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Cabello M, Hernández-García M, Maruri-Aransolo A, Michelena M, Pérez-Viso B, Ponce-Alonso M, Cantón R, Ruiz-Garbajosa P. Occurrence of multi-carbapenemase-producing Enterobacterales in a tertiary hospital in Madrid (Spain): A new epidemiologic scenario. J Glob Antimicrob Resist 2024; 38:281-291. [PMID: 38996870 DOI: 10.1016/j.jgar.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
INTRODUCTION Multi-carbapenemase-producing Enterobacterales (M-CPE) are increasingly described. We characterized the M-CPE isolates prospectively recovered in our hospital (Madrid, Spain) over two years (2021-2022). METHODS We collected 796 carbapenem resistant Enterobacterales (CRE) from clinical and surveillance samples. Carbapenemase production was confirmed with phenotypic (immunochromatographic, disk diffusion) and molecular (PCR, WGS) techniques. Antimicrobial susceptibility was evaluated by a standard broth microdilution method. Clinical and demographic data were collected. RESULTS Overall, 23 M-CPE (10 Klebsiella pneumoniae, 6 Citrobacter freundii complex, 3 Escherichia coli, 2 Klebsiella oxytoca, and 2 Enterobacter hormaechei) isolates were recovered from 17 patients (3% with CPE, 0.26-0.28 cases per 1000 admissions). OXA-48 + KPC-3 (7/23) and KPC-3 + VIM-1 (5/23) were the most frequent carbapenemase combinations. All patients had prior antibiotics exposure, including carbapenems (8/17). High resistance rates to ceftazidime/avibactam (14/23), imipenem/relebactam (16/23) and meropenem/vaborbactam (7/23) were found. Ceftazidime/avibactam + aztreonam combination was synergistic in all metallo-β-lactamase producers. Clonal and non-clonal related isolates were found, particularly in K. pneumoniae (5 ST29, 3 ST147, 3 ST307) and C. freundii (3 ST8, 2 ST125, 1 ST563). NDM-1 + OXA-48 was introduced with the ST147-K. pneumoniae high-risk clone linked to the transfer of a Ukrainian patient. We identified four possible nosocomial clonal transmission events between patients of the same clone with the same combination of carbapenemases (KPC-3 + VIM-1-ST29-K. pneumoniae, NDM-1 + OXA-48-ST147-K. pneumoniae and KPC-2 + VIM-1-ST145-K. oxytoca). Carbapenemase-encoding genes were located on different plasmids, except for VIM-1 + KPC-2-ST145-K. oxytoca. Cross-species transmission and a possible acquisition overtime was found, particularly between K. pneumoniae and E. coli producing OXA-48 + KPC-3. CONCLUSION M-CPE is an emerging threat in our hospital. Co-production of different carbapenemases, including metallo-β-lactamases, limits therapeutic options and depicts the need to reinforce infection control measures.
