Stockholm – In Tuscany, there has been a proliferation of carbapenem-resistant enterobacteria in recent months. Intestinal bacteria, which cut carbapenems and almost all other beta-lactam antibiotics with Metallo beta-lactamase from New Delhi (NDM), were found in a total of 350 clinics out of 7. Tuscany being a popular tourist destination, the European Center for Disease Prevention and Control (ECDC) considers that it is possible to extend it to other countries. Clinics are advised to inquire about the admission of patients after a stay in Tuscany and to carry out screening during a stay in this locality.
NDM-resistant bacteria were first discovered in 2008 in a Swedish patient who had been treated in a clinic in the Indian capital. Since then, NDM-resistant pathogens have been detected sporadically worldwide. A first outbreak of NDM-resistant Enterobacteriaceae in Europe was reported in 2011 in a Bologna clinic. The following year, a nationwide outbreak with K. pneumoniae resistant to MND from Poland was reported. Subsequent investigations showed that pathogens were spreading in the Balkan countries. In Greece, several clinics had more than 300 people.
Between November 2018 and May 23, 2019, a total of 350 patients with NDM-resistant enterobacteria were found in seven Tuscan clinics. Pathogens were found in blood samples (50 cases), urine (43 cases) and respiratory samples (15 cases). A total of 242 patients excreted the pathogens with stool.
The pathogens belonged to the same clone, indicating the spread by a single index patient, which was not found. It remains difficult to know how the pathogens arrived in Tuscany. Since early 2010, enterobacteria, which have the enzyme Klebsiella pneumoniae carbapenamase (KPC) and therefore reduced susceptibility to carbapenem antibiotics, are also found in the same region.
According to the ECDC, the two resistances could complicate the treatment, because even more recent associations of beta-lactam antibiotic, ceftazidime and avibactam, a beta-lactamase inhibitor, could occur. prove ineffective.
According to the ECDC, travelers to Tuscany are not at increased risk if they are not treated in a clinic. There, however, they could become infected without being noticed and spread the pathogens on their return. Inpatients at increased risk of infection due to immune deficiency, for example patients on stem cell therapy, are particularly at risk. © heat / Good medical