EPIDEMIOLOGY AND BIOMOLECULAR CHARACTERIZATION OF CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE IN AN ITALIAN HOSPITAL
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Keywords

carbapenem-resistant klebsiella pneumoniae
bloodstream infection
mortality

Abstract

OBJECTIVE. To describe the occurrence of CRKP infections in a tertiary care hospital and to analyse the allelic profiles of the clinical strains involved and the most frequent carbapenemases.

DESIGN. The study analyzed cases of infection due to CRKP in the period 2013-2014. 147 cases of CRKP infection were recorded most of which (82.31%) were in-hospital infections.

SETTING. One hospital in northern Italy.

METHODS. We retrospectively collected: data on patient characteristics, microbiological characteristics of CRKP. The isolates from 72 of the-hospital cases underwent molecular typing (MLST); in addition, in each isolate, a procedure for the detection of the blaKPC gene was carried out.

RESULTS: The in-hospital death rate was 24.0% in 2013 and 37.5% in 2014. However, the difference between these two values did not prove statistically significant (P> .05).

Analysis of mortality revealed that bloodstream infections were more frequently associated with death than other infections (CHI2=14.57, P<.001). The age-adjusted Cox proportional hazard model revealed that the patients with bacteremia due to CRKP had a 3-fold higher risk of death (HR 3.11; 95% CI 1.66 - 5.84, P< .001) than those with infections of other sites.

MLST revealed that the prevalent allelic profile was ST 512 (79.62%); the most frequent carbapenemase was KPC-3 (83.8%).

CONCLUSIONS. Our results are in line with those of recent studies, which have shown that the spread of CRKP in Italy is a matter of concern and further efforts have to been made to prevent, whenever possible, the potential dissemination of carbapenemase-producing clones of K. pneumoniae.

https://doi.org/10.15167/2421-4248/jpmh2016.57.3.639
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References

Perdelli F, Dallera M, Cristina ML, Sartini M, Ottria G, Spagnolo AM, Orlando P. A new microbiological problem in intensive care units: environmental contamination by MRSA with reduced susceptibility to glycopeptides. Int J Hyg Environ Health 2008;211(1-2):213-8.

Tumbarello M, Spanu T, Sanguinetti M, Citton R, Montuori E, Leone F, Fadda G, Cauda R. Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae: Risk Factors, Molecular Epidemiology, and Clinical Outcome. Antimicrob Agents Chemother 2006;50:498-504.

Lockhart SR, Abramson MA, Beekmann SE, Gallagher G, Riedel S, Diekema DJ, Quinn JP, Doern GV. Antimicrobial resistance among Gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004. J Clin Microbiol 2007; 45:3352-2259.

Onori R, Gaiarsa S, Comandatore F, Pongolini S, Brisse S, Colombo A, Cassani G, Marone P, Grossi P, Minoja G, Bandi C, Sassera D, Toniolo A. Tracking nosocomial Klebsiella pneumoniae infections and outbreaks by whole genome analysis: small-scale Italian scenario within a single hospital. J Clin Microbiol 2015; 53:2861-2868.

Marchaim D, Chopra T, Pogue JM, Perez F, Hujer AM, Rudin S, Endimiani A, Navon-Venezia S, Hothi J, Slim J, Blunden C, Shango M, Lephart PR, Salimnia H, Reid D, Moshos J, Hafeez W, Bheemreddy S, Chen TY, Dhar S, Bonomo RA, Kaye KS. Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan. Antimicrob Agents Chemother 2011;55:593–599

Jin Y, Shao C, Li J, Fan H, Bai Y, Wang Y. Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province, China. PLoS One. 2015;10:e0119571.

Kola A, Piening B, Pape UF, Veltzke-Schlieker W, Kaase M, Geffers C, Wiedenmann B, Gastmeier P. An outbreak of carbapenem-resistant OXA-48 - producing Klebsiella pneumoniae associated to duodenoscopy. Antimicrob Resist Infect Control 2015;4:8.

Marquez P, Terashita D, Dassey D, Mascola L. Population-based incidence of carbapenem-resistant Klebsiella pneumoniae along the continuum of care, Los Angeles County. Infect Control Hosp Epidemiol 2013;34:144-150.

Hussein K, Sprecher H, Maschiach T, Oren I, Kassis I, Finkelstein R. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol 2009;30:666–667.