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Affiliation(s)
- Margarita Cabello
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marta Hernández-García
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Ainhize Maruri-Aransolo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Malkoa Michelena
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Blanca Pérez-Viso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Ponce-Alonso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Ruiz-Garbajosa
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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García-Fernández S, Rodríguez-Grande J, Siller-Ruiz M, Fraile-Valcárcel N, Lara-Plaza I, Moure Z, Pablo-Marcos D, Rodríguez-Lozano J, Suberviola B, Cundín MPR, Fariñas MC, Ocampo-Sosa A, Calvo-Montes J. Within-host transition to GES-55 during a GES-6-producing Serratia marcescens outbreak: Emergence of ceftazidime-avibactam resistance and increased susceptibility to carbapenems. Int J Antimicrob Agents 2024; 64:107257. [PMID: 38914141 DOI: 10.1016/j.ijantimicag.2024.107257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/22/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVES To describe the in vivo emergence of ceftazidime-avibactam resistance in GES-type carbapenemases and to characterize an unusual outbreak of GES-6-producing Serratia marcescens during the COVID-19 pandemic in Spain. METHODS Retrospective study to describe a GES-CPSM outbreak based on whole genome sequencing and antimicrobial susceptibility testing (AST). Transferability of blaGES-carrying plasmid was assessed by conjugation experiments. RESULTS In December 2020, we identified a cluster of S. marcescens harbouring blaGES-6 involving 9 patients. Whole-genome sequence analysis revealed a clonal relationship (≤3 SNPs) between the first isolates identified in each of the evolved patients and environmental samples with GES-CPSM detection. Plasmid analysis showed that the blaGES-6 gene was located in an IncQ3-type plasmid. Triparental mating experiments using a helper plasmid demonstrated mobilization of the blaGES-6-carrying plasmid. Our results also demonstrate within-host evolution in S. marcescens isolates, leading to a transition from blaGES-6 to the new blaGES-55, caused by the P162S mutation, in a subsequent infection in one of the affected patients. In blaGES-55 we identified emergence of ceftazidime-avibactam resistance along with an increase of carbapenems susceptibility. This patient had been treated with a 14-day course of ceftazidime-avibactam. AST of the transformants bearing blaGES-6 and blaGES-55 plasmids, confirmed susceptibility variation affecting ceftazidime-avibactam and carbapenems. CONCLUSIONS We report an unusual outbreak of GES-6 whose incidence is becoming increasing. Transition from GES-6 to GES-55 may readily occur in vivo leading to ceftazidime-avibactam resistance, which brings to the fore the critical need for developing more accurate diagnosis tools for detection of GES β-lactamases and optimise the use of antimicrobials.
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Affiliation(s)
- Sergio García-Fernández
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jorge Rodríguez-Grande
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - María Siller-Ruiz
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Nuria Fraile-Valcárcel
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Isabel Lara-Plaza
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Zaira Moure
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Daniel Pablo-Marcos
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Jesús Rodríguez-Lozano
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Borja Suberviola
- Servicio de Medicina Preventiva, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - M Paz Rodríguez Cundín
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - María Carmen Fariñas
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Alain Ocampo-Sosa
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Calvo-Montes
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Amadesi S, Bianco G, Secci B, Fasciana T, Boattini M, Costa C, Gaibani P. Complete Genome Sequence of a Klebsiella pneumoniae Strain Carrying Novel Variant blaKPC-203, Cross-Resistant to Ceftazidime/Avibactam and Cefiderocol, but Susceptible to Carbapenems, Isolated in Italy, 2023. Pathogens 2024; 13:507. [PMID: 38921804 PMCID: PMC11206468 DOI: 10.3390/pathogens13060507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a concerning pathogen, responsible for hospital-associated outbreaks. Multi drug resistant (MDR) strains are especially hard to treat. We conducted whole-genome sequencing on a MDR K. pneumoniae strain in order to identify genomic features potentially linked to its phenotype. METHODS DNA sequencing was performed on the Illumina iSeq 100 platform. Genome assembly was carried out with SPAdes. The genome was annotated with RASTtk. Typing was performed with MLST and Kaptive. Antibiotic resistance genes were detected with AMRFinderPlus and Abricate, and further verified with BLAST. RESULTS The strain exhibited resistance to ceftazidime/avibactam and cefiderocol, but remained susceptible to carbapenems. The strain belonged to sequence type ST101, serotype O1:K17. The analysis of antibiotic resistance genes indicated that the strain carried a novel KPC variant, designated as KPC-203, featuring a EL deletion at amino acid position 166-167, within the Ω-loop, and a nine-amino-acid insertion (LAVYTRAPM) at position 259. Sequence alterations were found in porin genes ompK35 and ompK36. Unlike molecular testing, which was able to detect the KPC-203 variant, all phenotypic carbapenemase detection methods achieved negative results. CONCLUSIONS KPC-203, a novel KPC variant, showed a sequence modification in a cephalosporin resistance-associated hotspot. Interestingly, such alterations typically correlate with the restoration of carbapenem susceptibility. We hypothesize that KPC-203 likely led to resistance to ceftazidime/avibactam and cefiderocol, while maintaining susceptibility to carbapenems.
