Evaluation of carbapenem-resistant Enterobacteriaceae in an Italian setting: Report from the trench

Barbarini, Daniela; Russello, Giuseppe; Brovarone, Flavia; Capatti, C.; Colla, Rossana; Perilli, Mariagrazia; Moro, Maria Luisa; Carretto, Edoardo

doi:10.1016/j.meegid.2014.11.025

Cited by 29 publications

(16 citation statements)

References 31 publications

(32 reference statements)

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“…The correct identification of carbapenemase genes is also necessary to address therapeutic options using the newer beta-lactam-beta-lactamase inhibitors with activity against serine-based carbapenemases (e.g., avibactam has no activity against MBLs, varborbactam covers only KPCs, and relebactam may have a different degree of efficacy related to the presence of particular genes) (24). Moreover, molecular confirmation of carbapenemase gene carriage may be useful to correctly identify CROs expressing low MICs for carbapenems, as sometimes happens for bla VIM and bla OXA-48 (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of the Xpert Carba-R Assay for Detection of Carbapenemase Genes in Gram-Negative Isolates

et al. 2018

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This multicenter study evaluated the performance of the Cepheid Xpert Carba-R assay, a qualitative PCR test designed for the rapid detection of ,, ,, and carbapenem resistance genes from bacterial isolates grown on blood agar or MacConkey agar. The results were compared to those obtained from bidirectional DNA sequence analysis of nucleic acid extracted from pure colonies. Isolates of ,, and that tested as either intermediate or resistant to a carbapenem antibiotic were analyzed. A total of 467 isolates were evaluated, including prospectively collected clinical isolates, frozen isolates, and a group of contrived broth specimens sent by a central reference laboratory. The assay was run on the GeneXpert platform and took 48 min, with less than 1 min of hands-on time. Compared to the results of the reference methods, the overall sensitivity of the assay was 100% (95% confidence interval [CI], 99.0 to 100%) for isolates grown on both blood and MacConkey agars. Overall specificity was 98.1% (95% CI, 93.1 to 99.8%) and 97.1% (95% CI, 91.7 to 99.4%) for blood and MacConkey agars, respectively. This platform, previously demonstrated to be effective for the detection of carbapenemase genes in rectal swabs, is also adequate for the detection of these genes in bacterial colonies isolated from blood and MacConkey agars.

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Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of the Xpert Carba-R Assay for Detection of Carbapenemase Genes in Gram-Negative Isolates

et al. 2018

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“…Several surveys conducted in Italy have shown that the KPC‐type enzymes most commonly encountered are KPC‐3 followed by KPC‐2 . The bla VIM gene has been reported with a minor prevalence . A survey conducted in 2011 involving 25 Italian cities, distributed throughout the nation and covering most Italian regions including two hospitals in Apulia, Southern Italy, reported that among 13 749 clinical isolates of Enterobacteriaceae , carbapenemases were found in 2.0% of the isolates and K. pneumoniae contributed to the majority of carbapenem‐resistant Enterobacteriaceae (CRE) (86.7%) representing the 11.9% of the isolates.…”

Section: Discussionmentioning

confidence: 99%

“…In Italy, the spread of carbapenem‐resistant K. pneumoniae has dramatically increased since 2009, the KPC‐3 variant being the predominant clone circulating in Italy . In this country, there are hotspot data on the diffusion and type of carbapenemases‐producing Enterobacteriaceae and K. pneumoniae in particular, and few of these data come from Apulia and Basilicata .…”

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Carbapenemases-producingKlebsiella pneumoniaein hospitals of two regions of Southern Italy

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et al. 2017

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Carbapenem-resistant Klebsiella pneumoniae infections are reported with increasing frequency elsewhere in the world, representing a worrying phenomenon for global health. In Italy, there are hotspot data on the diffusion and type of carbapenemase-producing Enterobacteriaceae and K. pneumoniae in particular, with very few data coming from Apulia and Basilicata, two regions of Southern Italy. This study was aimed at characterizing by phenotypic and genotypic methods carbapenem-resistant K. pneumoniae isolated from several Hospitals of Apulia and Basilicata, Southern Italy. Antibiotic susceptibility was also evaluated. The relatedness of carbapenemase-producing K. pneumoniae strains was established by pulsed-field gel electrophoresis (PFGE). Among the 150 K. pneumoniae carbapenemase producers, KPC-3 genotype was the most predominant (95%), followed by VIM-1 (5%). No other genotypes were found and no co-presence of two carbapenemase genes was found. A full concordance between results obtained by both the phenotypic and the genotypic tests was observed. All strains were resistant to β-lactam antibiotics including carbapenems, and among antibiotics tested, only tetracycline and gentamycin showed low percentage of resistance (18% and 15%, respectively). Resistance to colistin was detected in 17.3% of strains studied. The analysis of PFGE profiles of the carbapenemases-positive strains shows that one group (B) of the five (A to E) main groups identified was the most prevalent and detected in almost all the hospitals considered, while the other groups were randomly distributed. Three different sequence types (ST 307, ST 258, and ST 512) were detected with the majority of isolates belonging to the ST 512. Our results demonstrated the wide diffusion of K. pneumoniae KPC-3 in the area considered, the good concordance between phenotypic and genotypic tests. Gentamicin and colistin had a good activity against these strains.

