Ongoing spread of colistin-resistant Klebsiella pneumoniae in different wards of an acute general hospital, Italy, June to December 2011.
Caterina Mammina,Celestino Bonura,F. Di Bernardo,Aurora Aleo,Teresa Fasciana,Concetta Sodano,Maria Antonietta Saporito,Maria Stella Verde,Romano Tetamo,Daniela Maria Palma +9 more
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TLDR
Cross-transmission containment measures and intensification of staff and environmental hygiene could not stop the outbreak, and selective pressure and horizontal transmission probably contributed to emergence and spread of three different strains of colistin-resistant K. pneumoniae in the hospital.Abstract:
We describe polyclonal spread of colistin-resistant Klebsiella pneumoniae in an acute general hospital in Italy. Between June and December 2011, 58 colistin-resistant K. pneumoniae isolates were recovered from 28 patients admitted to different wards, but mainly in the intensive care units. All isolates were tested for drug susceptibility and the presence of beta-lactamase (bla) genes. Clonality was investigated by repetitive extragenic palindromic (rep)-PCR and multilocus sequence typing (MLST). Fifty-two isolates had minimum inhibitory concentrations (MICs) for colistin of 6-128 mg/L, carried blaKPC3 and were attributed to sequence type ST258. The remaining six isolates were susceptible to carbapenems, exhibited MICs for colistin of 3-32 mg/L, and belonged to two different types, ST15 and ST273. Rep-PCR included all isolates in three clusters, one containing all ST258 KPC-3-producing isolates and two containing ST15 and ST273 isolates. Cross-transmission containment measures and intensification of staff and environmental hygiene could not stop the outbreak. Selective pressure and horizontal transmission probably contributed to emergence and spread of three different strains of colistin-resistant K. pneumoniae in the hospital. Strict implementation of the above measures and a wider awareness of the antimicrobial resistance threat are crucial to preserve the last therapeutic options of the multidrug-resistant Gram-negative infections.
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Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases
L. Silvia Munoz-Price,L. Silvia Munoz-Price,Laurent Poirel,Robert A. Bonomo,Robert A. Bonomo,Mitchell J. Schwaber,George L. Daikos,Martin Cormican,Giuseppe Cornaglia,Javier Garau,Marek Gniadkowski,Mary K. Hayden,Karthikeyan Kumarasamy,David M. Livermore,David M. Livermore,Juan J. Maya,Patrice Nordmann,Jean B. Patel,David L. Paterson,Johann D. D. Pitout,Maria Virginia Villegas,Hui Wang,Neil Woodford,John P. Quinn +23 more
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TL;DR: An observational study conducted during 2009 to 2010 in two hospitals located in a high-prevalence area to evaluate the clinical outcome of patients with CP-Kp bloodstream infections, and to identify predictors of mortality and the various antibiotic schemes employed.
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Ivelina Damjanova,Ákos Tóth,Judit Pászti,Gabriella Hajbel-Vékony,Melinda Jakab,Judit Berta,Hedda Milch,Miklós Füzi +7 more
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