians have, for the first time, examined the spread of particularly dreaded multidrug-resistant Enterobacteriaceae throughout Europe and collected comparable data. Klebsiella pneumoniae and Escherichia coli —gut bacteria that are increasingly becoming resistant to carbapenem— were the central focus of the survey.
Multidrug-resistant bacteria constitute an increasing global problem. Resistance to antibiotics from the carbapenem group are proving to be particularly dangerous. These antibiotics, which are related to penicillin, are used as last-resort antibiotic in severe infections, when all other drugs fail. However, Enterobacteriaceae—inhabitants of our gut flora—are increasingly producing carbapenemase: an enzyme that targets the antibiotic and renders it ineffective. And not only that—all other penicillin-related antibiotics belonging to the beta-lactam antibiotic group are also destroyed. Currently, the carbapenemase-producing bacteria Klebsiella pneumoniae and E. coli are particularly dreaded. In immunocompromised patients, these usually harmless gut bacteria can cause difficult-to-treat infections, such as urinary tract infections, pneumonia and septicaemia.
“We need reliable data, in order to effectively tackle the spread of multidrug-resistant bacteria on an as global a scale as possible,” explains Prof Harald Seifert, DZIF scientist at the University Hospital Cologne. “But this is more difficult than expected, because standardised testing for specific pathogens and resistance is not possible in every hospital.” However, the scientists succeeded in including 455 hospitals in 36 European countries. In so-called national expert laboratories, they jointly developed standardised diagnostic methods for testing the isolated samples. A total of 2703 isolates were tested for carbapenemase-producing bacteria.
Carbapenemase-producing bacteria know no boundaries
Klebsiella pneumoniae was confirmed in 85 percent of the isolates and E. coli bacteria in 15 percent. The analyses showed that carbapenemase occurs in both Klebsiella and E. coli: multidrug-resistant Klebsiella demonstrated this specific resistance in 71 percent—i.e. three out of four isolates produced this carbapenem-splitting enzyme. For E. coli, 40 percent of the isolates showed this resistance mechanism. The researchers consider the fact that this resistance mechanism is transferable to other bacteria to be particularly dangerous. The prevalence varied greatly between the countries; while in Germany only 0.5 out of 10,000 hospital patients were colonised with these multidrug-resistant bacteria, the rate in a few Mediterranean countries and the Balkans was over ten times higher. And another important finding: in many cases, the carbapenemase-producing bacteria were resistant to other “last-line antibiotics”, for instance colistin.
Hospital hygiene and a sensible use of antibiotics remain the most important tasks
“We know from other studies that these resistant pathogens are frequently imported into hospitals by patients, but the transmission of the pathogens in the hospitals also plays an important role,” explains Seifert. “Therefore, improving hospital hygiene not only in Germany but everywhere in Europe will become more important than ever in future. Using antibiotics only when really necessary and avoiding their unjustified use is equally important.” With this European survey on Klebsiella and E. coli, the scientists have set diagnostic standards that could also be used in other hospitals.
