ANDREA BELLODI1*, LISETTE DEL CORSO1
, SERENA FAVORINI1
, ELISA MOLINARI1
, ERIKA COPPO2
, GIOVANNI ORENGO3
, RICCARDO GHIO1
, ELEONORA ARBOSCELLO1
Clinic of Internal Medicine 3 – IRCCS AOU San Martino IST, Genoa, Italy - 2
Microbiology – IRCCS AOU San Martino IST,
Genoa, Italy - 3
Clinic Risk and Quality Management, IRCCS AOU San Martino IST, Genoa, Italy - 4
Clinic of Infectious Diseases –
IRCCS AOU San Martino IST, Genoa, Italy
Introduction: Italy has a high incidence of Klebsiella pneumoniae producing carbapenemase (CRKP) infections. We report
and discuss the experience of our Centre, an Internal Medicine Unit in North-Western Italy, focusing on the high clinical challenge
dealing with this infections in year 2012 with data expanded over three years of surveillance.
Materials and methods: we retrospectively analyzed data of patients with isolation of CRKP during years 2011–2013.
Results: In 2011 2 patients had positive cultures for CRKP; in 2012 CRKP was isolated in 21 patients. The mean age of the
cohort was 77,6 (range 52-89). Cultures were positive in different specimens: urines 71,4%, blood 9.52%, upper respiratory tract
9.52%, wounds 9,52%. Most relevant infection-associated risk factors were identified in presence of devices such as urinary catheter
(UC) (76% of patients) or central venous catheter (CVC) (47% of patients). In 2013 we observed 6 cases. Cultures were positive on
urines, blood and abdominal drainage, blood, sputum and bronchial-alveolar lavage. In conclusion, in three years of surveillance we
observed 29 patients with CRKP isolation: 17 urinary tract infections (response 6/13), 4 blood stream infections (response 1/3), 4
respiratory tract infections (response 1/3), 4 skin and soft tissue infections/colonization (not treated); crude mortality was 51% and
global response to therapy was 42,1% on 19 treated patients.
Conclusions: the 2012 outbreak was contained and the major awareness of the problem produced systematic new measures for
infection control: screening with rectal swab for CRKP for patients admitted from other Hospitals or wards, sudden isolation of colonized/infected
patients, more accurate attention to environmental and personal hygiene. CRPK is an important cause of morbidity
and mortality; efficiency of single agent antibiotic therapy against CRPK seems to be not satisfying. Dedicated guidelines of new
combination therapy are required.
Klebsiella pneumoniae KPC, carbapenemase, antibiotic resistance, outbreak, internal medicine, infection control