Trends in the annual incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections: a 8-year retrospective study in a large teaching hospital in northern Italy

Alicino, Cristiano; Giacobbe, Daniele Roberto; Orsi, Andrea; Tassinari, Federico; Trucchi, Cecilia; Sarteschi, Giovanni; Copello, F; Bono, Valerio Del; Viscoli, Claudio; Icardi, Giancarlo

doi:10.1186/s12879-015-1152-0

Cited by 46 publications

(45 citation statements)

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“…This rendered K. pneumoniae the most commonly isolated pathogen from bloodstream infections in our hospital. Even though a similar steep increase in the CP-Kp incidence was observed in a tertiary hospital in Genoa, Italy, during an eight-year period, incidence of CP-Kp bacteraemias per 10 000 patient-days remained significantly lower as compared with ours (0.9 vs 2.4 per 10 000 patient-days) (Alicino et al, 2015). In addition to the narrow armamentarium against them, surveillance of these pathogens is absolutely necessary (Papadimitriou- et al, 2014b;Tzouvelekis et al, 2012).…”

Section: Discussionmentioning

confidence: 52%

A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates

Spyropoulou

Papadimitriou-Olivgeris

Bartzavali

et al. 2016

Journal of Medical Microbiology

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Resistance patterns and carbapenemase gene presence among Klebsiella pneumoniae isolates from the University General Hospital of Patras, Greece during a ten-year period were analysed under a surveillance programme for multi-drug-resistant bacteria. From 2005 to 2014, K. pneumoniae isolates from clinically significant specimens were identified by the Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the agar disc diffusion method and Etest. The strains were tested for the presence of bla VIM , bla IMP , bla KPC , bla NDM and bla OXA-48 genes by PCR. PFGE of chromosomal Xbal DNA digests was performed. A total of 3449 K. pneumoniae isolates were recovered during the last decade. Among them, 1668 (48 %) were carbapenemase-producing: 1333 (80 %) K. pneumoniae carbapenemase (KPC)-, 286 (17 %) Verona imipenemase (VIM), 45 (3 %) KPC-and VIM-, and four New Delhi metallo-beta-lactamase (NDM)-producing. Their resistance rates to gentamicin, colistin and tigecycline were 41 %, 23 % and 16 %, respectively. VIM-producing K. pneumoniae were isolated in 2005 and since 2008 have been endemic. KPC-producing K. pneumoniae (KPC-Kp) isolates were introduced in 2008 and until now represent the predominant carbapenemase-producing K. pneumoniae in our institution. PFGE of 97 KPC-Kp strains identified three types: A, 84 (87 %); B, 11 (11 %); and E, two (2 %). Eleven co-producing KPC and VIM K. pneumoniae isolates belonged to PFGE B. The four NDM-positives were classified to type F. The number of K. pneumoniae bacteraemias increased during the study period, which may be solely attributed to the increase of carbapenemase-producing isolates. The threat of carbapenemase-producing K. pneumoniae emphasizes the urgent need for implementation of infection control measures and budgetary allocations to infection control.

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Section: Discussionmentioning

confidence: 52%

A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates

Spyropoulou

Papadimitriou-Olivgeris

Bartzavali

et al. 2016

Journal of Medical Microbiology

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“…2D). The finding that these K. pneumoniae clinical isolates were susceptible to components in NHS is intriguing, because ST258 is well-known to cause fatal bacteremia, albeit in individuals with significant comorbidities, such as immunosuppression (14)(15)(16)(17)(18)(19)(20).…”

Section: Resultsmentioning

confidence: 99%

“…Carbapenem-resistant K. pneumoniae infections are often associated with bacteremia. The rate of mortality among these patients is high (ϳ50%), primarily because of patient comorbidities and limited treatment options (7,(14)(15)(16)(17)(18)(19)(20)(21)(22). In the …”

Section: Resultsmentioning

confidence: 99%

“…In addition, carbapenem-resistant K. pneumoniae strains have spread globally and are highly prevalent in Israel, Greece, Italy, China, and South America (10)(11)(12)(13). Infections with MDR K. pneumoniae strains are associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization, critically ill patients, and individuals with invasive devices (7,(14)(15)(16)(17)(18)(19)(20)(21)(22). The expanded drug resistance profile of K. pneumoniae KPC strains has severely limited the treatment options available following infection (23,24).…”

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confidence: 99%

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Survival of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 258 in Human Blood

DeLeo

Kobayashi

Porter

et al. 2017

Antimicrob Agents Chemother

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Klebsiella pneumoniae is a prominent cause of nosocomial infections worldwide. Bloodstream infections caused by carbapenem-resistant K. pneumoniae, including the epidemic lineage known as multilocus sequence type 258 (ST258), are difficult to treat, and the rate of mortality from such infections is high. Thus, it is imperative that we gain a better understanding of host defense against this pathogen as a step toward developing novel therapies. Here we tested the hypothesis that the resistance of ST258 to bactericidal components of human blood, such as serum complement, is linked to virulence capacity in the context of bacteremia. There was significant variance in the survival of ST258 clinical isolates in heparinized human blood or normal human serum. The rate of survival of ST258 isolates in human blood was, in general, similar to that in normal human serum, suggesting a prominent role for complement (rather than leukocytes) in the healthy host defense against ST258 isolates and related organisms. Indeed, deposition of serum complement-the C5b to C9 (C5b-C9) membrane attack complex-onto the surface of ST258 isolates accompanied serum bactericidal activity. Human serum treated with pharmacological inhibitors of complement, depleted of antibody, or heated at 56°C for 30 min had significantly reduced or absent bactericidal activity. In contrast to heparinized blood from humans, that from BALB/c mice lacked bactericidal activity toward the ST258 isolates tested, but the virulence of these ST258 isolates in a mouse bacteremia model was inexplicably limited. Our data highlight the importance of the complement system in host defense against ST258 bacteremia, and we propose that there is the potential to enhance complement-mediated bactericidal activity using an antibody-based approach.

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“…Currently, due to increase in surgical procedures, intensive use of invasive instruments, immunosuppressive therapy and other similar practices incidence of health care associated infections (HAI) and its significance have increased worldwide (Kaiser et al 2013; Kontopidou et al 2014; Alicino et al 2015). BSI, either HAI or community-acquired are among the most severe life–threatening infections (Alicino et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

et al. 2016

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Purpose Klebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI).MethodsThe characteristics of patients >16 years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors.ResultsOne hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower.ConclusionsSepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.

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Trends in the annual incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections: a 8-year retrospective study in a large teaching hospital in northern Italy

Cited by 46 publications

References 15 publications

A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates

A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates

Survival of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 258 in Human Blood

Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

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