High-Risk Clone of Klebsiella pneumoniae Co-Harbouring Class A and D Carbapenemases in Italy

International Journal of Environmental Research and Public Health

卷:19

Giovanna Deiana¹  Arcadia Del Rio¹  Laura Saderi²  Giovanni Sotgiu²  Manuela Usai³  Enrico Calaresu⁴  Clementina Cocuzza⁴  Marianna Martinelli⁴  Bianca Maria Are⁵  Andrea Fausto Piana⁵  Andrea Cossu⁵  Alessandra Palmieri⁵  Narcisa Muresu⁵  Illari Sechi⁵ 

[1] Biomedical Science PhD School, Biomedical Science Department, University of Sassari, 07100 Sassari, Italy;

[2] Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;

[3] Department of Humanistic and Social Sciences, University of Sassari, 07100 Sassari, Italy;

[4] Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;

[5] Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;

关键词: antimicrobial resistance;    Carbapenemase genes;    Klebsiella pneumoniae;    nosocomial infections;   

DOI  :  10.3390/ijerph19052623

来源: DOAJ

【 摘 要 】

Background: Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) is endemic globally, causing severe infections in hospitalized patients. Surveillance programs help monitor and promptly identify the emergence of new clones. We reported the rapid spread of a novel clone of K. pneumoniae co-harbouring class A and D carbapenemases in colonized patients, and the potential risk factors involved in the development of infections. Methods: Rectal swabs were used for microbiological analyses and detection of the most common carbapenemase encoding genes by real-time PCR (i.e., blaKPC, blaOXA-48, blaNDM, blaVIM, and blaIMP). All strains co-harbouring KPC and OXA-48 genes were evaluated. For each patient, the following variables were collected: age, sex, length and ward of stay, device use, and outcome. Clonality of CR-Kp was assessed by preliminary pulsed field gel electrophoresis (PFGE), followed by multi-locus sequence typing (MLST) analyses. Results: A total of 127 isolates of K. pneumoniae co-harbouring KPC and OXA-48 were collected between September 2019 and December 2020. The median age (IQR) of patients was 70 (61–77). More than 40% of patients were admitted to intensive care unit (ICU). Around 25% of patients developed an invasive infection, the majority of which were respiratory tract infections (17/31; 54.8%). ICU stay and invasive infection increased the risk of mortality (OR: 5.39, 95% CI: 2.42–12.00; OR 6.12, 95% CI: 2.55–14.69, respectively; p-value ≤ 0.001). The antibiotic susceptibility test showed a resistance profile for almost all antibiotics considered. Monoclonal origin was confirmed by PFGE and MLST showing a similar restriction pattern and belonging to ST-512. Conclusions: We report the spread and the marked antibiotic resistance profiles of K. pneumoniae strains co-producing KPC and OXA-48. Further study could clarify the roles of clinical and microbiological variables in the development of invasive infection and increasing risk of mortality, in colonized patients.

【 授权许可】

Unknown