Increase in Escherichia coli isolates carrying blaNDM-5 in the European Union/European Economic Area, 2012–2022
Analysis of whole genome sequencing and epidemiological data of 874 E. coli isolates from the national collections of 13 countries confirmed the increase of E. coli isolates carrying blaNDM-5 which was previously detected in the CCRE survey.
Executive summary
Unpublished preliminary results of the survey of carbapenem- and/or colistin-resistant Enterobacterales (CCRE- survey) conducted in 36 European countries in 2019 had shown that NDM-5 had become the most frequently reported carbapenemase in Escherichia coli. The aim of this study was to determine the extent of the spread of E. coli isolates carrying blaNDM-5 in the European Union/European Economic Area (EU/EEA). Analysis of whole genome sequencing and epidemiological data of 874 E. coli isolates from the national collections of 13 countries confirmed the increase of E. coli isolates carrying blaNDM-5 which was previously detected in the CCRE survey.
While the blaNDM-5 gene was detected in 83 different E. coli sequence types (STs) from national collections, there was a strong predominance of a few STs, mainly ST167, ST405, ST410, ST361, and ST648. The high number and the large size of multi-country clusters in the dataset, including recent isolates from 2022, suggest an ongoing rapid global expansion of these dominant E. coli STs carrying blaNDM-5, including the EU/EEA.
Despite limited data completeness, about 84.2% of the E. coli isolates carrying blaNDM-5 with available information on travel and/or hospitalisation within the six months before sampling were linked to a country outside of the EU/EEA, mainly countries in Africa and Asia. This suggests that travel-related acquisition may still be the most likely origin of these isolates. Additionally, about 30% of the E. coli isolates carrying blaNDM-5 were documented as related to infections, emphasising the clinical relevance and need for early detection.
Furthermore, a high proportion of the isolates carrying blaNDM-5 also co-harboured resistance markers to aminoglycosides, fluoroquinolones, and trimethoprim-sulfamethoxazole, indicating multidrug resistance with limited options left for the treatment of patients.
Further spread of E. coli isolates carrying blaNDM-5 within and between the EU/EEA countries, particularly in healthcare facilities, as well as introductions from outside of the EU/EEA have the potential to increase dissemination, with severe consequences on the health-related and economic burden caused by these infections. Due to resistance to carbapenems as well as other antibiotics, such a scenario would leave limited options for the treatment of E. coli infections, both in healthcare and community.
