Prevalence and Molecular Typing of Carbapenemase-Producing Enterobacterales among Newborn Patients in Italy

Abstract

The spread of carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli), is a serious public health threat in pediatric hospitals. The associated risk in newborns is due to their underdeveloped immune system and limited treatment options. The aim was to estimate the prevalence and circulation of CPE among the neonatal intensive units of a major pediatric hospital in Italy and to investigate their molecular features. A total of 124 CPE were isolated from rectal swabs of 99 newborn patients at Bambino Gesù Children’s Hospital between July 2016 and December 2019. All strains were characterized by antimicrobial susceptibility testing, detection of resistance genes, and PCR-based replicon typing (PBRT). One strain for each PBRT profile of K. pneumoniae or E. coli was characterized by multilocus-sequence typing (MLST). Interestingly, the majority of strains were multidrug-resistant and carried the blaNDM gene. A large part was characterized by a multireplicon status, and FII, A/C, FIA (15%) was the predominant. Despite the limited size of collection, MLST analysis revealed a high number of Sequence Types (STs): 14 STs among 28 K. pneumoniae and 8 STs among 11 E. coli, with the prevalence of the well-known clones ST307 and ST131, respectively. This issue indicated that some strains shared the same circulating clone. We identified a novel, so far never described, ST named ST10555, found in one E. coli strain. Our investigation showed a high heterogeneity of CPE circulating among neonatal units, confirming the need to monitor their dissemination in the hospital also through molecular methods.

Clonal Spread of Hospital-Acquired NDM-1-Producing Klebsiella pneumoniae and Escherichia coli in an Italian Neonatal Surgery Unit: A Retrospective Study

“…Few studies have been carried out to evaluate the dissemination of CPE among neonatal patients in Italy, but in all of these cases KPC-producing strains emerged [ 25 , 26 , 27 , 28 ]. To the best of our knowledge, the present study and another previously published by our team [ 12 ], represent the only investigations describing the circulation of NDM-producing K. pneumoniae and E. coli in Italian NICUs between July 2016 and December 2019. Since January 2020, the circulation of NDM-producing Enterobacterales gradually decreased, with a total of 22 new NDM-colonization cases in NSU (prevalence of 78% among 28 CPE isolated before the 16th of November).…”

“…Indeed, the global rise in CPE results in increased healthcare costs, prolonged hospitalization, failure of infection treatment and mortality rate [ 10 , 11 ]. This is particularly serious for neonatal intensive care units (NICU) where the colonization of pediatric patients is recurrent [ 4 , 12 , 13 ]. Indeed, the frequent occurrence of common infections in children increases their exposure to selective antimicrobial pressure, and, consequently, failure of treatment [ 14 ].…”

Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries

“…After removing duplicates, 8,558 articles were assessed for eligibility by screening the title and the abstract. There were 382 articles eligible for full-text review, among which 254 were excluded (Fig 1 Tanzania [46], Tunisia [47], and Zambia [48]), Asia (n = 10; Bangladesh [34,49], China , India [34, , Iran [114], Israel [115], Japan [116], Nepal [117], Pakistan [34, [118][119][120][121][122], Saudi Arabia [123,124], and Vietnam [125][126][127][128]), Europe (n = 8; France [129], Greece [130], Hungary [131], Italy [132][133][134][135][136][137][138][139][140][141][142], Portugal [143], Russia [144], Turkey [145][146][147], and the United Kingdom [148]), and South America (Colombia [149][150][151][152] and Venezuela [153]) (Fig…”

New Antimicrobials for the Treatment of Neonatal Sepsis Caused by Multi-Drug-Resistant Bacteria: A Systematic Review

“…Multi-drug resistance (MDR) bacteria were alarmingly reported in the latest years as causing agents of both EOS and LOS [ 6 , 7 , 8 , 9 ]. Moreover, several outbreaks caused by MDR organisms in Neonatal Intensive Care Units (NICUs) recently occurred in different regions, including high-income countries (HICs) [ 10 , 11 , 12 , 13 , 14 ], and consistent colonization of both patients admitted to NICUs [ 15 , 16 , 17 ] and of pregnant women [ 18 ] is reported, threatening the outcomes of both EOS and LOS cases.…”

“…Despite routine screening for EBSL-producing and carbapenem-resistant Enterobacterales (CRE) is not performed in NICUs, colonization of admitted patients is increasingly documented worldwide [ 15 , 17 , 31 , 32 ]. Colonization by CRE at NICU admission was reported in 21–30% by studies from Vietnam and Turkey [ 15 , 31 ], and significant colonization acquisition during NICU stay was observed [ 15 ].…”