BACKGROUND The spread of carbapenemase-producing Enterobacteriaceae (CPE) in the Southwest Indian Ocean area (SIOA) is poorly documented. Reunion Island is a French overseas territory located close to Madagascar and connected with Southern Africa, Indian sub-continent and Europe, with several weekly flights. Here we report the results of the CPE surveillance program in Reunion Island over a six-year period. METHODS All CPE were collected between January 2011 and December 2016. Demographics and clinical data of the carrier patients were collected. We determined their susceptibility to antimicrobials, identified the carbapenemases and ESBL by PCR and sequencing, and explored their genetic relationship using pulsed-field gel electrophoresis and multi-locus sequence typing. RESULTS A total of 61 CPEs isolated from 53 patients were retrieved in 6 public or private laboratories of the island. We found that 69.8% of CPE patients were linked to a foreign country of SIOA and that almost half of CPE cases (47.2%) reached the island through a medical evacuation. The annual number of CPE cases strongly increased over the studied period (one case in 2011 vs. 21 cases in 2016). A proportion of 17.5% of CPE isolates were non-susceptible to colistin. blaNDM was the most frequent carbapenemase (79.4%), followed by blaIMI (11.1%), and blaIMP-10 (4.8%). Autochtonous CPE cases (30.2%) harboured CPE isolates belonging to a polyclonal population. CONCLUSIONS Because the hospital of Reunion Island is the only reference healthcare setting of the SIOA, we can reasonably estimate that its CPE epidemiology reflects that of this area. Mauritius was the main provider of foreign CPE cases (35.5%). We also showed that autochthonous isolates of CPEs are mostly polyclonal, thus unrelated to cross-transmission. This demonstrates the local spread of carbapenemase-encoding genes (i.e. blaNDM) in a polyclonal bacterial population and raises fears that Reunion Island could contribute to the influx of NDM-carbapenemase producers into the French mainland territory.

中文翻译：

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产生碳青霉烯酶的肠杆菌科细菌在留尼汪岛（在印度洋西南部的法国领土）流通。

背景技术很少有文献报道产生碳青霉烯酶的肠杆菌科细菌（CPE）在西南印度洋地区（SIOA）中的传播。留尼汪岛是法国的海外领土，靠近马达加斯加，并与南部非洲，印度次大陆和欧洲相连，每周有几次航班。在这里，我们报告了留尼汪岛六年来​​CPE监视计划的结果。方法收集2011年1月至2016年12月的所有CPE。收集携带者的人口统计学和临床​​资料。我们确定了它们对抗菌剂的敏感性，通过PCR和测序鉴定了碳青霉烯酶和ESBL，并使用脉冲场凝胶电泳和多位点序列分型法探索了它们的遗传关系。结果在岛上的6个公共或私人实验室中，共从53名患者中分离出61种CPE。我们发现69.8％的CPE患者与SIOA的外国有联系，并且几乎一半的CPE病例（47.2％）通过医疗后送到达了该岛。在研究期间，每年的CPE病例数大幅增加（2011年为1例，2016年为21例）。比例为17.5％的CPE分离株对粘菌素不敏感。blaNDM是最常见的碳青霉烯酶（79.4％），其次是blaIMI（11.1％）和blaIMP-10（4.8％）。地方性CPE病例（30.2％）带有属于多克隆种群的CPE分离株。结论由于留尼汪岛医院是SIOA的唯一参考医疗机构，因此我们可以合理地估计其CPE流行病学反映了该地区的情况。毛里求斯是外国CPE案件的主要提供方（35.5％）。我们还显示，CPE的本地分离株大部分是多克隆的，因此与交叉传播无关。这证明了碳青霉烯酶编码基因（即blaNDM）在多克隆细菌种群中的局部传播，并引发了人们对留尼汪岛可能导致NDM-卡巴内酰胺酶生产者大量涌入法国大陆的担忧。