title: Carbapenem-resistant Gram-negative bacilli in Canada 2009-10: results from the Canadian Nosocomial Infection Surveillance Program (CNISP).
abstract: OBJECTIVE
  To investigate the occurrence and molecular mechanisms associated with carbapenemases in carbapenem-resistant Gram-negative isolates from Canadian cases.
  
  
  METHODS
  Twenty hospital sites across Canada submitted isolates for a 1 year period starting 1 September 2009. All Enterobacteriaceae with MICs ≥ 2 mg/L and Acinetobacter baumannii and Pseudomonas aeruginosa with MICs ≥ 16 mg/L of carbapenems were submitted to the National Microbiology Laboratory (NML) where carbapenem MICs were confirmed by Etest and isolates were characterized by PCR for carbapenemase genes, antimicrobial susceptibilities, PFGE and plasmid isolation.
  
  
  RESULTS
  A total of 444 isolates (298 P. aeruginosa, 134 Enterobacteriaceae and 12 A. baumannii) were submitted to the NML of which 274 (61.7%; 206 P. aeruginosa, 59 Enterobacteriaceae and 9 A. baumannii) met the inclusion criteria as determined by Etest. Carbapenemase genes were identified in 30 isolates: bla(GES-5) (n = 3; P. aeruginosa), bla(KPC-3) (n = 7; Enterobacteriaceae), bla(NDM-1) (n = 2; Enterobacteriaceae), bla(VIM-2) and bla(VIM-4) (n = 8; P. aeruginosa) bla(SME-2) (n = 1; Enterobacteriaceae) and bla(OXA-23) (n = m9; A. baumannii). PFGE identified a cluster in each of Enterobacteriaceae, P. aeruginosa and A. baumannii corresponding to isolates harbouring carbapenemase genes. Three KPC plasmid patterns (IncN and FllA) were identified where indistinguishable plasmid patterns were identified in unrelated clinical isolates.
  
  
  CONCLUSIONS
  Carbapenemases were rare at the time of this study. Dissemination of carbapenemases was due to both dominant clones and common plasmid backbones.
authors.affiliation: Public Health Agency of Canada, Winnipeg, MB,  Canada.
authors.forename: L F
authors.initials: LF
authors.lastname: Mataseje
authors.forename: E
authors.initials: E
authors.lastname: Bryce
authors.forename: D
authors.initials: D
authors.lastname: Roscoe
authors.forename: D A
authors.initials: DA
authors.lastname: Boyd
authors.forename: J
authors.initials: J
authors.lastname: Embree
authors.forename: D
authors.initials: D
authors.lastname: Gravel
authors.forename: K
authors.initials: K
authors.lastname: Katz
authors.forename: P
authors.initials: P
authors.lastname: Kibsey
authors.forename: M
authors.initials: M
authors.lastname: Kuhn
authors.forename: A
authors.initials: A
authors.lastname: Mounchili
authors.forename: A
authors.initials: A
authors.lastname: Simor
authors.forename: G
authors.initials: G
authors.lastname: Taylor
authors.forename: E
authors.initials: E
authors.lastname: Thomas
authors.forename: N
authors.initials: N
authors.lastname: Turgeon
authors.forename: M R
authors.initials: MR
authors.lastname: Mulvey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D002170:Canada / Q000453:epidemiology; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008969:Molecular Sequence Data; D058889:Molecular Typing; D010957:Plasmids / Q000032:analysis; D016133:Polymerase Chain Reaction; D015995:Prevalence; D017422:Sequence Analysis, DNA; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D004269:DNA, Bacterial; D001618:beta-Lactamases; C063912:carbapenemase