R. Cantón, M. Akóva, Y. Carmeli, C. G. Giske, Y. Glupczynski, M

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Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe R. Cantón, M. Akóva, Y. Carmeli, C.G. Giske, Y. Glupczynski, M. Gniadkowski, D.M. Livermore, V. Miriagou, T. Naas, G.M. Rossolini, Ø. Samuelsen, H. Seifert, N. Woodford, P. Nordmann Clinical Microbiology and Infection Volume 18, Issue 5, Pages 413-431 (May 2012) DOI: 10.1111/j.1469-0691.2012.03821.x Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 1 European situation regarding carbapenemase-producing Enterobacteriaceae, using an epidemiological scale of nationwide expansion (data have been updated from reference 17) and carbapenemase types in different countries or geographical areas known until January 2012. Clinical Microbiology and Infection 2012 18, 413-431DOI: (10.1111/j.1469-0691.2012.03821.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 2 Rates of non-susceptibility (intermediate plus resistant) of Klebsiella pneumoniae to carbapenems in European countries. Data were obtained from the EARS-Net database (2010). (http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/database/Pages/database.aspx). Only those countries with non-susceptible isolates are included. Clinical Microbiology and Infection 2012 18, 413-431DOI: (10.1111/j.1469-0691.2012.03821.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 3 Evolution of the carbapenemase-producing Enterobacteriaceae (CPE) isolates in Belgium (92 isolates referred to the National Reference Centre, Belgium, January 2007–December 2011) (data have been updated from reference 150). Clinical Microbiology and Infection 2012 18, 413-431DOI: (10.1111/j.1469-0691.2012.03821.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 4 Numbers of UK laboratories referring at least one carbapenemase-producing Enterobacteriaceae (CPE) isolate to the Antibiotic Resistance Monitoring and Reference Laboratory (ARMRL) (Health Protection Agency). Additionally, in 2010 and 2011, two and one laboratories, respectively, referred IMI-producing CPE isolates, respectively. In 2011, one laboratory referred at least one CPE isolate producing both KPC and VIM enzymes. Clinical Microbiology and Infection 2012 18, 413-431DOI: (10.1111/j.1469-0691.2012.03821.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions