Abstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) is endemic globally, causing severe infections in hospitalized patients. Surveillance programs help monitor and promptly identify the emergence of new clones. We reported the rapid spread of a novel clone of K. pneumoniae co-harbouring class A and D carbapenemases in colonized patients, and the potential risk factors involved in the development of infections. Methods: Rectal swabs were used for microbiological analyses and detection of the most common carbapenemase encoding genes by real-time PCR (i.e., blaKPC, blaOXA-48, blaNDM, blaVIM, and blaIMP). All strains co-harbouring KPC and OXA-48 genes were evaluated. For each patient, the following variables were collected: age, sex, length and ward of stay, device use, and outcome. Clonality of CR-Kp was assessed by preliminary pulsed field gel electrophoresis (PFGE), followed by multi-locus sequence typing (MLST) analyses. Results: A total of 127 isolates of K. pneumoniae co-harbouring KPC and OXA-48 were collected between September 2019 and December 2020. The median age (IQR) of patients was 70 (61–77). More than 40% of patients were admitted to intensive care unit (ICU). Around 25% of patients developed an invasive infection, the majority of which were respiratory tract infections (17/31; 54.8%). ICU stay and invasive infection increased the risk of mortality (OR: 5.39, 95% CI: 2.42–12.00; OR 6.12, 95% CI: 2.55–14.69, respectively; p-value ≤ 0.001). The antibiotic susceptibility test showed a resistance profile for almost all antibiotics considered. Monoclonal origin was confirmed by PFGE and MLST showing a similar restriction pattern and belonging to ST-512. Conclusions: We report the spread and the marked antibiotic resistance profiles of K. pneumoniae strains co-producing KPC and OXA-48. Further study could clarify the roles of clinical and microbiological variables in the development of invasive infection and increasing risk of mortality, in colonized patients.
Highlights
Materials and MethodsAn observational retrospective study was carried out at the University of Sassari, Italy
Introduction distributed under the terms andHospital-acquired infections (HAIs) are associated with significant morbidity and mortality [1]
In the present study we describe the epidemiological characteristics of a novel clone of K. pneumoniae co-harbouring KPC and OXA-48 carbapenemases isolated from colonized patients, and the associations between demographic/clinical variables and invasive infection and death
Summary
An observational retrospective study was carried out at the University of Sassari, Italy. We considered all strains of K. pneumoniae co-producing KPC and OXA-48, since first detection in September 2019 to December 2020, isolated during the activities of the screening program. The first positive rectal swabs, collected during the activities of the screening program, were selected for the present study. Colonization status was defined as a detection of CRE from rectal swab or faeces without any evidence of active infection, whereas infection, refers to the detection of carbapenem-resistant K. pneumoniae in patients with infection-related symptoms, isolated from clinical specimens or a normally sterile site (i.e., blood or bronchoalveolar lavage, respectively). The following variables were retrospectively collected: demographics (sex, age), comorbidities, history of community or healthcare-associated infections, ward of admission, length of hospital stay, use of devices, and final clinical outcome
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