Emerging Infectious Diseases (Sep 2018)

Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada

  • Philipp P. Kohler,
  • Roberto G. Melano,
  • Samir N. Patel,
  • Shumona Shafinaz,
  • Amna Faheem,
  • Brenda L. Coleman,
  • Karen Green,
  • Irene Armstrong,
  • Huda Almohri,
  • Sergio Borgia,
  • Emily Borgundvaag,
  • Jennie Johnstone,
  • Kevin Katz,
  • Freda Lam,
  • Matthew P. Muller,
  • Jeff Powis,
  • Susan M. Poutanen,
  • David Richardson,
  • Anu Rebbapragada,
  • Alicia Sarabia,
  • Andrew Simor,
  • Allison McGeer

DOI
https://doi.org/10.3201/eid2409.180164
Journal volume & issue
Vol. 24, no. 9
pp. 1674 – 1682

Abstract

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We analyzed population-based surveillance data from the Toronto Invasive Bacterial Diseases Network to describe carbapenemase-producing Enterobacteriaceae (CPE) infections during 2007–2015 in south-central Ontario, Canada. We reviewed patients’ medical records and travel histories, analyzed microbiologic and clinical characteristics of CPE infections, and calculated incidence. Among 291 cases identified, New Delhi metallo-β-lactamase was the predominant carbapenemase (51%). The proportion of CPE-positive patients with prior admission to a hospital in Canada who had not received healthcare abroad or traveled to high-risk areas was 13% for patients with oxacillinase-48, 24% for patients with New Delhi metallo-β-lactamase, 55% for patients with Klebsiella pneumoniae carbapenemase, and 67% for patients with Verona integron-encoded metallo-β-lactamase. Incidence of CPE infection increased, reaching 0.33 cases/100,000 population in 2015. For a substantial proportion of patients, no healthcare abroad or high-risk travel could be established, suggesting CPE acquisition in Canada. Policy and practice changes are needed to mitigate nosocomial CPE transmission in hospitals in Canada.

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