Epidemic diffusion of KPC carbapenemase-producing Klebsiella pneumoniae in Italy: results of the first countrywide survey, 15 May to 30 June 2011

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) are emerging as a public health problem in various settings. In Italy, a rapid and remarkable increase of carbapenem-non-susceptible Klebsiella pneumoniae has been reported since 2010. Here we report on the results of a countrywide cross-sectional survey, carried out from 15 May to 30June 2011 to investigate the diffusion of CRE in Italy and to characterise the most prevalent resistance mechanisms and their dissemination patterns. CRE were reported from most (23 of 25) participating laboratories, with an overall proportion of 3.5% and 0.3% among consecutive non-duplicate clinical isolates of Enterobacteriaceae from inpatients (n=7,154) and outpatients (n=6,595), respectively. K. pneumoniae was the most frequent species (proportion of carbapenem-non-susceptible isolates: 11.9%), while a minority of CRE of other species were detected. Carbapenemase production was detected in the majority (85%) of CRE. KPC-type enzymes were by far the most common (89.5% of carbapenemase producers), followed by VIM-1 (9.2%) and OXA-48 (1.3%). KPC-producing K. pneumoniae (KPC-KP) were detected in most centres and contributed majorly to the epidemic dissemination of CRE recently observed in our country. Dissemination of KPC-KP was mostly sustained by strains of clonal complex 258 (ST-258 producing KPC-2 or KPC-3, and ST-512 producing KPC-3), while a minority belonged to ST-101.

Epidemiology of Meropenem/Vaborbactam Resistance in KPC-Producing Klebsiella pneumoniae Causing Bloodstream Infections in Northern Italy, 2018

“…We observed that patients with BSI due to KPC-Kp resistant to both meropenem/vaborbactam and ceftazidime/avibactam had a short colonization time, thus suggesting that cross-resistance did not result from selection pressure due to recently antimicrobial therapy. Therefore, considering the high incidence of KPC-Kp strains in our country, it is plausible that patients acquired cross-resistant strains during hospitalization or that meropenem/vaborbactam and ceftazidime/avibactam resistance emerged after prolonged antimicrobial treatments in colonized patients [20]. Overall, clinical and microbiological failure was observed in two out of three patients with pneumonia, while no specific treatment was associated to clinical success.…”

Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party†

“…Carbapenem resistance was initially slow to emerge in Enterobacteriaceae but is now steadily increasing, and mediated more and more by acquired carbapenemases (predominantly by KPC, VIM, IMP, NDM and OXA-48-like types) [33][34][35][36] 41 . This clone also spread widely earlier in the USA 42 and then in Israel 43 , where an aggressive, nationwide infection control intervention was successful in bringing it under control 44,45 .…”

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Klebsiella pneumoniae Lipopolysaccharides Serotype O2afg Induce Poor Inflammatory Immune Responses Ex Vivo

“…The genetic analysis of 178 IRCCS-ISMETT K. pneumoniae clinical isolates showed that they belong to several STs, including 37 ST258, 28 ST307 and 51 ST512. In Italy, CRE K. pneumoniae strains are predominantly one of these three STs [ 35 , 36 ]. Out of 178 K. pneumoniae isolates, 163 belonged to the O2afg serotype, i.e., 91.6%.…”