Prolonged outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE), Tuscany, Italy, 2018 to 2019

Abstract

In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.

Increased Risk of Acquisition of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) among a Cohort of COVID-19 Patients in a Teaching Hospital in Tuscany, Italy

“…In the Pisa Teaching Hospital, the organizational structure, including the establishment of COVID designated wards, and patient management protocols were modified to address the clinical needs of the patients, as well as the concern for the protection of healthcare workers from infection by SARS-CoV-2 [ 3 ]. However, Tuscany hospital services were already facing a challenge represented by the diffusion of multidrug-resistant organisms (MDRO), especially New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) [ 4 , 5 ]. This issue was addressed by linking the already existing HCAI surveillance system with the epidemic surveillance protocols for COVID-19.…”

New Delhi metallo‐β‐lactamase (NDM‐1)‐producingKlebsiella pneumoniaeof sequence type ST11: first identification in a hospital of central Italy

“…This report describes the first NDM‐1‐producing K. pneumoniae in the Molise regional healthcare setting, which occurred at the same time as a prolonged outbreak of NDM‐producing carbapenem‐resistant Enterobacteriaceae (CRE) reported in the Tuscany region, central Italy (Tavoschi et al . 2020) between November 2018 and October 2019, with a peak observed in September 2019 (Regional Health Agency of Tuscany region). Particularly, 1645 samples from patients admitted to hospitals in the North‐West area of Tuscany were NDM‐CRE positive (Tavoschi et al .…”

“…Particularly, 1645 samples from patients admitted to hospitals in the North‐West area of Tuscany were NDM‐CRE positive (Tavoschi et al . 2020), which led to the release of a rapid risk assessment by ECDC in order to reduce risk of spreading and limit cross‐border transmission (ECDC 2019b). The outbreak was largely attributable to K. pneumoniae ST147 clone producing NDM‐1 enzyme, and NDM‐5 clones to a lesser extent, resistant to all β‐lactams, which also acquired resistance to aztreonam, aminoglycosides and ceftazidime/avibactam, while retained susceptibility to fosfomycin and colistin (ECDC 2019b; Tavoschi et al .…”

Molecular Mechanisms, Epidemiology, and Clinical Importance of β-Lactam Resistance in Enterobacteriaceae

“…In 2017, NDM-1 was found in 134 (3.2%) of 4247 CRE isolates submitted to the Centers for Disease Control and Prevention’s National Healthcare Safety Network for analysis [ 112 ]. Since then, NDM-producing Enterobacteriaceae were isolated in Balkan states [ 113 ], China [ 114 ], and Tuscany (Italian region) [ 115 ]. VIM-producing Enterobacteriaceae are mainly reported, in Europe, as a cause of sporadic hospital outbreaks, with VIM-2 being the most common VIM enzyme worldwide [ 116 , 117 ].…”