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Observational Study
. 2023 Jul;28(27):2200774.
doi: 10.2807/1560-7917.ES.2023.28.27.2200774.

Nationwide, population-based observational study of the molecular epidemiology and temporal trend of carbapenemase-producing Enterobacterales in Norway, 2015 to 2021

Oskar Ljungquist  1   2   3 , Bjørg Haldorsen  1 , Anna Kaarina Pöntinen  1   4 , Jessin Janice  1 , Ellen Haldis Josefsen  1 , Petter Elstrøm  5 , Oliver Kacelnik  5 ; Norwegian Study Group on CPE  6 ; Arnfinn Sundsfjord  1   2 , Ørjan Samuelsen  1   7 ; Members of The Norwegian Study Group on CPE
Collaborators, Affiliations
Observational Study

Nationwide, population-based observational study of the molecular epidemiology and temporal trend of carbapenemase-producing Enterobacterales in Norway, 2015 to 2021

Oskar Ljungquist et al. Euro Surveill. 2023 Jul.

Abstract

IntroductionNational and regional carbapenemase-producing Enterobacterales (CPE) surveillance is essential to understand the burden of antimicrobial resistance, elucidate outbreaks, and develop infection-control or antimicrobial-treatment recommendations.AimThis study aimed to describe CPE and their epidemiology in Norway from 2015 to 2021.MethodsA nationwide, population-based observational study of all verified clinical and carriage CPE isolates submitted to the national reference laboratory was conducted. Isolates were characterised by antimicrobial susceptibility testing, whole genome sequencing (WGS) and basic metadata. Annual CPE incidences were also estimated.ResultsA total of 389 CPE isolates were identified from 332 patients of 63 years median age (range: 0-98). These corresponded to 341 cases, 184 (54%) being male. Between 2015 and 2021, the annual incidence of CPE cases increased from 0.6 to 1.1 per 100,000 person-years. For CPE-isolates with available data on colonisation/infection, 58% (226/389) were associated with colonisation and 38% (149/389) with clinical infections. WGS revealed a predominance of OXA-48-like (51%; 198/389) and NDM (34%; 134/389) carbapenemases in a diversified population of Escherichia coli and Klebsiella pneumoniae, including high-risk clones also detected globally. Most CPE isolates were travel-related (63%; 245/389). Although local outbreaks and healthcare-associated transmission occurred, no interregional spread was detected. Nevertheless, 18% (70/389) of isolates not directly related to import points towards potentially unidentified transmission routes. A decline in travel-associated cases was observed during the COVID-19 pandemic.ConclusionsThe close-to-doubling of CPE case incidence between 2015 and 2021 was associated with foreign travel and genomic diversity. To limit further transmission and outbreaks, continued screening and monitoring is essential.

Keywords: Enterobacterales; NDM; OXA-48; carbapenemase; high-risk clones; molecular epidemiology; whole genome sequencing.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Distributions of CPE cases’ (A) annual incidence rate per 100,000 person-yearsa and (B) age categories, and distributions of CPE isolates according to (C) infection, colonisation, or (D) health region, as well as (E) annual proportion of CPE isolates associated with travelb, Norway 2015–2021a (n = 332 patients representing 341 cases; n = 389 isolates)
Figure 2
Figure 2
Distribution of isolates of carbapenemase-producing Enterobacterales (A) according to species and (B) carbapenemase variant, Norway 2015–2021 (n = 389)
Figure 3
Figure 3
Meropenem MIC distribution of CPE isolates according to carbapenemase variant, Norway, 2015–2021 (n = 389)
Figure 4
Figure 4
Maximum-likelihood phylogenetic trees of carbapenemase-producing (A) E. coli (n = 193) and (B) K. pneumoniae (n = 146), Norway, 2015–2021
See this image and copyright information in PMC

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