title: Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study.
abstract: Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals.
  
  
  
  National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis.
  
  
  
  Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] K pneumoniae and 402 (15%) E coli). 850 (37%) of 2301 K pneumoniae samples and 77 (19%) of 402 E coli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1. 1·3 patients per 10 000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics.
  
  
  
  This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Enterobacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks.
  
  
  
  European Centre for Disease Prevention and Control.
authors.affiliation: Department of Infection Prevention and Hospital Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Netherlands. Electronic address: hajo.grundmann@uniklinik-freiburg.de.
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Netherlands; The Centre for Genomic Pathogen Surveillance, Wellcome Trust Genome Campus, Cambridgeshire, UK.
authors.forename: Corinna
authors.initials: C
authors.lastname: Glasner
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Barbara
authors.initials: B
authors.lastname: Albiger
authors.affiliation: The Centre for Genomic Pathogen Surveillance, Wellcome Trust Genome Campus, Cambridgeshire, UK; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Aanensen
authors.affiliation: Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London, UK.
authors.forename: Chris T
authors.initials: CT
authors.lastname: Tomlinson
authors.affiliation: Department of Clinical Microbiology, University Hospital for Infectious Diseases, Zagreb, Croatia.
authors.forename: Arjana Tambić
authors.initials: AT
authors.lastname: Andrasević
authors.affiliation: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Unidad de Resistencia a Antibióticos y Virulencia Bacteriana asociada al Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
authors.affiliation: Division of Epidemiology, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Netherlands.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Friedrich
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Giske
authors.affiliation: Department of Clinical Microbiology, CHU Dinant-Godinne UCL, Namur, Université Catholique de Louvain, Yvoir, Belgium; National Reference Laboratory for Antibiotic Resistance Monitoring in Gram-negative Bacteria, CHU Dinant-Godinne UCL, Namur, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: Youri
authors.initials: Y
authors.lastname: Glupczynski
authors.affiliation: Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Gniadkowski
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Reference Microbiology Services, Public Health England, London, UK; Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
authors.affiliation: INSERM U914 (Emerging Resistance to Antibiotics), Associated National Reference Center for Antibiotic Resistance, Faculté de Médecine et Université Paris-Sud, K Bicêtre, France; Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science, University of Fribourg, Switzerland.
authors.forename: Patrice
authors.initials: P
authors.lastname: Nordmann
authors.affiliation: INSERM U914 (Emerging Resistance to Antibiotics), Associated National Reference Center for Antibiotic Resistance, Faculté de Médecine et Université Paris-Sud, K Bicêtre, France; Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science, University of Fribourg, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Poirel
authors.affiliation: Dipartimento di Biotecnologie Mediche, Università di Siena, Siena, Italy; SOD Microbiologia e Virologia, Azienda Ospedaliera-Universitaria Careggi, Fondazione Don Carlo Gnocchi, Firenze, Italy.
authors.forename: Gian M
authors.initials: GM
authors.lastname: Rossolini
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, Cologne University, Cologne, Germany; German Center for Infection Research (DZIF), Braunschweig, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Seifert
authors.affiliation: Department of Microbiology, National School of Public Health, Athens, Greece.
authors.forename: Alkiviadis
authors.initials: A
authors.lastname: Vatopoulos
authors.affiliation: Section of Medical Microbiology IIB, School of Medical Sciences, Cardiff University, Heath Park Hospital, Cardiff, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Walsh
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Reference Microbiology Services, Public Health England, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Dominique L
authors.initials: DL
authors.lastname: Monnet
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005060:Europe; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D001618:beta-Lactamases
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase