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Updated ECDC risk assessment on the spread of New Delhi metallo-β-lactamase (NDM) and its variants within Europe
Executive summary
The data currently available from scientific publications and enhanced surveillance established by some EU Member
States indicate that there is an increase in the spread of not only NDM-producing Enterobacteriaceae, but of all
carbapenemase-producing Enterobacteriaceae (CPE) in Europe. It is evident from these reports and surveillance
results that even though carbapenemases such as Klebsiella pneumoniae carbapenemase (KPC) and Verona
integron-encoded metallo-β-lactamase (VIM) are the most prevalent in Europe, others such as NDM and OXA-48
are on the increase, with recent reports of travel-related cases, autochthonous cases and outbreaks.
One of the major barriers to our understanding of the magnitude of risk that these highly antibiotic-resistant
bacteria represent for Europe is that EU Member States lack systematic surveillance systems and policies to detect
carriage or infection with NDM-producing Enterobacteriaceae and CPE generally. It is important that all EU Member
States implement such systems to ensure the collection of reliable surveillance data, the prompt notification of the
public health authorities, the surveillance of secondary transmission following travel-associated cases in the EU and
the timely implementation of infection control measures.
Patient mobility is a risk factor for the transmission of NDM-producing Enterobacteriaceae and CPE. Since the
reservoir of such resistance determinants in Europe and globally is unknown, any patient transferred from any
country is considered to be at risk of carrying these highly antibiotic-resistant bacteria. A recent ECDC risk
assessment suggests that active surveillance through rectal screening of any patient transferred across borders
could be an effective way to detect carriage of CPE and therefore prevent its introduction into healthcare settings
in the EU.
Public health preparedness should be enhanced by developing the necessary infrastructure to prevent further
spread of all CPE in EU Member States.
Structures and measures to put in place include the development and
dissemination of national guidelines, active surveillance of high-risk patients and ensuring that clinical and
reference microbiological laboratories have adequate resources for the detection and prompt reporting of imported
or indigenous cases to surveillance systems and public health authorities.
EU-wide surveillance could be strengthened by linking national reference laboratories and public health institutes
through current antimicrobial resistance surveillance networks such as EARS-Net, to enable monitoring of CPE and
other highly antibiotic-resistant bacteria.
National generic reporting and early warning systems should be compared
to identify elements of appropriate practice. These elements could then be harnessed for rapid information
exchange at EU level via the Epidemic Intelligence Information System (EPIS) or the Early Warning and Response
System (EWRS).
Reported cases of NDM-producing bacteria
Summary
Within the EU/EEA, 13 countries reported a total of 106 cases (plus one bacterial isolate from an endoscope not
counted as a case) of NDM-producing Enterobacteriaceae up to 31 March 2011.
This is an increase on the total 77 cases reported to ECDC by the same 13 countries on 4 October 2010 (4). This
means that 29 additional cases of NDM-producing Enterobacteriaceae were reported in the EU/EEA during this
period, more specifically from the UK (n=17 cases), France (n=5), Germany (n=3), Sweden (n=2), Netherlands
(n=1) and Slovenia (n=1). No new EU/EEA country reported cases.
Overall, the majority of cases were reported
from the UK (n=68).
Klebsiella pneumoniae was the predominant NDM-producing bacterial species (n=84 isolates), followed by 34
isolates of E. coli and 10 of Enterobacter spp.
In total, seven deaths were reported from four countries: one patient
of unclear aetiology, five (three of these were Acinetobacter spp.) due to other causes and one patient, a 51 yearold diabetic man, whose death was attributed to septic shock from a necrotic leg wound infected with NDM-1-
producing E. coli.
Aside from the reported cases of Enterobacteriaceae, there were six new cases of NDM-producing Acinetobacter
spp., one from the UK and five from Germany (one case from Germany with a travel history to Egypt was the first
report of NDM-2).
Read more - ECDC
Executive summary
The data currently available from scientific publications and enhanced surveillance established by some EU Member
States indicate that there is an increase in the spread of not only NDM-producing Enterobacteriaceae, but of all
carbapenemase-producing Enterobacteriaceae (CPE) in Europe. It is evident from these reports and surveillance
results that even though carbapenemases such as Klebsiella pneumoniae carbapenemase (KPC) and Verona
integron-encoded metallo-β-lactamase (VIM) are the most prevalent in Europe, others such as NDM and OXA-48
are on the increase, with recent reports of travel-related cases, autochthonous cases and outbreaks.
One of the major barriers to our understanding of the magnitude of risk that these highly antibiotic-resistant
bacteria represent for Europe is that EU Member States lack systematic surveillance systems and policies to detect
carriage or infection with NDM-producing Enterobacteriaceae and CPE generally. It is important that all EU Member
States implement such systems to ensure the collection of reliable surveillance data, the prompt notification of the
public health authorities, the surveillance of secondary transmission following travel-associated cases in the EU and
the timely implementation of infection control measures.
Patient mobility is a risk factor for the transmission of NDM-producing Enterobacteriaceae and CPE. Since the
reservoir of such resistance determinants in Europe and globally is unknown, any patient transferred from any
country is considered to be at risk of carrying these highly antibiotic-resistant bacteria. A recent ECDC risk
assessment suggests that active surveillance through rectal screening of any patient transferred across borders
could be an effective way to detect carriage of CPE and therefore prevent its introduction into healthcare settings
in the EU.
Public health preparedness should be enhanced by developing the necessary infrastructure to prevent further
spread of all CPE in EU Member States.
Structures and measures to put in place include the development and
dissemination of national guidelines, active surveillance of high-risk patients and ensuring that clinical and
reference microbiological laboratories have adequate resources for the detection and prompt reporting of imported
or indigenous cases to surveillance systems and public health authorities.
EU-wide surveillance could be strengthened by linking national reference laboratories and public health institutes
through current antimicrobial resistance surveillance networks such as EARS-Net, to enable monitoring of CPE and
other highly antibiotic-resistant bacteria.
National generic reporting and early warning systems should be compared
to identify elements of appropriate practice. These elements could then be harnessed for rapid information
exchange at EU level via the Epidemic Intelligence Information System (EPIS) or the Early Warning and Response
System (EWRS).
Reported cases of NDM-producing bacteria
Summary
Within the EU/EEA, 13 countries reported a total of 106 cases (plus one bacterial isolate from an endoscope not
counted as a case) of NDM-producing Enterobacteriaceae up to 31 March 2011.
This is an increase on the total 77 cases reported to ECDC by the same 13 countries on 4 October 2010 (4). This
means that 29 additional cases of NDM-producing Enterobacteriaceae were reported in the EU/EEA during this
period, more specifically from the UK (n=17 cases), France (n=5), Germany (n=3), Sweden (n=2), Netherlands
(n=1) and Slovenia (n=1). No new EU/EEA country reported cases.
Overall, the majority of cases were reported
from the UK (n=68).
Klebsiella pneumoniae was the predominant NDM-producing bacterial species (n=84 isolates), followed by 34
isolates of E. coli and 10 of Enterobacter spp.
In total, seven deaths were reported from four countries: one patient
of unclear aetiology, five (three of these were Acinetobacter spp.) due to other causes and one patient, a 51 yearold diabetic man, whose death was attributed to septic shock from a necrotic leg wound infected with NDM-1-
producing E. coli.
Aside from the reported cases of Enterobacteriaceae, there were six new cases of NDM-producing Acinetobacter
spp., one from the UK and five from Germany (one case from Germany with a travel history to Egypt was the first
report of NDM-2).
Read more - ECDC