title: Active surveillance scheme in three Romanian hospitals reveals a high prevalence and variety of carbapenamase-producing Gram-negative bacteria: a pilot study, December 2014 to May 2015.
abstract: We report the findings of an active surveillance scheme for detection of asymptomatic carriers with carbapenemase-producing Gram-negative bacteria (CP-GNB) in Romanian hospitals. During a pilot study from December 2014 to May 2015, faecal cultures were screened in three hospitals (two large, one medium-size) for patients newly admitted to selected wards or inpatients transferred from other wards to an intensive-care unit. The study revealed a high prevalence of CP-GNB detected in 22/27 and 28/38 of the carbapenem non-susceptible isolates from Hospitals 1 and 3, respectively. CP-GNB identified through faecal screening included NDM-1-producing Serratia marcescens and Klebsiella pneumoniae, OXA-48-producing K. pneumoniae and OXA-23-producing Acinetobacter baumannii. The distribution of the CP-GNB varied between the hospitals, with NDM-1-producing S. marcescens and K. pneumoniae being prevalent in the north-central part of the country and OXA-23/24-producing A. baumannii, OXA-48-producing K.pneumoniae, Morganella morganii and VIM-2-producing Escherichia coli/Pseudomonas aeruginosa detected in the north-east of the country. Conjugation studies showed that carbapenem resistance was transferable and PCR-based replicon typing identified blaNDM-1 on IncFIIs in S. marcescens and K. pneumoniae from Hospital 1 and blaOXA-48 on IncL plasmids in all Klebsiella spp. isolates from Hospitals 1 and 3. Our findings underline the importance of active surveillance for detection of CP-GNB asymptomatic faecal carriers and suggest a likely endemic spread of CP-GNB in Romania.
authors.affiliation: School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, United Kingdom.
authors.forename: Dorina
authors.initials: D
authors.lastname: Timofte
authors.forename: Carmen Valentina
authors.initials: CV
authors.lastname: Panzaru
authors.forename: Iuliana Elena
authors.initials: IE
authors.lastname: Maciuca
authors.forename: Maria
authors.initials: M
authors.lastname: Dan
authors.forename: Anca Delia
authors.initials: AD
authors.lastname: Mare
authors.forename: Adrian
authors.initials: A
authors.lastname: Man
authors.forename: Felicia
authors.initials: F
authors.lastname: Toma
mesh_terms: D001426:Bacterial Proteins / Q000378:metabolism*; D016358:Contact Tracing; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000201:enzymology* / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Romania; carbapenemase-producing organisms; infection control; surveillance