Abstract
Following the rapid increase of infections due to carbapenemase-producing Enterobacteriaceae (CPE) in Italy, the national surveillance of bloodstream infections (BSI) due to CPE (Klebsiella pneumoniae and Escherichia coli) was instituted in 2013. All CPE-BSI cases reported to the surveillance in the years 2014–17 were analysed in order to investigate incidence rate (IR), trend, main individual characteristics and enzymes involved in CPE resistance. Throughout this period, 7,632 CPE-BSI cases (IR: 3.14/100,000 inhabitants) were reported from all 21 regions and autonomous provinces in Italy, with an increasing number of reported cases (2014: 1,403; 2015: 1,838; 2016: 2,183; 2017: 2,208). CPE-BSI cases mainly occurred in subjects aged over 60 years (70.9%) and more frequently in males (62.7%) than in females. Most of the cases originated in hospitals (87.2%), mainly in intensive care units (38.0%), and were associated with central or peripheral venous catheter use (23.9%) or with urinary tract infections (21.1%). Almost all CPE-BSI (98.1%) were due to K. pneumoniae carrying the K. pneumoniae carbapenemase (KPC) enzyme (95.2%). These data show that carbapenemase-producing K. pneumoniae are endemic in our country, causing a high number of BSI and representing a threat to patient safety.
Highlights
The increase in carbapenem resistance in Enterobacteriaceae through carbapenemase enzyme production has been reported worldwide [1,2,3,4,5,6]
All bloodstream infections (BSI) due to K. pneumoniae or E. coli with at least one of the following characteristics: (i) non-susceptibility to the carbapenem antibiotics imipenem and/or meropenem obtained by a routine antibiotic susceptibility method; and (ii) production of carbapenemase identified by a phenotypic method [20] or by the detection of a carbapenemase gene by PCR or another molecular method
When BSI onset occurred in hospital, patients were more commonly in intensive care units (ICU) (2,430/6,401, 38.0%), in general medicine wards
Summary
The increase in carbapenem resistance in Enterobacteriaceae through carbapenemase enzyme production has been reported worldwide [1,2,3,4,5,6]. According to the new taxonomy [10], carbapenem resistance is present in the family Enterobacteriaceae sensu stricto and in the other families belonging in the Enterobacterales order. When compared with carbapenem-susceptible infections, those due to carbapenem-resistant Enterobacterales (CRE) show higher mortality rates, especially for bloodstream infections (BSI) [11,12]. Resistance to carbapenems impacts considerably on healthcare costs and loss of productivity [13]. The high occurrence of cases, dearth of alternative drugs, high mortality and economic burden make CPE infections an important threat to public health worldwide
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