Evolving beta-lactamase epidemiology in Enterobacteriaceae from Italian nationwide surveillance, October 2013: KPC-carbapenemase spreading among outpatients

Abstract

Extended-spectrum beta-lactamases (ESBLs), AmpC-type beta-lactamases (ACBLs) and carbapenemases are among the most important resistance mechanisms in Enterobacteriaceae. This study investigated the presence of these resistance mechanisms in consecutive non-replicate isolates of Escherichia coli (n = 2,352), Klebsiella pneumoniae (n = 697), and Proteus mirabilis (n = 275) from an Italian nationwide cross-sectional survey carried out in October 2013. Overall, 15.3% of isolates were non-susceptible to extended-spectrum cephalosporins but susceptible to carbapenems (ESCR-carbaS), while 4.3% were also non-susceptible to carbapenems (ESCR-carbaR). ESCR-carbaS isolates were contributed by all three species, with higher proportions among isolates from inpatients (20.3%) but remarkable proportions also among those from outpatients (11.1%). Most ESCR-carbaS isolates were ESBL-positive (90.5%), and most of them were contributed by E. coli carrying blaCTX-M group 1 genes. Acquired ACBLs were less common and mostly detected in P. mirabilis. ESCR-carbaR isolates were mostly contributed by K. pneumoniae (25.1% and 7.7% among K. pneumoniae isolates from inpatients and outpatients, respectively), with blaKPC as the most common carbapenemase gene. Results showed an increasing trend for both ESBL and carbapenemase producers in comparison with previous Italian surveys, also among outpatients.

Antibiotic-resistant pathogens in different patient settings and identification of surveillance gaps in Switzerland – a systematic review

“…Prevalence was reported to be as low as 0.1% upon hospital admission in Germany [61] and 0.4% among hospitalised acute care patients in southern France in 2012 [62]. In Italy, 8% of clinical Enterobacteriaceae isolates from inpatients were carbapenem-resistant in 2013 [63]. In Switzerland, according to national laboratory-based surveillance data, absolute numbers of CPE have been increasing in recent years, with OXA-48 being the most commonly reported carbapenemase followed by K. pneumoniae carbapenemase [64].…”

Plasmid-encoded colistin resistance: mcr-one, two, three and counting

“…The situation in Denmark may not be representative for other settings. For example, a paper from Rosslini et al, in this issue [ref 12 ] shows that resistance in Italy is high. Their surveillance project (in October 2013) in several Italian hospitals, found that a quarter of all Klebsiella pneumoniae isolates from hospitalised patients were resistant to carbapenems.…”

mcr-3 and mcr-4 Variants in Carbapenemase-Producing Clinical Enterobacteriaceae Do Not Confer Phenotypic Polymyxin Resistance

“…T he worldwide distribution of plasmid-mediated colistin resistance determinants (mcr-1, mcr-2, mcr-3, and mcr-4) coupled to the emerging observation that colistin resistance is more prevalent in carbapenem-resistant Enterobacteriaceae (CRE) (1,2) presents a daunting challenge in combatting antimicrobial resistance. Undoubtedly, next-generation sequencing approaches have expedited the discovery of mobile colistin resistance determinants (3).…”