Emergence and dissemination of multi-resistant Gram negative Enterobacteriaceae: lessons to be learnt from local and national surveillance programs in Belgium

Abstract

Infections caused by multi drug resistant bacteria (MDRB) constitutes an international health care problem. Since the year 2000, a longitudinal surveillance programme (LSP) and two multicentric surveys (100 hospitals, 826 isolates) were performed to monitor the emergence of MDRB in Belgium. The implementation of a LSP detected the emergence and spread of new types of ESBLs (CTX-M), mostly among community associated E. coli in the setting of a university hospital several years before the large spread and recognition in Belgium of a pathogenic E. coli CTX-M-15 (B2-O25:H4-ST131) pandemic clone (found in extra-intestinal virulent strains). This finding supports the progressive increase in Belgium of systemic infections including UTI caused by MDRB with limited therapeutical options. The real burden of the problem remains however, difficult to estimate in the absence of any surveillance network in Belgium to monitor the epidemiology of antimicrobial resistance in the community. The current Belgian national recommendations for the detection, surveillance, prevention and control of epidemics by ESBL-producing organisms and possibly other MDRBs (eg: Carbapenemase producing Enterobacteriaceae [CPE]) must be updated taking into accounts these new elements. A global coordinated network for antimicrobial surveillance resistance gathering experts (e.g: public health epidemiologists, representative of the national reference centres of antimicrobial resistance, field experts in infection control, infectious disease specialists, other clinicians and general practitioners) must be urgently implemented, including the longitudinal analysis of resistance in different ecosystems (human, animal, water and food).

Keywords:

• ESBL
• surveillance
• antibiotic resistance
• Belgium
• multi-resistance
• Enterobacteriaceae
• carbapenemase

Acknowledgements

We thank our microbiologist colleagues for their participation in the national surveillance programmes and for referring the isolates for the different studies. We are very grateful to Beatrice Jans (Institute of Public Health) for her support and collaboration with the National Reference Laboratory for Monitoring of Antimicrobial Resistance in Gram-negative Bacteria.

This work was supported in part by grants from the Belgian Antibiotic Policy Coordination Committee (BAPCOC), Ministry of Public Health, Belgium and by the Fonds de la recherche scientifique Belge (FNRS) (grant number N3·4·522·09F).