Epidemiology of carbapenem-resistant and carbapenemase-producing Enterobacterales in the Netherlands 2017–2019
Authors: Wielders Cornelia C. H. , Schouls Leo M. , Woudt Sjoukje H. S. , Notermans Daan W. , Hendrickx Antoni P. A. , Bakker Jacinta , Kuijper Ed J. , Schoffelen Annelot F. , de Greeff Sabine C. ,   the Infectious Diseases Surveillance Information System-Antimicrobial Resistance (ISIS-AR) Study Group, Cohen Stuart J. W. T. , Melles D. C. , van Dijk K. , Alzubaidy A. , Werdmuller B. F. M. , Blaauw G. J. , Diederen B. M. W. , Alblas H. J. , Altorf-van der Kuil W. , Bierman S. M. , de Greeff S. C. , Groenendijk S. R. , Hertroys R. , Kuijper E. J. , Monen J. C. , Notermans D. W. , van den Reek W. J. , Schoffelen A. F. , Smilde A. E. , Wielders C. C. H. , Woudt S. H. S. , Zoetigheid R. E. , van den Bijllaardt W. , Kraan E. M. , Mattsson E. E. , da Silva J. M. , de Jong E. , Maraha B. , van Griethuysen A. J. , van Asselt G. J. , Demeulemeester A. , Wintermans B. B. , van Trijp M. , Ott A. , Sinnige J. , Melles D. C. , Silvis W. , Bakker L. J. , Dorigo-Zetsma J. W. , Waar K. , Bernards A. T. , Leversteijn-van Hall M. A. , Schaftenaar E. , Nabuurs-Franssen M. H. , Wertheim H. , Diederen B. M. W. , Bode L. , van Rijn M. , Dinant S. , Pontesilli O. , Ong D. S. Y. , Wong M. , Muller A. E. , Renders N. H. , Bentvelsen R. G. , Buiting A. G. M. , Vlek A. L. M. , Stam A. J. , Troelstra A. , Overdevest I. T. M. A. , van Meer M. P. A. , Oliveira dos Santos C. , Wolfhagen M. J. H. M. ,   the Dutch CPE Surveillance Study Group, Maijer-Reuwer A. , Leversteijn-van Hall M. A. , van den Bijllaardt W. , Spijkerman I. J. B. , van Dijk K. , Halaby T. , Zwart B. , Diederen B. M. W. , Voss A. , Dorigo-Zetsma J. W. , Ott A. , Oudbier J. H. , van der Vusse M. , Vlek A. L. M. , Buiting A. G. M. , Bode L. , Paltansing S. , van Griethuysen M. den Reijer A. J. , van Trijp M. , Wong M. , Muller A. E. , van der Linden M. P. M. , van Rijn M. , Wolfhagen M. J. H. M. , Waar K. , Kolwijck E. , al Naiemi N. , Schulin T. , Damen M. , Dinant S. , van Mens S. P. , Melles D. C. , Cohen Stuart J. W. T. , van Ogtrop M. L. , Overdevest I. T. M. A. , van Dam A. P. , Wertheim H. , Maraha B. , Sinnige J. C. , Mattsson E. E. , Bosboom R. W. , Stam A. , de Jong E. , Roescher N. , Heikens E. , Steingrover R. , Troelstra A. , Bathoorn E. , Trienekens T. A. M. , van Dam D. W. , de Brauwer E. I. G. B. , Stals F. S. 
Published: April 2022

Abstract
Background
The Netherlands is currently considered a low endemic country for carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE), experiencing only sporadic hospital outbreaks. This study aims to describe susceptibility to carbapenems and the epidemiology of carbapenemase production in Enterobacterales in the Netherlands in 2017–2019.

Methods
Three complementary nationwide surveillance systems are in place to monitor carbapenem susceptibility in the Netherlands. Routine antimicrobial susceptibility test results from medical microbiology laboratories were used to study phenotypic susceptibility of Escherichia coli and Klebsiella pneumoniae. Pathogen surveillance (of all Enterobacterales species) and mandatory notifications were used to describe the characteristics of CPE positive isolates and affected persons.

Results
The prevalence of isolates with gradient strip test-confirmed elevated meropenem (> 0.25 mg/L) or imipenem (> 1 mg/L) minimum inhibitory concentration (MIC) in the Netherlands was very low in 2017–2019, with percentages of 0.06% in E. coli and 0.49% in K. pneumoniae, and carbapenem resistances of 0.02% and 0.18%, respectively. A total of 895 unique species/carbapenemase-encoding allele combinations of CPE from 764 persons were submitted between 2017 and 2019, with the annual number of submissions increasing slightly each year. Epidemiological data was available for 660 persons. Screening because of presumed colonisation risk was the reason for sampling in 70.0% (462/660) of persons. Hospitalization abroad was the most common risk factor, being identified in 45.9% of persons.

Conclusions
Carbapenem resistance of E. coli and K. pneumoniae remains low in the Netherlands. The annual number of CPE isolates slightly increased during the period 2017–2019. Recent hospitalization abroad is the main risk factor for acquisition of CPE.