Variations in the Occurrence of Resistance Phenotypes and Carbapenemase Genes Among Enterobacteriaceae Isolates in 20 Years of the SENTRY Antimicrobial Surveillance Program

Mariana Castanheira, Lalitagauri M Deshpande, Rodrigo E Mendes, Rafael Canton, Helio S Sader, Ronald N Jones, Mariana Castanheira, Lalitagauri M Deshpande, Rodrigo E Mendes, Rafael Canton, Helio S Sader, Ronald N Jones

Abstract

Background: A total of 178 825 Enterobacteriaceae isolates collected in 199 hospitals from 42 countries worldwide over 20 years (1997 to 2016) of the SENTRY Program were susceptibility tested by reference broth microdilution methods.

Methods: Trends in percentages over time were analyzed by the χ2 test. Results were reported as the percentage difference between the first (1997-2000) and the last (2013-2016) time period.

Results: Enterobacteriaceae exhibiting resistance to cephalosporins (extended-spectrum β-lactamase [ESBL] phenotype) and carbapenem resistance (CRE) significantly increased (P < 0.05; χ2 test) from 10.3% to 24.0% and 0.6% to 2.9%, respectively. Similar trends were noted for all regions and infection sources. Klebsiella pneumoniae mainly drove the CRE increase. Multidrug-resistance (MDR) rates significantly increased from 7.3% to 15.3% overall, with important trends in all regions and infection sources. Significant increases were noted for MDR K. pneumoniae and Escherichia coli, polymyxin-resistant K. pneumoniae (2.0% to 5.5% overall), and aminoglycoside-resistant E. coli (7.0% to 18.0%) and K. pneumoniae (18.1% to 26.9%) over time in North America and Latin America. Carbapenemase-encoding genes were screened after 2007, and the occurrence of these genes was compared for 2007-2009 and 2014-2016. Among 1298 CRE isolates from the 2 study periods, bla KPC was detected among 186 (49.7%) and 501 (54.2%) isolates in 2007-2009 and 2014-2016, respectively. Metallo-β-lactamase genes were detected among 4.3% of the isolates from 2007 to 2009 and 12.7% of the isolates from 2014 to 2016, mainly due to the dissemination of isolates carrying bla NDM. Genes encoding IMP and VIM enzymes were observed in 1.9% and 2.4% (7 and 9 isolates) of the isolates from 2007 to 2009 and 0.4% and 1.9% of the isolates from 2014 to 2016. OXA-48 and variants increased from 4.3% in 2007-2009 to 12.6% in 2014-2016 (mainly in Europe).

Conclusions: A change in the epidemiology of carbapenemases and important increases in ESBL, CRE, MDR, and other resistant phenotypes among virtually all geographic regions and infection sources were noted in the 20 years of surveillance, highlighting the impact of antimicrobial resistance and the importance of its continuous monitoring.

Keywords: CRE; ESBL; Enterobacteriaceae; MDR; carbapenemases.

Figures

Figure 1.
Figure 1.
Geographic (A) and infection sources (B) of the Enterobacteriaceae isolates analyzed. aSkin and skin structure infection isolates were mainly recovered from wounds and abscesses.
Figure 2.
Figure 2.
Selected antimicrobial resistance trends for all Enterobacteriaceae by (A) infection source and (B) geographic region. Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; ESBL, extended-spectrum β-lactamase; MDR, multidrug-resistant.
Figure 3.
Figure 3.
Antimicrobial resistance trends for selected antimicrobial classes of (A) all Enterobacteriaceae or (B) bacterial species.
Figure 4.
Figure 4.
Carbapenem-resistant Enterobacteriaceae (CRE) trends over years by region.
Figure 5.
Figure 5.
Extended-spectrum β-lactamase (ESBL), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant (MDR) rates among countries participating in the SENTRY Program. (Figure continues on next page)
Figure 5.
Figure 5.
Extended-spectrum β-lactamase (ESBL), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant (MDR) rates among countries participating in the SENTRY Program. (Figure continues on next page)

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