Emerging extensively drug-resistant bacteria (eXDR) in France in 2018.

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• Healthcare-associated infections (HAIs) pose a significant threat globally.
• The emergence and spread of extensively drug-resistant (eXDR) bacteria, such as carbapenemase-producing Enterobacteriaceae (CPE) and glycopeptide-resistant Enterococcus faecium (GRE), represent a critical challenge in antimicrobial resistance (AMR).
• Effective surveillance and response systems are crucial for monitoring and controlling the spread of these resistant pathogens in hospital settings.

Purpose of the Study:

• To describe the epidemiology of emerging eXDR bacteria in France based on 2018 Healthcare-Associated Infections Early Warning and Response System (HAI-EWRS) notifications.
• To analyze the trends in carbapenemase-producing Enterobacteriaceae (CPE) and glycopeptide-resistant Enterococcus faecium (GRE) notifications and strains received by the National Reference Center for anti-microbial resistance (NRC).
• To evaluate the control measures implemented in hospital settings for managing eXDR bacteria.

Main Methods:

• Analysis of all HAI-EWRS notifications of eXDR received nationally and all eXDR strains received at the NRC between January 1 and January 31, 2018.
• Data collection included number of cases, number of strains, resistance mechanisms, sample types, foreign country links, and implemented control measures.
• Comparison of 2018 data with 2012 data to identify trends in notifications and strain prevalence.

Main Results:

• In 2018, France reported 1704 CPE and 315 GRE notifications, showing a significant increasing trend since 2012 (×6 for CPE, ×3 for GRE).
• The number of hospitals reporting these notifications also increased substantially (+66% for CPE, +57% for GRE).
• eXDR strains were predominantly isolated from rectal screening swabs, and notifications associated with standard precautions were more frequently linked to outbreaks than those with contact precautions.

Conclusions:

• The rising annual number of eXDR notifications and strains highlights a concerning spread of these resistant bacteria in France.
• While the overall number of eXDR infections remains low, the data indicate that current control recommendations are not consistently implemented in healthcare facilities.
• There is an urgent need to reinforce the implementation of existing infection control strategies to mitigate the spread of eXDR bacteria.