Tracking Multidrug-Resistant Klebsiella pneumoniae from an Italian Hospital: Molecular Epidemiology and Surveillance by PFGE, RAPD and PCR-Based Resistance Genes Prevalence

Abstract

Antimicrobial-resistant Klebsiella pneumoniae represent a global public health concern. K. pneumoniae strains isolated during 2010 and 2014-2016 within a single hospital of Molise Region, Central Italy, were analyzed testing antimicrobial susceptibility, clonality by pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD)-PCR, and prevalence of carbapenem resistance genes by PCR. Forty isolates (23 wild-type in 2010 and 17 non-wild-type in 2014-2016) were collected from hospitalized patients (65.2 ± 18.1 years old, 75% male, 80% from intensive care unit-ICU). K. pneumoniae showed multidrug-resistant profiles and 15 resistotypes were identified (discriminatory power D = 0.88). The 69.6 and 17.4% of isolates in 2010 resulted intermediate and resistant to imipenem, respectively, and 91.3% was sensitive to meropenem, while 88.2% of isolates of 2014-2016 were resistant to both antibiotics. PFGE identified 16 clusters versus 23 by RAPD, 26 pulsotypes versus 33 RAPD patterns (D ≥ 0.97). PFGE separated strains according to isolation period and identified an outbreak occurred in the ICU during December 2014 and January 2015. No strains harbored bla, bla, bla, and bla genes, as well as AmpC plasmid-mediated beta-lactamases genes. Only K. pneumoniae isolated during 2014-2016 were bla positive. Prevalence of bla was 87 and 76.5% during 2010 and 2014-2016, respectively. No strains colistin-resistant harbored mcr-1 plasmid-mediated resistance gene. The study findings underline an increased circulation of multidrug-resistant K. pneumoniae within the hospital, and the acquisition of carbapenem resistance mechanism. The implementation of surveillance and molecular characterization of isolates are needed to identify outbreaks, reduce the spread of resistance, and guide empirical therapy.

<p>Epidemiology of carbapenem-resistant Enterobacteriaceae: a 5-year experience at a tertiary care hospital</p>

“…The main risk factors for CRE acquisition or infection were exposure to healthcare, including admission to the ICU, medical devices, invasive procedures, and antibiotics 15. Acquisition of CRKP was associated with poor functional status and ICU stay 16,17. Risk factors associated with CRKP infection include recent organ or stem-cell transplantation, receipt of mechanical ventilation, and longer hospital stay 18.…”

<p>Dissemination Pattern of Multidrug Resistant Carbapenemase Producing <em>Klebsiella pneumoniae</em> Isolates Using Pulsed-Field Gel Electrophoresis in Southwestern Iran</p>

“…Surveying the molecular typing of carbapenemase-producing Enterobacteriaceae (CPE) isolates can provide a better perspective of bacterial dissemination. 14,15 Due to the importance of the aforementioned variants of carbapenemase genes and the increase in the rate of these genes in hospitalized patients, especially in K. pneumoniae, finding their source is important. Hence, we investigated the antibiotic resistance and pattern of carbapenemase gene spread by PFGE among K. pneumoniae isolates obtained from hospitalized patients in Shiraz, southwest Iran.…”

<p>Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview</p>

“…54 – 56 Amongst these pathogens, Klebsiella pneumoniae , which is the most common resistant pathogen, especially in ICU settings, is a significant concern. 57 , 58 The prevention and control of HCAIs is therefore very complicated, and a multi-dimensional approach and strategies are required to address this significant public health concern. 36 , 50 , 59 – 63 …”

“…[54][55][56] Amongst these pathogens, Klebsiella pneumoniae, which is the most common resistant pathogen, especially in ICU settings, is a significant concern. 57,58 The prevention and control of HCAIs is therefore very complicated, and a multidimensional approach and strategies are required to address this significant public health concern. 36,50,[59][60][61][62][63] In the following sections, we discuss the primary ways of addressing the impact of HCAIs as determined in the papers identified in the search and published in wellregarded journals 36, These are the main issues identified in these papers, noting that (depending on the focus of the research and findings) some articles report on a single issue, whereas others report on a number.…”