Abstract
In this study we report the analysis of 131 Klebsiella pneumoniae (K. pneumoniae) clinical isolates from patients hospitalized in various wards, of Perugia General Hospital, from August 2014 to January 2015. Forty two isolates (32.1 %), were resistant to at least one carbapenem antibiotic and, among these isolates, 14 (33.3 %) exhibited resistance to colistin. All isolates were carbapenemases producers and 41 (97.6 %) harboured the bla KPC gene. Carbapenem-resistant K. pneumoniae isolates (CRKPs) were, also, typed for the genotypic diversity and the results revealed the circulation of two major clusters.
This surveillance study evidences the spread of CRKP isolates in Perugia General Hospital and confirms that carbapenem-resistant K. pneumoniae isolates have reached epidemic dissemination in Italy. In addition the percentage of resistance to colistin resulted to be less than that observed in other hospital laboratories across Italy. In conclusion the circulation of these isolates should be monitored and appropriate policy of surveillance must be used, in a target manner, in order to reduce the spread of carbapenem-resistant isolates.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Agodi A, Voulgari E, Barchitta M et al (2011) Containment of an outbreak of KPC-3-producing Klebsiella pneumoniae in Italy. J Clin Microbiol 49(11):3986–3989. doi:10.1128/JCM.01242-11
Ah YM, Kim AJ, Lee JY (2014) Colistin resistance in Klebsiella pneumoniae. Int J Antimicrob Agents 44(1):8–15. doi:10.1016/j.ijantimicag.2014.02.016
Ambretti S, Gaibani P, Caroli F et al (2010) A carbapenem-resistant Klebsiella pneumoniae isolate harboring KPC-1 from Italy. New Microbiol 33(3):281–282
Bogdanovich T, Adams-Haduch JM, Tian GB et al (2011) Colistin-resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258. Clin Infect Dis 53(4):373–376. doi:10.1093/cid/cir401
Bratu S, Brooks S, Burney S, Kochar S, Gupta J, Landman D, Quale J (2007) Detection and spread of Escherichia coli possessing the plasmid-borne carbapenemase KPC-2 in Brooklyn, New York. Clin Infect Dis 44(7):972–975. doi:10.1086/512370
Brolund A, Haeggman S, Edquist PJ et al (2010) The DiversiLab system versus pulsed-field gel electrophoresis: characterisation of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae. J Microbiol Methods 83(2):224–230. doi:10.1016/j.mimet.2010.09.004
Canton R, Akova M, Carmeli Y et al (2012) Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 18(5):413–431. doi:10.1111/j.1469-0691.2012.03821.x
Corbellini S, Caccuri F, Gelmi M et al (2014) Emergence of carbapenem-resistant Klebsiella pneumoniae strains producing KPC-3 in Brescia Hospital, Italy. New Microbiol 37(2):177–183
European Centre for Disease Prevention Control (ECDC) (2013) Antimicrobial resistance surveillance in Europe 2012. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). http://www.ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-surveillance-europe-2012.pdf. Accessed 5 Oct 2015
European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2013) EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. Version 1.0. http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Resistance_mechanisms/EUCAST_detection_of_resistance_mechanisms_v1.0_20131211.pdf. Accessed 1 Oct 2015
European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2015) Breakpoint tables for interpretation of MICs and zone diameters. Version 5.0. http://www.eucast.org. Accessed 8 Oct 2015
Falagas ME, Karageorgopoulos DE, Nordmann P (2011) Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes. Future Microbiol 6(6):653–666. doi:10.2217/fmb.11.49
Fontana C, Favaro M, Sarmati L et al (2010) Emergence of KPC-producing Klebsiella pneumoniae in Italy. BMC Res Notes 3:40. doi:10.1186/1756-0500-3-40
Giani T, D'Andrea MM, Pecile P et al (2009) Emergence in Italy of Klebsiella pneumoniae sequence type 258 producing KPC-3 Carbapenemase. J Clin Microbiol 47(11):3793–3794. doi:10.1128/JCM.01773-09
Giani T, Pini B, Arena F et al (2013) Epidemic diffusion of KPC carbapenemase-producing Klebsiella pneumoniae in Italy: results of the first countrywide survey, 15 May to 30 June 2011. Euro Surveill 18(22) pii:20489
Giske CG, Gezelius L, Samuelsen O et al (2011) A sensitive and specific phenotypic assay for detection of metallo-beta-lactamases and KPC in Klebsiella pneumoniae with the use of meropenem disks supplemented with aminophenylboronic acid, dipicolinic acid and cloxacillin. Clin Microbiol Infect 17(4):552–556. doi:10.1111/j.1469-0691.2010.03294.x
Healy M, Huong J, Bittner T et al (2005) Microbial DNA typing by automated repetitive-sequence-based PCR. J Clin Microbiol 43(1):199–207. doi:10.1128/JCM.43.1.199-207.2005
Higgins PG, Hujer AM, Hujer KM et al (2012a) Interlaboratory reproducibility of DiversiLab rep-PCR typing and clustering of Acinetobacter baumannii isolates. J Med Microbiol 61(Pt 1):137–141. doi:10.1099/jmm.0.036046-0
Higgins PG, Janssen K, Fresen MM et al (2012b) Molecular epidemiology of Acinetobacter baumannii bloodstream isolates obtained in the United States from 1995 to 2004 using rep-PCR and multilocus sequence typing. J Clin Microbiol 50(11):3493–3500. doi:10.1128/JCM.01759-12