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“…Sporadic outbreaks of Pseudomonas aeruginosa containing bla VIM have been reported in South America (11,12) and in Chicago (13). One paper by Barbarini and colleagues described the changing epidemiology of CPOs in an Italian hospital over a 3-year period, in which 44 bla VIM -positive K. pneumoniae isolates were reported (14). Another study reported a single isolate of sequence type 258 (ST258) bla KPC K. pneumoniae that was also found to coexpress bla VIM in addition to other resistance determinants (15).…”

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Rapid Identification of Five Classes of Carbapenem Resistance Genes Directly from Rectal Swabs by Use of the Xpert Carba-R Assay

et al. 2017

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Carbapenemase-producing organisms (CPO) have been identified by global health leaders as an urgent threat. Detection of patients with gastrointestinal carriage of CPO is necessary to interrupt their spread within health care facilities. In this multisite study, we assessed the performance of the Xpert Carba-R test, a rapid real-time quantitative PCR (qPCR) assay that detects five families of carbapenemase genes (bla IMP , bla KPC , bla NDM , bla , and bla VIM ) directly from rectal swab specimens. Using dual swabs, specimens from 755 patients were collected and tested prospectively. An additional 432 contrived specimens were prepared by seeding well-characterized carbapenem-susceptible and -nonsusceptible strains into a rectal swab matrix and inoculating them onto swabs prior to testing. Antimicrobial susceptibility testing, broth enriched culture, and DNA sequencing were performed by a central laboratory blind to the Xpert Carba-R results. The Xpert Carba-R assay demonstrated a positive percentage of agreement (PPA) between 60 and 100% for four targets (bla KPC , bla NDM , bla VIM , and bla ) and a negative percentage of agreement (NPA) ranging between 98.9 and 99.9% relative to the reference method (culture and sequencing of any carbapenem-nonsusceptible isolate). There were no prospective bla IMP -positive samples. Contrived specimens demonstrated a PPA between 95 and 100% and an NPA of 100% for all targets. Testing of rectal swabs directly using the Xpert Carba-R assay is effective for rapid detection and identification of CPO from hospitalized patients.KEYWORDS Gram-negative bacteria, multidrug resistance, public health, surveillance studies T he rapid dissemination of carbapenemase-producing organisms (CPOs) throughout the world has raised concerns globally. Bacteria harboring these enzymes represent an infection control challenge for health care facilities and have proven to be a major public health threat (1-3).In the United States, most clinical infections due to CPOs have been attributed to organisms containing the Klebsiella pneumoniae carbapenemase (KPC) or the New Delhi metallo-␤-lactamase (NDM) (2). More recently, however, outbreaks due to organisms containing oxacillinase enzymes (e.g., OXA-48) have been reported, particularly in some European countries (4, 5). KPC-containing organisms have reached endemic levels in parts of Europe and Israel (6, 7), and NDM-containing organisms have been recovered throughout the Indian subcontinent (8) from clinical samples as well as from the

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Evaluation of carbapenem-resistant Enterobacteriaceae in an Italian setting: Report from the trench

Cited by 29 publications

References 31 publications

Multicenter Evaluation of the Xpert Carba-R Assay for Detection of Carbapenemase Genes in Gram-Negative Isolates

Multicenter Evaluation of the Xpert Carba-R Assay for Detection of Carbapenemase Genes in Gram-Negative Isolates

Carbapenemases-producingKlebsiella pneumoniaein hospitals of two regions of Southern Italy

Rapid Identification of Five Classes of Carbapenem Resistance Genes Directly from Rectal Swabs by Use of the Xpert Carba-R Assay

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