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ECDC: Updated Risk Assessment on the Spread of metallo-beta-lactamase 2009 and its Variants Within Europe

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  • ECDC: Updated Risk Assessment on the Spread of metallo-beta-lactamase 2009 and its Variants Within Europe


    november 2012


    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).

    Full report
    “Addressing chronic disease is an issue of human rights – that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ ~~~