Amit S, Mishali H, Kotlovsky T, Schwaber MJ, Carmeli Y. Bloodstream infections among carriers of carbapenem-resistant Klebsiella pneumoniae: etiology, incidence and predictors. Clin Microbiol Infect. 2015;21:30-34.

Cristina ML, Spagnolo AM, Orlando P, Perdelli F. The role of the environment in the spread of emerging pathogens in at-risk hospital wards. Rev Med Microbiol 2013;24:104–112

Hoxha A, Kärki T, Giambi C, Montano C, Sisto A, Bella A, D'Ancona F, Study Working Group. Attributable mortality of carbapenem-resistant Klebsiella pneumoniae infections in a prospective matched cohort study in Italy, 2012-2013. J Hosp Infect 2016; 92:61-66.

Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;45:493-496.

The European Committee on Antimicrobial Susceptibility Testing (EUCAST). 2013. Breakpoint tables for interpretation of MICs and zone diameters. Version 3.1. http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/Breakpoint_table_v_3.1.pdf. Accessed 12.01.16.

Centers for Disease Control and Prevention (CDC) 2015. Modified Hodge Test for Carbapenemase Detection in Enterobacteriaceae. http://www.cdc.gov/HAI/pdfs/labSettings/HodgeTest_Carbapenemase_Enterobacteriaceae.pdf. Accessed 12.01.16.

Anderson KF, Lonsway DR, Rasheed JK, Biddle J, Jensen B, McDougal LK, Carey RB, Thompson A, Stocker S, Limbago B, Patel JB. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol 2007;45:2723-2725.

Centers for Disease Control and Prevention (CDC). Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care, facilities. Morb Mortal Wkly Rep 2009;58:256-260.

Albiger B, Glasner C, Struelens MJ, Grundmann H, Monnet DL, the European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) working group. Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015. Euro Surveill 2015;20(45). doi: 10.2807/1560-7917.ES.2015.20.45.30062.

Chang LW, Buising KL, Jeremiah CJ, Cronin K, Poy Lorenzo YS, Howden BP, Kwong J, Cocks J, Blood A, Greenough J, Waters MJ. Managing a nosocomial outbreak of carbapenem-resistant Klebsiella pneumoniae: an early Australian hospital experience. Intern Med J 2015;45:1037-1043.

Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:1028–1033.

Tumbarello M, Trecarichi EM, Tumietto F, Del Bono V, De Rosa FG, Bassetti M, Losito AR, Tedeschi S, Saffioti C, Corcione S, Giannella M, Raffaelli F, Pagani N, Bartoletti M, Spanu T, Marchese A, Cauda R, Viscoli C, Viale P. Predictive models for identification of hospitalized patients harboring KPC-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 2014;58:3514-3520.

Gagliotti C, Cappelli V, Carretto E, Marchi M, Pan A, Ragni P, Sarti M, Suzzi R, Tura GA, Moro ML; Emilia-Romagna Group for CPE Control. Control of carbapenemase-producing Klebsiella pneumoniae: a region-wide intervention. Euro Surveill 2014; 19(43). pii: 20943.

Pan YJ, Lin TL, Lin YT, Su PA, Chen CT, Hsieh PF, Hsu CR, Chen CC, Hsieh YC, Wang JT. Identification of capsular types in carbapenem-resistant Klebsiella pneumoniae strains by wzc sequencing and implications for capsule depolymerase treatment. Antimicrob Agents Chemother 2015;59:1038-1047.

Ridolfo AL, Rimoldi SG, Pagani C, Marino AF, Piol A, Rimoldi M, Olivieri P, Galli M, Dolcetti L, Gismondo MR. Diffusion and transmission of carbapenem-resistant Klebsiella pneumoniae in the medical and surgical wards of a university hospital in Milan, Italy. J Infect Public Health 2016;9(1):24-33.

Nouvenne A, Ticinesi A, Lauretani F, Maggio M, Lippi G, Guida L, Morelli I, Ridolo E, Borghi L, Meschi T. Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an in an internal medicine unit. PLoS One 2014;9(10):e110001.

Richter SN, Frasson I, Franchin E, Bergo C, Lavezzo E, Barzon L, Cavallaro A, Palù G. KPC-mediated resistance in Klebsiella pneumoniae in two hospitals in Padua, Italy, June 2009-December 2011: massive spreading of a KPC-3-encoding plasmid and involvement of non-intensive care units. Gut Pathog 2012;4(1):7. doi: 10.1186/1757-4749-4-7.

