Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

Abstract

Carbapenem antibiotics are used as a last resort to treat serious Gram-negative bacteria (GNB) infections; however, carbapenemase-producing strains of GNB have emerged as a major source of resistance. Owing to the highly transmissible nature of plasmid-borne carbapenemases, numerous reports have warned about the likely spread into the community from healthcare settings. Since the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the community is largely unknown, we conducted a scoping review of the literature to assess the percentage of CRE isolates that could be associated with the community. Initially, 361 studies were assessed and 15 met the inclusion criteria. Although 5 studies (33.3%) found no community-associated CRE, the remaining 10 studies identified percentages ranging from 0.04% to 29.5% of either community-associated or community-onset CRE among their samples, with US-based studies alone ranging from 5.6 to 10.8%. The presence of CRE in the community poses an urgent public health threat.

Keywords: Antimicrobial resistance; Carbapenem-resistant Enterobacteriaceae; Community-associated infections.

Fig. 1

Study selection process. HAI, healthcare-associated infection; CAI, community-associated infection; CRE, carbapenem-resistant Enterobacteriaceae.

Fig. 2

Geographical distribution of studies included in the review (percentage of community-associated or community-onset carbapenem-resistant Enterobacteriaceae). Dates represent the study period.