Carriage of Carbapenem-Resistant Enterobacterales in Adult Patients Admitted to a University Hospital in Italy

Abstract

The emerging spread of carbapenemase-producing Enterobacterales (CPE) strains, in particular, Klebsiella pneumoniae and Escherichia coli, has become a significant threat to hospitalized patients. Carbapenemase genes are frequently located on plasmids than can be exchanged among clonal strains, increasing the antibiotic resistance rate. The aim of this study was to determine the prevalence of CPE in patients upon their admission and to analyze selected associated factors. An investigation of the antibiotic resistance and genetic features of circulating CPE was carried out. Phenotypic tests and molecular typing were performed on 48 carbapenemase-producing strains of K. pneumoniae and E. coli collected from rectal swabs of adult patients. Carbapenem-resistance was confirmed by PCR detection of resistance genes. All strains were analyzed by PCR-based replicon typing (PBRT) and multilocus sequence typing (MLST) was performed on a representative isolate of each PBRT profile. More than 50% of the strains were found to be multidrug-resistant, and the blaKPC gene was detected in all the isolates with the exception of an E. coli strain. A multireplicon status was observed, and the most prevalent profile was FIIK, FIB KQ (33%). MLST analysis revealed the prevalence of sequence type 512 (ST512). This study highlights the importance of screening patients upon their admission to limit the spread of CRE in hospitals.

Prevalence and incidence of carbapenem-resistant K. pneumoniae colonization: systematic review and meta-analysis

“…The pooled prevalence of colonization for the Asian continent is 4.56%. Similarly, reports from Italy show variation in the prevalence rate from 2 to 9% [ 37 , 39 ], with a 6.16% pooled estimate of prevalence for Europe. This finding indicates that there is no uniform distribution of colonization in different localities, even within a country.…”

“…As shown in Table 1 , a total of 35 studies with 37,661 participants were included for systematic review. Ten of the included studies were cohort studies [ 33 , 36 , 38 , 39 , 41 , 42 , 45 , 48 , 58 ] and 4 of them case-control [ 32 , 37 , 44 , 62 ], while the rest were cross-sectional studies. Two studies [ 34 , 35 ] have included outpatients while the rest were conducted upon admission and after admission to a setting.…”

Prevalence, Antibiotic-Resistance, and Replicon-Typing of Salmonella Strains among Serovars Mainly Isolated from Food Chain in Marche Region, Italy

“…The amplicons were detected through capillary electrophoresis on the AATI Fragment Analyzer (Agilent, Santa Clara, CA, USA) using the dsDNA 906 Reagent kit (Advanced Analytical, Ankeny, IA, USA). This amplicon analysis allows the combination of two multiplex PCRs in the same lane, resolving up to eight peaks, as previously published [ 58 ]. The positive peaks were successively analysed using the tool “PBRT plugin” [ 58 ] developed in cooperation with the Advanced Analytical Company that allows automatic peak calling and the recording of positive replicons.…”

“…This amplicon analysis allows the combination of two multiplex PCRs in the same lane, resolving up to eight peaks, as previously published [ 58 ]. The positive peaks were successively analysed using the tool “PBRT plugin” [ 58 ] developed in cooperation with the Advanced Analytical Company that allows automatic peak calling and the recording of positive replicons.…”

Antimicrobial Resistance (AMR) in Italy over the Past Five Years: A Systematic Review

“…All studies were published between 2016 and 2021 . However, the studies examined very heterogeneous periods of time between 1988 [32] and 2020 [47][48][49]51,52]. The study that analysed the longest time period described the AMR found between 1988 and 2017 [32], the one with the shortest time period between March and May 2020 [47].…”