High-Risk Clone of Klebsiella pneumoniae Co-Harbouring Class A and D Carbapenemases in Italy

Arcadia Del Rio, Narcisa Muresu, Giovanni Sotgiu, Laura Saderi, Illari Sechi, Andrea Cossu, Manuela Usai, Alessandra Palmieri, Bianca Maria Are, Giovanna Deiana, Clementina Cocuzza, Marianna Martinelli, Enrico Calaresu and Andrea Fausto Piana
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Arcadia Del Rio: Biomedical Science PhD School, Biomedical Science Department, University of Sassari, 07100 Sassari, Italy
Narcisa Muresu: Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Giovanni Sotgiu: Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Laura Saderi: Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Illari Sechi: Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Andrea Cossu: Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Manuela Usai: Department of Humanistic and Social Sciences, University of Sassari, 07100 Sassari, Italy
Alessandra Palmieri: Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Bianca Maria Are: Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Giovanna Deiana: Biomedical Science PhD School, Biomedical Science Department, University of Sassari, 07100 Sassari, Italy
Clementina Cocuzza: Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
Marianna Martinelli: Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
Enrico Calaresu: Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
Andrea Fausto Piana: Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy

IJERPH, 2022, vol. 19, issue 5, 1-11

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.

Keywords: antimicrobial resistance; Carbapenemase genes; Klebsiella pneumoniae; nosocomial infections (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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