Prevalence of Klebsiella pneumoniae strains producing carbapenemases and increase of resistance to colistin in an Italian teaching hospital from January 2012 To December 2014

BMC Infectious Diseases

Research Article

Stefania Stefani¹  Roberto Ghirardo²  Monica Basso²  Elisa Franchin²  Nicola Menegotto²  Elena Castellani²  Saverio Giuseppe Parisi²  Alessandro Berto²  Giorgio Palù²  Erica Santacatterina²  Andrea Bartolini²  Roberto Rinaldi³  Tiziana Tommasini⁴  Ettore De Canale⁴ 

[1] Department of Biomedical and Biotecnological Sciences, University of Catania, Catania, Italy;Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy;Infectious Diseases Unit, Padova Hospital, Padova, Italy;Microbiology and Virology Unit, Padova Hospital, Padova, Italy;

关键词: Klebsiella pneumoniae carbapenemase producing;    Active surveillance;    Rectal swabs;    Colistin resistance;    Multilocus sequence typing;   

DOI  :  10.1186/s12879-015-0996-7

 received in 2015-02-16, accepted in 2015-06-22,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe aim of this study was to characterize the spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) in a tertiary level hospital using ongoing active surveillance with rectal swab cultures. Furthermore, this study analyzed the presence of CPKP in the clinical samples (CS) of a single patient as well as the evolution of Colistin-sensitive strains (CoS) to Colistin-resistant strains (CoR).MethodsThis study was performed from January 1, 2012 to December 31, 2014. In 2012, a survey was conducted in the Intensive Care Department. In autumn 2013, active monitoring was extended to the Surgery Department, and since mid-2014, the surveillance has included the Medical Department as well. Only the first isolated strain from each patient was included. Antimicrobial susceptibility testing was performed on CPKP isolates: Klebsiella pneumoniae carbapenemase, oxacillinase-48, Verona integron-encoded metallo-β-lactamase and New Delhi metallo-β-lactamase were detected using a validated in-house PCR method, and multilocus sequence typing (MLST) was used to investigate the clonal transmission of strains.ResultsA total of 15,104 patients were included in the study, and 496 consecutive non-replicated strains of CPKP were collected: 149 strains were collected in 2012 (39 [26.2 %] from surveillance rectal swabs [SRS]), 133 strains were collected in 2013 (70 [52.6 %] from SRS) and 214 strains were collected in 2014 (164 [76.6 %] from SRS). We observed a significant increase in the percentage of positive SRS cases in 2014 relative to 2013 and 2012 (p = 0.0001 and p = 0.0172, respectively) and in the proportion of CPKP first isolated by SRS relative to those identified by CS (p < 0.0001). Among all available samples, the number of CoR isolated from SRS was higher in 2013 and 2014 compared with 2012 (p = 0.0019 and p = 0.008, respectively). ST-258 and ST-512 were more prevalent in the tested specimens, and a new single locus variant (SLV) of ST-512 (ST-745) was isolated.ConclusionsThe results of this 3-year study of 15,104 patients highlight the clinical relevance of antimicrobial resistance as well as the drug-selection pressure of colistin therapy. The active surveillance in the three different departments increased the level of CPKP cases isolated by SRS.

【 授权许可】

CC BY   
© Parisi et al. 2015