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Prevalence of Klebsiella pneumoniae strains producing carbapenemases and increase of resistance to colistin in an Italian teaching hospital from January 2012 To December 2014.

Parisi SG, Bartolini A, Santacatterina E, Castellani E, Ghirardo R, Berto A, Franchin E, Menegotto N, De Canale E, Tommasini T, Rinaldi R, Basso M, Stefani S, Palù G - BMC Infect. Dis. (2015)

Bottom Line: Among all available samples, the number of CoR isolated from SRS was higher in 2013 and 2014 compared with 2012 (p = 0.0019 and p = 0.008, respectively).The results of this 3-year study of 15,104 patients highlight the clinical relevance of antimicrobial resistance as well as the drug-selection pressure of colistin therapy.The active surveillance in the three different departments increased the level of CPKP cases isolated by SRS.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy. saverio.parisi@unipd.it.

ABSTRACT

Background: The aim of this study was to characterize the spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) in a tertiary level hospital using ongoing active surveillance with rectal swab cultures. Furthermore, this study analyzed the presence of CPKP in the clinical samples (CS) of a single patient as well as the evolution of Colistin-sensitive strains (CoS) to Colistin-resistant strains (CoR).

Methods: This study was performed from January 1, 2012 to December 31, 2014. In 2012, a survey was conducted in the Intensive Care Department. In autumn 2013, active monitoring was extended to the Surgery Department, and since mid-2014, the surveillance has included the Medical Department as well. Only the first isolated strain from each patient was included. Antimicrobial susceptibility testing was performed on CPKP isolates: Klebsiella pneumoniae carbapenemase, oxacillinase-48, Verona integron-encoded metallo-β-lactamase and New Delhi metallo-β-lactamase were detected using a validated in-house PCR method, and multilocus sequence typing (MLST) was used to investigate the clonal transmission of strains.

Results: A total of 15,104 patients were included in the study, and 496 consecutive non-replicated strains of CPKP were collected: 149 strains were collected in 2012 (39 [26.2 %] from surveillance rectal swabs [SRS]), 133 strains were collected in 2013 (70 [52.6 %] from SRS) and 214 strains were collected in 2014 (164 [76.6 %] from SRS). We observed a significant increase in the percentage of positive SRS cases in 2014 relative to 2013 and 2012 (p = 0.0001 and p = 0.0172, respectively) and in the proportion of CPKP first isolated by SRS relative to those identified by CS (p < 0.0001). Among all available samples, the number of CoR isolated from SRS was higher in 2013 and 2014 compared with 2012 (p = 0.0019 and p = 0.008, respectively). ST-258 and ST-512 were more prevalent in the tested specimens, and a new single locus variant (SLV) of ST-512 (ST-745) was isolated.

Conclusions: The results of this 3-year study of 15,104 patients highlight the clinical relevance of antimicrobial resistance as well as the drug-selection pressure of colistin therapy. The active surveillance in the three different departments increased the level of CPKP cases isolated by SRS.

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Carbapenemase producing Klebsiella pneumoniae strains isolated from surveillance rectal swabs and from clinical samples in 2012, 2013 and 2014. IC: intensive care. CS: clinical samples. SRS: surveillance rectal swabs
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Fig2: Carbapenemase producing Klebsiella pneumoniae strains isolated from surveillance rectal swabs and from clinical samples in 2012, 2013 and 2014. IC: intensive care. CS: clinical samples. SRS: surveillance rectal swabs

Mentions: During the study period, 5,305 subjects were screened in the ICD, 7,560 were screened in the SD, and 2,239 patients were screened in the MD. The comparative analysis of the detection of CPKP by SRS versus CS revealed an increased rate of CPKP identified by SRS relative to CS (Fig. 2).Fig. 2


Prevalence of Klebsiella pneumoniae strains producing carbapenemases and increase of resistance to colistin in an Italian teaching hospital from January 2012 To December 2014.

Parisi SG, Bartolini A, Santacatterina E, Castellani E, Ghirardo R, Berto A, Franchin E, Menegotto N, De Canale E, Tommasini T, Rinaldi R, Basso M, Stefani S, Palù G - BMC Infect. Dis. (2015)

Carbapenemase producing Klebsiella pneumoniae strains isolated from surveillance rectal swabs and from clinical samples in 2012, 2013 and 2014. IC: intensive care. CS: clinical samples. SRS: surveillance rectal swabs
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4482166&req=5

Fig2: Carbapenemase producing Klebsiella pneumoniae strains isolated from surveillance rectal swabs and from clinical samples in 2012, 2013 and 2014. IC: intensive care. CS: clinical samples. SRS: surveillance rectal swabs
Mentions: During the study period, 5,305 subjects were screened in the ICD, 7,560 were screened in the SD, and 2,239 patients were screened in the MD. The comparative analysis of the detection of CPKP by SRS versus CS revealed an increased rate of CPKP identified by SRS relative to CS (Fig. 2).Fig. 2

Bottom Line: Among all available samples, the number of CoR isolated from SRS was higher in 2013 and 2014 compared with 2012 (p = 0.0019 and p = 0.008, respectively).The results of this 3-year study of 15,104 patients highlight the clinical relevance of antimicrobial resistance as well as the drug-selection pressure of colistin therapy.The active surveillance in the three different departments increased the level of CPKP cases isolated by SRS.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy. saverio.parisi@unipd.it.

ABSTRACT

Background: The aim of this study was to characterize the spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) in a tertiary level hospital using ongoing active surveillance with rectal swab cultures. Furthermore, this study analyzed the presence of CPKP in the clinical samples (CS) of a single patient as well as the evolution of Colistin-sensitive strains (CoS) to Colistin-resistant strains (CoR).

Methods: This study was performed from January 1, 2012 to December 31, 2014. In 2012, a survey was conducted in the Intensive Care Department. In autumn 2013, active monitoring was extended to the Surgery Department, and since mid-2014, the surveillance has included the Medical Department as well. Only the first isolated strain from each patient was included. Antimicrobial susceptibility testing was performed on CPKP isolates: Klebsiella pneumoniae carbapenemase, oxacillinase-48, Verona integron-encoded metallo-β-lactamase and New Delhi metallo-β-lactamase were detected using a validated in-house PCR method, and multilocus sequence typing (MLST) was used to investigate the clonal transmission of strains.

Results: A total of 15,104 patients were included in the study, and 496 consecutive non-replicated strains of CPKP were collected: 149 strains were collected in 2012 (39 [26.2 %] from surveillance rectal swabs [SRS]), 133 strains were collected in 2013 (70 [52.6 %] from SRS) and 214 strains were collected in 2014 (164 [76.6 %] from SRS). We observed a significant increase in the percentage of positive SRS cases in 2014 relative to 2013 and 2012 (p = 0.0001 and p = 0.0172, respectively) and in the proportion of CPKP first isolated by SRS relative to those identified by CS (p < 0.0001). Among all available samples, the number of CoR isolated from SRS was higher in 2013 and 2014 compared with 2012 (p = 0.0019 and p = 0.008, respectively). ST-258 and ST-512 were more prevalent in the tested specimens, and a new single locus variant (SLV) of ST-512 (ST-745) was isolated.

Conclusions: The results of this 3-year study of 15,104 patients highlight the clinical relevance of antimicrobial resistance as well as the drug-selection pressure of colistin therapy. The active surveillance in the three different departments increased the level of CPKP cases isolated by SRS.

Show MeSH
Related in: MedlinePlus