Abstract
The study describes the spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a regional healthcare network in Italy. The project included several stages: (1) Establishment of a laboratory-based regional surveillance network, including all the acute care hospitals of the Marches Region (n = 20). (2) Adoption of a shared protocol for the surveillance of Multi-Drug Resistant Organisms (MDROs). Only the first CRKP isolate for each patient has been included in the surveillance in each hospital. The anonymous tracking of patients, and their subsequent microbial records within the hospital network, allowed detection of networks of inter-hospital exchange of CRKP and its comparison with transfer of patients within the hospital network. Pulsed-Field Gel Electrophoresis (PFGE) analysis has been used to study selected isolates belonging to different hospitals. 371,037 admitted patients have been included in the surveillance system. CRKP has shown an overall incidence rate of 41.0 per 100,000 days of stay (95% confidence interval, CI 38.5–43.5/100,000 DOS), a CRKP incidence rate of isolation in blood of 2.46/100,000 days of stay (95% CI 1.89–3.17/100,000 days of stay (DOS) has been registered; significant variability has been registered in facilities providing different levels of care. The network of CRKP patients’ exchange was correlated to that of the healthcare organization, with some inequalities and the identification of bridges in CRKP transfers. More than 73% of isolates were closely related. Patients’ exchange was an important route of spread of antimicrobial resistance, highlighting the pivotal role played by the hub, and selected institution to be used in prioritizing infection control efforts.
Highlights
The incidence of Multi-Drug Resistant Organisms (MDROs) has dramatically increased over the last decades and is considered one of the preeminent infectious disease problems in Europe, and worldwide [1]
Data obtained from national experiences and those obtained by the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) have shown how Italy is among the European countries with an higher burden of disease caused by Carbapenem Resistant Enterobacteriaceae (CRE) [2,3,4,5,6]
Data from the Italian surveillance of antibiotic resistance reporting to the European Antimicrobial Resistance Network (EARS-Net), showed that from a non-susceptibility of 1.3%; in 2009, the percentage of carbapenem-resistant Klebsiella pneumoniae (CRKP) causing BSI increased dramatically to 34.3% in 2013, and has established at 26.8% in 2018 making Klebsiella pneumoniae the most important antibiotic-resistance threat in Italy [7]
Summary
The incidence of Multi-Drug Resistant Organisms (MDROs) has dramatically increased over the last decades and is considered one of the preeminent infectious disease problems in Europe, and worldwide [1]. In addition to locally-based infection control policies, the ongoing reorganization of healthcare providers within a regionally managed healthcare service based on network models occurring in the Marches region of Italy, may have an impact in infection control; it has been already shown that patients’ transfers may act as pivotal routes of transmission [9,10,11], and highly connected hospitals may have the most potential to transmit MDROs in the entire network [10,12,13]. Screening on admission represents an important activity of local microbiology laboratory and the crucial support of laboratory information in infection control may be improved by the analysis of patient movements within the network, in order to highlight high-risk routes of transmission
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