Nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae in an Italian university hospital: a molecular epidemiological study

G. Sotgiu, B. M. Are, L. Pesapane, A. Palmieri, N. Muresu, A. Cossu, M. Dettori, A. Azara, I. I. Mura, C. Cocuzza, S. Aliberti, A. Piana

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Abstract

Aim: To describe the phenotypic and genotypic profiles of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) strains isolated from patients with invasive infections at an Italian university hospital in order to assess the epidemiological trend. Methods: An observational prospective study was undertaken at the University Hospital of Sassari, Italy to detect KPC-Kp strains in patients with invasive bacteraemia. Isolates were identified phenotypically; carbapenemase production was assessed using phenotypic and genotypic methods. Sequencing of blaKPC genes, pulsed-field gel electrophoresis and multi-locus sequence typing were performed. Results: During the period 2015–2017, 46 cases of invasive infection with K. pneumoniae were recorded. Two-thirds (67.4%) of the patients were male, and the mean age was 69.4 years. Most patients had at least one comorbidity (56.5%) and/or had been hospitalized previously (70.5%), 81.8% had current or recent medical device use, and 85.4% had recent antibiotic exposure. The mortality rate was 52.3%. A multi-drug-resistant pattern (including carbapenems, fluoroquinolones, third-/fourth-generation cephalosporins) was shown for all K. pneumoniae isolates. KPC-3 and -2 were produced by all strains. The most common sequence types were 512 (91.3%) and 101 (8.7%), grouped into three clusters (A, A1 and B). Conclusions: A high incidence of KPC-Kp in patients with invasive infections was recorded at an Italian university hospital compared with the incidence measured before 2015. This study confirmed the importance of the KPC-3 carbapenemase variant, as reported by other Italian studies. High mortality and comorbidity rates appear to be associated with KPC-Kp infection.

Original languageEnglish
Pages (from-to)413-418
Number of pages6
JournalJournal of Hospital Infection
Volume99
Issue number4
DOIs
Publication statusPublished - Aug 1 2018

Fingerprint

Carbapenems
Klebsiella pneumoniae
Epidemiologic Studies
Comorbidity
Klebsiella Infections
Infection
Mortality
Pulsed Field Gel Electrophoresis
Fluoroquinolones
Incidence
Cephalosporins
Bacteremia
Italy
Observational Studies
carbapenemase
Prospective Studies
Anti-Bacterial Agents
Equipment and Supplies

Keywords

  • Genotypic analysis
  • Klebsiella pneumoniae carbapenemase-producing K. pneumoniae
  • Surveillance

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae in an Italian university hospital : a molecular epidemiological study. / Sotgiu, G.; Are, B. M.; Pesapane, L.; Palmieri, A.; Muresu, N.; Cossu, A.; Dettori, M.; Azara, A.; Mura, I. I.; Cocuzza, C.; Aliberti, S.; Piana, A.

In: Journal of Hospital Infection, Vol. 99, No. 4, 01.08.2018, p. 413-418.

Research output: Contribution to journalArticle

Sotgiu, G. ; Are, B. M. ; Pesapane, L. ; Palmieri, A. ; Muresu, N. ; Cossu, A. ; Dettori, M. ; Azara, A. ; Mura, I. I. ; Cocuzza, C. ; Aliberti, S. ; Piana, A. / Nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae in an Italian university hospital : a molecular epidemiological study. In: Journal of Hospital Infection. 2018 ; Vol. 99, No. 4. pp. 413-418.
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abstract = "Aim: To describe the phenotypic and genotypic profiles of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) strains isolated from patients with invasive infections at an Italian university hospital in order to assess the epidemiological trend. Methods: An observational prospective study was undertaken at the University Hospital of Sassari, Italy to detect KPC-Kp strains in patients with invasive bacteraemia. Isolates were identified phenotypically; carbapenemase production was assessed using phenotypic and genotypic methods. Sequencing of blaKPC genes, pulsed-field gel electrophoresis and multi-locus sequence typing were performed. Results: During the period 2015–2017, 46 cases of invasive infection with K. pneumoniae were recorded. Two-thirds (67.4{\%}) of the patients were male, and the mean age was 69.4 years. Most patients had at least one comorbidity (56.5{\%}) and/or had been hospitalized previously (70.5{\%}), 81.8{\%} had current or recent medical device use, and 85.4{\%} had recent antibiotic exposure. The mortality rate was 52.3{\%}. A multi-drug-resistant pattern (including carbapenems, fluoroquinolones, third-/fourth-generation cephalosporins) was shown for all K. pneumoniae isolates. KPC-3 and -2 were produced by all strains. The most common sequence types were 512 (91.3{\%}) and 101 (8.7{\%}), grouped into three clusters (A, A1 and B). Conclusions: A high incidence of KPC-Kp in patients with invasive infections was recorded at an Italian university hospital compared with the incidence measured before 2015. This study confirmed the importance of the KPC-3 carbapenemase variant, as reported by other Italian studies. High mortality and comorbidity rates appear to be associated with KPC-Kp infection.",
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AU - Sotgiu, G.

AU - Are, B. M.

AU - Pesapane, L.

AU - Palmieri, A.

AU - Muresu, N.

AU - Cossu, A.

AU - Dettori, M.

AU - Azara, A.

AU - Mura, I. I.

AU - Cocuzza, C.

AU - Aliberti, S.

AU - Piana, A.

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KW - Surveillance

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