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Affiliation(s)
- Stefano Amadesi
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy; (S.A.); (B.S.); (P.G.)
| | - Gabriele Bianco
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.B.); (C.C.)
| | - Benedetta Secci
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy; (S.A.); (B.S.); (P.G.)
| | - Teresa Fasciana
- Department of Health Promotion, Maternal and Child Health, Internal Medicine and Specialty Excellence “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.B.); (C.C.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
- Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.B.); (C.C.)
- Department of Public Health and Paediatrics, University of Torino, 10126 Turin, Italy
| | - Paolo Gaibani
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy; (S.A.); (B.S.); (P.G.)
- Department of Diagnostic and Public Health, Microbiology Section, Verona University, 37134 Verona, Italy
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Budia-Silva M, Kostyanev T, Ayala-Montaño S, Bravo-Ferrer Acosta J, Garcia-Castillo M, Cantón R, Goossens H, Rodriguez-Baño J, Grundmann H, Reuter S. International and regional spread of carbapenem-resistant Klebsiella pneumoniae in Europe. Nat Commun 2024; 15:5092. [PMID: 38877000 PMCID: PMC11178878 DOI: 10.1038/s41467-024-49349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 05/31/2024] [Indexed: 06/16/2024] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) are of particular concern due to the spread of antibiotic resistance genes associated with mobile genetic elements. In this study, we collected 687 carbapenem-resistant strains recovered among clinical samples from 41 hospitals in nine Southern European countries (2016-2018). We identified 11 major clonal lineages, with most isolates belonging to the high-risk clones ST258/512, ST101, ST11, and ST307. blaKPC-like was the most prevalent carbapenemase-encoding gene (46%), with blaOXA-48 present in 39% of isolates. Through the combination and comparison of this EURECA collection with the previous EuSCAPE collection (2013-2014), we investigated the spread of high-risk clones circulating in Europe exhibiting regional differences. We particularly found blaKPC-like ST258/512 in Greece, Italy, and Spain, blaOXA-48 ST101 in Serbia and Romania, blaNDM ST11 in Greece, and blaOXA-48-like ST14 in Türkiye. Genomic surveillance across Europe thus provides crucial insights for local risk mapping and informs necessary adaptions for implementation of control strategies.
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Affiliation(s)
- Mabel Budia-Silva
- Institute for Infection Prevention and Control, University of Freiburg - Medical Center, Freiburg, Germany
| | - Tomislav Kostyanev
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
- Research Group for Global Capacity Building, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Stefany Ayala-Montaño
- Institute for Infection Prevention and Control, University of Freiburg - Medical Center, Freiburg, Germany
| | - Jose Bravo-Ferrer Acosta
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena; and Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - Maria Garcia-Castillo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Caja de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Institute de Salud Carlos III, Madrid, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Caja de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Institute de Salud Carlos III, Madrid, Spain
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Jesus Rodriguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena; and Departamento de Medicina, Universidad de Sevilla, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Institute de Salud Carlos III, Madrid, Spain
| | - Hajo Grundmann
- Institute for Infection Prevention and Control, University of Freiburg - Medical Center, Freiburg, Germany
| | - Sandra Reuter
- Institute for Infection Prevention and Control, University of Freiburg - Medical Center, Freiburg, Germany.