Poulou A, Voulgari E, Vrioni G, Xidopoulos G, Pliagkos A, Chatzipantazi V, Markou F, Tsakris A. Imported Klebsiella pneumoniae carbapenemase-producing K. pneumoniae clones in a Greek hospital: impact of infection control measures for restraining their dissemination. J Clin Microbiol 2012;50:2618-2623.

Kanerva M, Skogberg K, Ryynänen K, Pahkamäki A, Jalava J, Ollgren J, Tarkka E, Lyytikäinen O. Coincidental detection of the first outbreak of carbapenemase-producing Klebsiella pneumoniae colonisation in a primary care hospital, Finland, 2013. Euro Surveill 2015;20(26).pii: 21172.

Monaco M, Giani T, Raffone M, Arena F, Garcia-Fernandez A, Pollini S, Network EuSCAPE-Italy, Grundmann H, Pantosti A, Rossolini GM. Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill 2014;19(42) pii: 20939.

Nouvenne A, Ticinesi A, Meschi T. Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards. Ital J Med 2015;9:116-119. doi: http://dx.doi.org/10.4081/itjm.2014.476 http://www.italjmed.org/index.php/ijm/article/view/itjm.2014.476/634. Accessed: 26 Jul. 2016

Gasink LB, Edelstein PH, Lautenbach E, Synnestvedt M, Fishman NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Infect Control Hosp Epidemiol 2009;30:1180-1185.

Saidel-Odes L, Borer A. Limiting and controlling carbapenem-resistant Klebsiella pneumoniae. Infect Drug Resist 2013;7:9-14.

Murphy CN, Clegg S. Klebsiella pneumoniae and type 3 fimbriae: nosocomial infection, regulation and biofilm formation. Future Microbiol 2012;7:991-1002.

Murphy CN, Mortensen MS, Krogfelt KA, Clegg S. Role of Klebsiella pneumoniae type 1 and type 3 fimbriae in colonizing silicone tubes implanted into the bladders of mice as a model of catheter-associated urinary tract infections. Infect Immun 2013;81:3009-3017.

Orlando P, Cristina ML, Dallera M, Ottria G, Vitale A, Badolati G. Surface disinfection: evaluation of the efficacy of a nebulization system spraying hydrogen peroxide. J Prev Med Hyg 2008;49(3):116-9.

Ottria G, Dallera M, Aresu O, Manniello MA, Parodi B, Spagnolo AM, Cristina ML. Environmental monitoring programme in the cell therapy facility of a research centre: Preliminary investigation. J Prev Med Hyg 2010;51(4):133-8.

Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections Curr Opin Infect Dis 2013;26(4):338-44.

Falagas ME, Tansarli GS, Karageorgopoulos DE, Vardakas KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections Emerg Infect Dis 2014;20:1170-1175.

Spagnolo AM, Orlando P, Panatto D, Perdelli F, Cristina ML. An overview of carbapenem-resistant Klebsiella pneumoniae: epidemiology and control measures. Rev Med Microbiol 2014;25:7–14.

Borer A, Saidel-Odes L, Riesenberg K, Eskira S, Peled N, Nativ R, Schlaeffer F, Sherf M. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009;30:972-976.

Falcone M, Russo A, Iacovelli A, Restuccia G, Ceccarelli G, Giordano A, Farcomeni A, Morelli A, Venditti M. Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Clin Microbiol Infect 2016;22(5):444-50.

van Duin D, Doi Y. Outbreak of Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae: Are We at the End of the Road? J Clin Microbiol 2015;53:3116-3117.

Pulcrano G, Iula DV, de Luca C, Roscetto E, Vollaro A, Rossano F, Catania MR. Clonal dissemination of Klebsiella pneumoniae ST512 carrying blaKPC-3 in a hospital in southern Italy. APMIS 2014;122:42-46.

Schwaber MJ, Lev B, Israeli A, Solter E, Smollan G, Rubinovitch B, Shalit I, Carmeli Y, Israel Carbapenem-Resistant Enterobacteriaceae Working Group. Israel Carbapenem-Resistant Enterobacteriaceae Working Group. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52:848-55.

López-Cerero L, Egea P, Gracia-Ahufinger I, González-Padilla M, Rodríguez-López F, Rodríguez-Baño J, Pascual A. Characterisation of the first ongoing outbreak due to KPC-3-producing Klebsiella pneumoniae (ST512) in Spain. Int J Antimicrob Agents 2014;44:538-540.