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Incidence rates of carbapenemase-producing Enterobacteriaceae clinical isolates in France: a prospective nationwide study in 2011-12.
Robert, Jerome 1,2,3,*; Pantel, Alix 4,5; Merens, Audrey 6; Lavigne, Jean-Philippe 4,5; Nicolas-Chanoine, Marie-Helene 7,8,9; Brieu, N.; Vrain, A.; Scanvic, A.; Porcheret, H.; Garnier, P.; Bertrand, X.; Descamps, D.; Hombrouck, C.; Soullie, B.; Heym, B.; de Montclos, H.; Garrec, H.; Levast, M.; Mendes-Martins, L.; Decousser, J. W.; Huet, C.; Bert, F.; Herzig, V.; Klein, J. P.; Nebbad, B.; Hendricx, S.; Verhaeghe, A.; Lafaurie, C.; Lanselle, C.; Elsayed, F.; Carrer, A.; Drieux-Rouzet, L.; Evreux, F.; Varache, C.; Wallet, F.; Martin, C.; Le-Bris, J. M.; Moulhade, M. C.; Deville, E.; Menouni, O.; Jean-Pierre, H.; Pierrot, P.; Delarbre, J. M.; Coude, B.; Foca, M.; Degand, N.; Prots, L.; Pantel, A.; Adam, M. N.; Laurens, E.; Raskine, L.; Laouira, S.; Arlet, G.; Sanchez, R.; Peuchant, O.; Grau, V.; Laurent, C.; De-Champs, C.; Vachee, A.; Harriau, P.; Merens, A.; Belmonte, O.; Michel, G.; Henry, C.; Picot, S.; Glatz, I.; Gueudet, T.; Honderlick, P.; Cavalie, L.; Galinier, J. L.; Patoz, P.; van-der-Mee-Marquet, N.; Haguenoer, E.; Canis, F.; Kassis-Chikhany, N.; Le-Garrec, Y.
[Article] Journal of Antimicrobial Chemotherapy. 69(10):2706-2712, October 2014.

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Objectives: To determine proportions and incidence rates of Enterobacteriaceae producing carbapenemase among those non-susceptible (NS) to carbapenems in France.

Methods: From November 2011 to April 2012, 71 laboratories recorded non-duplicate Enterobacteriaceae clinical isolates NS to at least one carbapenem and the total number of isolates of the different species. Carbapenem MICs were determined by broth microdilution and the [beta]-lactamase content by DNA microarray.

Results: During the study period, the 71 laboratories identified 133 244 Enterobacteriaceae isolates, of which 846 (0.63%) were NS to at least one carbapenem. Carbapenem-NS isolates accounted for 0.07% (61/90 148) among Escherichia coli isolates, 1.1% (111/10 436) among Klebsiella pneumoniae, 8.2% (492/5971) among Enterobacter cloacae and 4.0% (84/2104) among Enterobacter aerogenes. Among the 541 available carbapenem-NS isolates, 222 (including 63 randomly selected E. cloacae) were further analysed after confirmation of carbapenem non-susceptibility. None of the Enterobacter spp. isolates produced carbapenemase. Among the other species, 28 isolates produced carbapenemases (22 OXA-48, 4 KPC and 2 NDM), accounting for an estimated proportion of carbapenemase-producing isolates of 0.08% for all species, 0.01% for E. coli and 0.27% for K. pneumoniae. The incidence-density rate in the participating hospitals was 0.0041 per 1000 hospital-days and the incidence rate was 0.0027 per 100 admissions.

Conclusions: The incidence-density rate of carbapenemase-producing isolates per 1000 hospital-days was low and 30-fold lower than that of carbapenem-NS isolates (0.125) and almost 300-fold lower than that of ESBL-producing isolates (1.104) in these French hospitals.