The High Incidence of Carbapenem-ResistantKlebsiella pneumoniaein Urine from Elderly Hospital Patients May Facilitate the Spread of Resistant Strains to the Community

Abstract

Almost all European countries are affected by the expansion of carbapenem-resistant Enterobacteriaceae occurring during recent years. In the two hospitals of Verona, Italy, the incidence of carbapenem-nonsusceptible Klebsiella pneumoniae (CNSKP) began to increase by the first months of 2011, reached a peak in the summer of the same year, and currently is around 30%. Contrary to what was reported by other hospitals and although significant percentages of CNSKP were detected in respiratory samples, blood and pus, urine from hospitalized patients, mainly geriatrics, are the clinical samples with the highest incidence of these strains. Elder patients are frequently transferred from the hospital to their own homes or long-term care facilities and vice-versa. Moreover, urinary tract infections are not considered as a severe pathology and frequently is asymptomatic in elderly. For these reasons, the presence of carbapenem non-susceptible bacteria in the urinary tract of geriatric patients might be an underestimated cause of multiresistant strain spreading to the non-hospitalized population and the community.

Diffusion and transmission of carbapenem-resistant Klebsiella pneumoniae in the medical and surgical wards of a university hospital in Milan, Italy

“…These findings are in line with those of recent studies showing that the spread of CRKP in Italy is becoming a matter of concern in areas of care that were Please cite this article in press as: Ridolfo Diffusion and transmission of CRKP 7 generally considered to be at lower risk in which one of the principal targets (and consequently a major reservoir) of CRKP is the geriatric population [26][27][28]. A possible change in the epidemiology of carbapenem-resistant Enterobacteriaceae from traditional high-risk settings (i.e., ICUs) to general care patients is also suggested to be a result of the study findings that were conducted in other countries.…”

Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

“…Hence, risk factors for colonisation and/or infection are the same as other drug-resistant organisms [12,13,35]. Long-term care settings, for example, are important reservoirs for community-onset, healthcare-associated transmission [37,50,51]. In the population-based surveillance of Guh et al, 55.9% of patients positive for CRE were sent to LTCFs following hospital discharge, demonstrating the potential for interfacility spread [25].…”

Epidemiology and clinical of infections and colonizations caused by Enterobacterales producing carbapenemases in a tertiary hospital

“…En este aspecto, nuestro estudio no objetivó mayor riesgo de infección entre los pacientes trasplantados, posiblemente esto se deba a la alta proporción de pacientes trasplantados que se colonizaron tras la cirugía en la UCI y que por tanto se sobreexpresan en el grupo de colonización. En el estudio de Patel et al [17] observaron que los pacientes trasplantados tienen mayor riesgo de adquisición de EPC, sobre todo en el periodo inmediato En nuestro estudio, se encuentra una mayor proporción de pacientes infectados entre los pacientes con adquisición ACS que en los que presentan adquisición nosocomial como se ha publicado previamente [8][9][10]. El porcentaje de infección frente colonización puede variar entre el 30 -60% según el tipo de hospital, así en hospitales de media estancia (HME) y complejidad menor, la infección clínica puede representar el 33,5% a costa de mayor frecuencia de colonización [9,11], y por el contrario en hospitales de mayor complejidad el porcentaje de infección asciende al 66% [5,11,12].…”

“…La mayor parte de la información clínica y terapéutica se ha obtenido de estudios que incluyen bacteriemias por K. pneumoniae sin incluir otras especies de EPC ni otros tipos de infección [13], por lo tanto, pueden no ser representativos de la mayoría de las infecciones por EPC. Las ITU son además, más frecuentemente adquiridas ACS [8][9][10]. La adquisición ACS se asoció con sepsis y recurrencia de la infección.…”