Enterobacterales carrying chromosomal AmpC β-lactamases in Europe (EuESCPM): Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020–2022

Matteo Boattini, Gabriele Bianco, Laura Iglesias Llorente, Laura Alonso Acero, Daniel Nunes, Miguel Seruca, Vasco Santos Mendes, André Almeida, Paulo Bastos, Ángel Rodríguez-Villodres, Adelina Gimeno Gascón, Ana Verónica Halperin, Rafael Cantón, Maria Nieves Larrosa Escartín, Juan José González-López, Pauline Floch, Clémence Massip, Delphine Chainier, Olivier Barraud, Laurent DortetGaëlle Cuzon, Clément Zancanaro, Assaf Mizrahi, Rogier Schade, Asger Nellemann Rasmussen, Kristian Schønning, Axel Hamprecht, Lukas Schaffarczyk, Stefan Glöckner, Jürgen Rödel, Katalin Kristóf, Ágnes Balonyi, Stefano Mancini, Chantal Quiblier, Teresa Fasciana, Anna Giammanco, Bianca Paglietti, Salvatore Rubino, Ana Budimir, Branka Bedenić, Zana Rubic, Jelena Marinović, Konstantina Gartzonika, Eirini Christaki, Viktoria Eirini Mavromanolaki, Sofia Maraki, Tuğba Yanık Yalçın, Özlem Kurt Azap, Monica Licker, Corina Musuroi, Daniela Talapan, Corneliu Ovidiu Vrancianu, Sara Comini, Patrycja Zalas-Więcek, Anna Michalska, Rossana Cavallo, José Melo Cristino, Cristina Costa

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Introduction: The ESCPM group (Enterobacter species including Klebsiella aerogenes - formerly Enterobacter aerogenes, Serratia species, Citrobacter freundii complex, Providencia species and Morganella morganii) has not yet been incorporated into systematic surveillance programs. Methods: We conducted a multicentre retrospective observational study analysing all ESCPM strains isolated from blood cultures in 27 European hospitals over a 3-year period (2020–2022). Diagnostic approach, epidemiology, and antimicrobial susceptibility were investigated. Results: Our study comprised 6,774 ESCPM isolates. MALDI-TOF coupled to mass spectrometry was the predominant technique for bacterial identification. Susceptibility to new β-lactam/β-lactamase inhibitor combinations and confirmation of AmpC overproduction were routinely tested in 33.3% and 29.6% of the centres, respectively. The most prevalent species were E. cloacae complex (44.8%) and S. marcescens (22.7%). Overall, third-generation cephalosporins (3GC), combined third- and fourth-generation cephalosporins (3GC + 4GC) and carbapenems resistance phenotypes were observed in 15.7%, 4.6%, and 9.5% of the isolates, respectively. AmpC overproduction was the most prevalent resistance mechanism detected (15.8%). Among carbapenemase-producers, carbapenemase type was provided in 44.4% of the isolates, VIM- (22.9%) and OXA-48-enzyme (16%) being the most frequently detected. E. cloacae complex, K. aerogenes and Providencia species exhibited the most notable cumulative antimicrobial resistance profiles, with the former displaying 3GC, combined 3GC + 4GC and carbapenems resistance phenotypes in 15.2%, 7.4%, and 12.8% of the isolates, respectively. K. aerogenes showed the highest rate of both 3GC resistant phenotype (29.8%) and AmpC overproduction (32.1%), while Providencia species those of both carbapenems resistance phenotype (42.7%) and carbapenemase production (29.4%). ESCPM isolates exhibiting both 3GC and combined 3GC + 4GC resistance phenotypes displayed high susceptibility to ceftazidime/avibactam (98.2% and 95.7%, respectively) and colistin (90.3% and 90.7%, respectively). Colistin emerged as the most active drug against ESCPM species (except those intrinsically resistant) displaying both carbapenems resistance phenotype (85.8%) and carbapenemase production (97.8%). Conclusions: This study presented a current analysis of ESCPM species epidemiology in Europe, providing insights to inform current antibiotic treatments and guide strategies for antimicrobial stewardship and diagnostics.

Original languageEnglish
Article number107115
JournalInternational Journal Of Antimicrobial Agents
Issue number5
Publication statusPublished - May 2024


  • AmpC β-lactamase
  • Antimicrobial resistance
  • Blood culture
  • COVID-19
  • Enterobacterales
  • Sepsis


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