MANAGEMENT OF KLEBSIELLA PNEUMONIAE KPC OUTBREAK IN INTERNAL MEDICINE

ANDREA BELLODI¹*, LISETTE DEL CORSO¹ , SERENA FAVORINI¹ , ELISA MOLINARI¹ , ERIKA COPPO² , GIOVANNI ORENGO³ , VALERIO DEL BONO⁴ , RICCARDO GHIO¹ , ELEONORA ARBOSCELLO¹

¹ 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.