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Prevalence of ESBL in the Netherlands: the ONE study

Abstract number: 1732_283

Mouton J., Voss A., Arends J., Bernards on behalf of the ONE Study group S.

Background: The prevalence of extended spectrum b-lactamase (ESBL) producers is increasing worldwide. Data on prevalence in The Netherlands are sparse. Therapeutic options for ESBL producers are generally limited to fluoroquinolones, aminoglycosides and carbapenems. Ertapenem is a new broad spectrum carbapenem that may be suited to use against ESBL-producing enterobacteriaceae. Aim of the ONE study was to determine the prevalence of ESBL in the Dutch population and the susceptibility of ESBL producers against Ertapenem and other antibiotics.

Methods: 22 laboratories equally distributed in the Netherlands participated in the study. Each lab was asked to collect up to 100 consecutive enterobacteriacea isolates from clinical samples during a 4 month period. Isolates from rectal and nose swabs were excluded, as were isolates from surveillance cultures. A maximum of one isolate per species per patient was allowed. Isolates were identified by participating laboratories using their own standard identification technique. MICs were determined using Etest on site for ertapenem, amoxicillin, amoxicillin/clavulanic acid, meropenem, piperacillin/tazobactam, ceftazidime, ceftriaxone, tobramycin, cotrimoxazole and ciprofloxacin. Control ATCC strains were included. Afterwards, strains were collected by the central lab for further analysis. For ESBL screening, primary isolates of Escherichia coli and Klebsiella pneumoniae were subcultured on a ESBL screening plate with ceftazidime and cefotaxim. Colonies growing on the screening plate were tested for ESBL using the Etest TZ/TZL and CT/CTL strip and if necessary the PM/PML strip. K. oxytoca was evaluated based on Etest results of ceftazidime and ceftriaxon. All other enterobacteriacae were tested with the Etest PM/PML strip to differentiate the ESBL from the AmpC producers.

Results: The overall prevalence of confirmed ESBL producers was close to 6%. 43% of all isolates were identified as E. coli and 12% as K. pneumoniae, with ESBL prevalences of up to 6% and 8%, respectively. The MIC90's (mg/L) were 0.38 for ciprofloxacin, 0.125 for ertapenem, 0.094 for meropenem, 32 for cotrimoxazole and 2 for tobramycin.

Conclusion: This was the first large scale survey to determine the prevalence of ESBL-producing enterobacteriaceae in the Netherlands. The overall prevalence of close to 6% is significant and indicates that there is reason to start monitoring ESBL prevalence on a regular basis in order to better guide control measures.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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