Multiresistant bacteria continue to spread in Danish hospitals

Multiresistant intestinal bacteria are becoming an increasing problem in the Danish healthcare system. From 2022 to 2023, the number of infections with CPE bacteria rose by 43 percent, according to new data from the surveillance DANMAP programme which SSI and the DTU National Food Institute stand behind.

Thursday 22 August 2024

Previously, the specific group of antibiotic-resistant bacteria known as carbapenemase-producing enterobactereales (CPE) was primarily contracted by Danes who had been hospitalized abroad or stayed outside the country for extended periods. However, in recent years, there has been a spread of these bacteria within Danish hospitals that cannot be traced back to foreign sources.

In 2023, there were altogether 436 reported cases in Denmark, reflecting a 43 percent increase compared to 304 cases the previous year. CPE are typically found in the intestines and are resistant to meropenem or other carbapenems, which are among our most critical antibiotics for treating critically ill patients.

Healthy individuals have a low risk of becoming seriously ill if infected with these bacteria. The greatest risk is for patients who are already weakened or have compromised immune systems due to conditions such as severe cancer. These are patients who have undergone prolonged treatment regimens.

It is the combination of a particularly vulnerable patient and prolonged antibiotic treatment that can lead to a CPE infection. The bacteria can become dangerous when they leave their usual environment in the intestines and enter the bloodstream, causing sepsis. When our usual antibiotic treatments fail because the infection is caused by a resistant bacterium, it can become critical with CPE bacteria in the blood.

Fortunately, in Denmark, it remains relatively rare for CPE bacteria to cause sepsis, and they are typically found in swabs, feces, or urine from patients. For instance, the proportion of sepsis cases caused by carbapenemase-producing E. coli remains below 1%.

In Denmark, CPE have been systematically surveilled since 2018, and results are published in the annual DANMAP report and presented at the annual DANMAP seminar, both happening in November. The chapter on antimicrobial resistance in human bacteria, which also includes data on CPO findings is already available here. DANMAP is a joint collaboration between DTU National Food Institute and Statens Serum Institut.  

More information regarding CPO is available at SSIs homepage (Danish) Carbapenemase-producerende organismer (CPO) (ssi.dk).

Fact Box

• CPO includes two main groups of bacteria, namely intestinal bacteria and environmental bacteria. The intestinal bacteria constitute the largest group and are referred to as CPE (carbapenemase-producing Enterobactereales). These are well-known intestinal bacteria such as E. coli, Klebsiella pneumoniae, and Citrobacter freundii, which have become so resistant that there are only a few effective antibiotics left for treatment.

• Many individuals infected with CPO bacteria are healthy carriers and have CPO bacteria in their intestines without showing symptoms.

• However, individuals who are already sick and weakened can become seriously ill from CPO bacteria because they are more prone to infections. In this case, CPO bacteria most often cause urinary tract infections or sepsis.

• Transmission occurs primarily through close contact with other people. CPE are intestinal bacteria that are excreted in feces, and the bacteria are particularly found on the skin in the groin area. Environmental bacteria are found on surfaces and in moist environments. You can prevent transmission through good hand hygiene, which is especially important after each toilet visit.

 
Source: The Danish Health Authority and Statens Serum Institut

 

Contact

Ute Wolff Sönksen Overlæge Statens Serum Insitut