title: Carbapenemase-producing Enterobacteriaceae in Sweden 2007-2013: Experiences from seven years of systematic surveillance and mandatory reporting.
abstract: Carbapenemase-producing Enterobacteriaceae (CPE) are increasing worldwide, and are a major threat to healthcare systems. Recent European data support that many countries have interregional spread of CPE or an endemic situation. In Sweden mandatory laboratory reporting of CPE of both colonisation and infection has been practiced since 2007 and since 2012 also by treating physicians. Between 2007 and 2013, 94 cases of CPE were detected in Sweden, out of which 24 were considered to cause clinical infections (bloodstream infection (n=4), urinary tract infection (n=12), wound infection (n=4), respiratory tract infection (n=2) and catheter related (n=2). The majority were detected in the hospital setting through faecal screening or as probable colonisers in clinical cultures. Travel abroad was observed in the majority of the patients (81%), and among them 84% had been hospitalised. During the study period only two chains of transmissions in Swedish hospitals were reported, involving four patients. Klebsiella pneumoniae was the primarily isolated species (n=57) followed by Escherichia coli (n=29). blaNDM was the predominant carbapenemase gene (n=36), followed by blaOXA-48-group, blaKPC and blaVIM. In 26/94 cases (28%) isolates were categorised as possible XDR (extensively drug-resistant). CPE are increasing in Sweden, but are still at a comparably low level.
authors.affiliation: Unit for Antibiotic and Infection Control, Public Health Agency of Sweden, Sweden. Electronic address: sonja.lofmark@folkhalsomyndigheten.se.
authors.forename: Sonja
authors.initials: S
authors.lastname: Löfmark
authors.affiliation: Unit for Antibiotic Resistance and Respiratory Bacterial Infection, Public Health Agency of Sweden, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Sjöström
authors.affiliation: Unit for Antibiotic and Infection Control, Public Health Agency of Sweden, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Mäkitalo
authors.affiliation: Unit for Antibiotic Resistance and Respiratory Bacterial Infection, Public Health Agency of Sweden, Sweden.
authors.forename: Petra
authors.initials: P
authors.lastname: Edquist
authors.affiliation: Department of Microbiology, Public Health Agency of Sweden, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Tegmark Wisell
authors.affiliation: Unit for Antibiotic Resistance and Respiratory Bacterial Infection, Public Health Agency of Sweden, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Giske
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005838:Genotype; D006801:Humans; D019221:Mandatory Reporting; D010641:Phenotype; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: CPE; Carbapenem resistance; KPC; NDM; OXA-48