Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance

Abstract

Abstract Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy. We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions. Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates. Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs. *Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca Key messages Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.