Hirsch EB, Tam VH (2010) Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother 65(6):1119–1125. doi:10.1093/jac/dkq108
Kaase M, Szabados F, Wassill L et al (2012) Detection of carbapenemases in Enterobacteriaceae by a commercial multiplex PCR. J Clin Microbiol 50(9):3115–3118. doi:10.1128/JCM.00991-12
Kelesidis T, Karageorgopoulos DE, Kelesidis I et al (2008) Tigecycline for the treatment of multidrug-resistant Enterobacteriaceae: a systematic review of the evidence from microbiological and clinical studies. J Antimicrob Chemother 62(5):895–904. doi:10.1093/jac/dkn311
Kontopoulou K, Protonotariou E, Vasilakos K et al (2010) Hospital outbreak caused by Klebsiella pneumoniae producing KPC-2 beta-lactamase resistant to colistin. J Hosp Infect 76(1):70–73. doi:10.1016/j.jhin.2010.03.021
Ligozzi M, Fontana R, Aldegheri M et al (2010) Comparative evaluation of an automated repetitive-sequence-based PCR instrument versus pulsed-field gel electrophoresis in the setting of a Serratia marcescens nosocomial infection outbreak. J Clin Microbiol 48(5):1690–1695. doi:10.1128/JCM.01528-09
Mencacci A, Monari C, Leli C et al (2013) Typing of nosocomial outbreaks of Acinetobacter baumannii by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 51(2):603–606. doi:10.1128/JCM.01811-12
Mezzatesta ML, Gona F, Caio C et al (2011) Outbreak of KPC-3-producing, and colistin-resistant, Klebsiella pneumoniae infections in two Sicilian hospitals. Clin Microbiol Infect 17(9):1444–1447. doi:10.1111/j.1469-0691.2011.03572.x
Ministero della Salute (2013) Circolare: Sorveglianza e controllo delle infezioni da batteri produttori di carbapenemasi (CPE). [Circular letter: surveillance and control of infections due to carbapenemase-producing bacteria (CPE)]. DGPRE. 0004968-P-26/02/2013. http://www.salute.gov.it/portale/documentazione/p6_2_6.jsp?lingua=italiano&area=27&btnCerca=cerca&iPageNo=4. Accessed 14 Oct 2015
Monaco M, Giani T, Raffone M et al (2014) Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill 19(42) pii:20939
Mouloudi E, Protonotariou E, Zagorianou A et al (2010) Bloodstream infections caused by metallo-beta-lactamase/Klebsiella pneumoniae carbapenemase-producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes. Infect Control Hosp Epidemiol 31(12):1250–1256. doi:10.1086/657135
Munoz-Price LS, Poirel L, Bonomo RA et al (2013) Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 13(9):785–796. doi:10.1016/S1473-3099(13)70190-7
Naas T, Nordmann P (1994) Analysis of a carbapenem-hydrolyzing class A beta-lactamase from Enterobacter cloacae and of its LysR-type regulatory protein. Proc Natl Acad Sci U S A 91(16):7693–7697
Nordmann P, Naas T, Poirel L (2011) Global spread of Carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 17(10):1791–1798. doi:10.3201/eid1710.110655
Patel G, Bonomo RA (2011) Status report on carbapenemases: challenges and prospects. Expert Rev Anti Infect Ther 9(5):555–570. doi:10.1586/eri.11.28
Patel G, Huprikar S, Factor SH et al (2008) Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 29(12):1099–1106. doi:10.1086/592412
Paterson DL, Bonomo RA (2005) Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 18(4):657–686. doi:10.1128/CMR.18.4.657-686.2005
Sievert DM, Ricks P, Edwards JR et al (2013) Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 34(1):1–14. doi:10.1086/668770
Tumbarello M, Viale P, Viscoli C et al (2012) Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis 55(7):943–950. doi:10.1093/cid/cis588
Tzouvelekis LS, Markogiannakis A, Psichogiou M et al (2012) Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev 25(4):682–707. doi:10.1128/CMR.05035-11
Wayne PA (2014) Analysis and presentation of cumulative antimicrobial susceptibility test data; Approved Guideline-Fourth Edition. CLSI document M39-A4
Wayne PA (2015) Performance standards for antimicrobial susceptibility testing; Twenty-Fifth Informational Supplement; CLSI document M100-S25
World Health Organization (WHO) (2015) WHONET software. Version 5.6. http://www.who.int/drugresistance/whonetsoftware. Accessed 27 Mar 2015
Yigit H, Queenan AM, Anderson GJ et al (2001) Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 45(4):1151–1161. doi:10.1128/AAC.45.4.1151-1161.2001
Zarkotou O, Pournaras S, Tselioti P et al (2011) Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clin Microbiol Infect 17(12):1798–1803. doi:10.1111/j.1469-0691.2011.03514.x
Acknowledgements
This work was supported by “Fondazione Cassa di Risparmio” of Perugia, Italy (grant No. 2014.0221.021).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Monari, C. et al. (2015). Carbapenem-Resistant Klebsiella pneumoniae: Results of a Laboratory Surveillance Program in an Italian General Hospital (August 2014–January 2015). In: Donelli, G. (eds) Advances in Microbiology, Infectious Diseases and Public Health. Advances in Experimental Medicine and Biology(), vol 901. Springer, Cham. https://doi.org/10.1007/5584_2015_5018
Download citation
DOI: https://doi.org/10.1007/5584_2015_5018
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-27934-3
Online ISBN: 978-3-319-27935-0
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)