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De la Cadena E, Mojica MF, Rojas LJ, Castro BE, García-Betancur JC, Marshall SH, Restrepo N, Castro-Caro NP, Fonseca-Carrillo M, Pallares C, Bonomo RA, Villegas MV. First report of KPC variants conferring ceftazidime-avibactam resistance in Colombia: introducing KPC-197. Microbiol Spectr 2024; 12:e0410523. [PMID: 38700337 PMCID: PMC11237465 DOI: 10.1128/spectrum.04105-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/19/2024] [Indexed: 05/05/2024] Open
Abstract
Resistance to ceftazidime-avibactam (CZA) due to Klebsiella pneumoniae carbapenemase (KPC) variants is increasing worldwide. We characterized two CZA-resistant clinical Klebsiella pneumoniae strains by antimicrobial susceptibility test, conjugation assays, and WGS. Isolates belonged to ST258 and ST45, and produced a KPC-31 and a novel variant KPC-197, respectively. The novel KPC variant presents a deletion of two amino acids on the Ω-loop (del_168-169_EL) and an insertion of two amino acids in position 274 (Ins_274_DS). Continued surveillance of KPC variants conferring CZA resistance in Colombia is warranted. IMPORTANCE Latin America and the Caribbean is an endemic region for carbapenemases. Increasingly high rates of Klebsiella pneumoniae carbapenemase (KPC) have established ceftazidime-avibactam (CZA) as an essential antimicrobial for the treatment of infections due to MDR Gram-negative pathogens. Although other countries in the region have reported the emergence of CZA-resistant KPC variants, this is the first description of such enzymes in Colombia. This finding warrants active surveillance, as dissemination of these variants could have devastating public health consequences.
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Affiliation(s)
- Elsa De la Cadena
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - María Fernanda Mojica
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
- Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Laura J. Rojas
- Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Betsy E. Castro
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Juan Carlos García-Betancur
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Steven H. Marshall
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Natalia Restrepo
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | | | | | - Christian Pallares
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Robert A. Bonomo
- Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Proteomics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - María Virginia Villegas
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
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Piazza A, Mattioni Marchetti V, Bielli A, Biffignandi GB, Piscopiello F, Giudici R, Tartaglione L, Merli M, Vismara C, Migliavacca R. A novel KPC-166 in ceftazidime/avibactam resistant ST307 Klebsiella pneumoniae causing an outbreak in intensive care COVID Unit, Italy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:457-469. [PMID: 38584042 DOI: 10.1016/j.jmii.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/31/2024] [Accepted: 03/24/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Aim of the study was the molecular characterization of 21 ceftazidime/avibactam resistant (CZA-R) Klebsiella pneumoniae strains, collected in the period October 2021-March 2022 from an Intensive Care COVID Unit in a Northern Italian Hospital. METHODS After growth on selective/chromogenic culture media and susceptibility tests assessment, resistance genes content was ascertained for all the isolates by the HybriSpot 12 multiplexing, PCR and Whole-Genome Sequencing (WGS). Clonality was assessed by PFGE and MLST according to the Pasteur scheme. A SNPs-based phylogenetic tree was obtained comparing representative isolates and global genomes. The blaKPC gene horizontal transmission was evaluated by conjugation experiments. blaKPC-166 was cloned in a pCR2.1 vector and transformed in chemically competent TOP10 cells. RESULTS Sixteen inpatients resulted positive for colonization and/or infection by KPC-producing K. pneumoniae (KPC-Kp) strains. The 21 CZA-R KPC-Kp isolates obtained showed MDR phenotype; susceptibility to meropenem was always retained. All the CZA-R KPC-Kp presented a novel blaKPC variant, named blaKPC-166, showing a single nucleotide substitution (T811C) compared to the blaKPC-94; but related to blaKPC-2. TWO DIFFERENT PULSOTYPES WERE DETECTED A in 18/21 and B in 1/21 cases, two strains from the same patient being untypable by PFGE. Interestingly, the outbreak was sustained by the high-risk clone ST307, although the ST22, ST6342, ST6418 and ST6811 have also been identified and associated to KPC-166. Worryingly, blaKPC-166 could be transferred horizontally and, after cloning, it conferred resistance to CZA. DISCUSSION This novel variant confers CZA-resistance and carbapenems susceptibility restoration. As KPC-166 was found expressed by multiple Kp clones, greater efforts should be made to prevent the further dissemination of such strains in Italian clinical settings.
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Affiliation(s)
- Aurora Piazza
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Vittoria Mattioni Marchetti
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Alessandra Bielli
- Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | | | - Francesca Piscopiello
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Riccardo Giudici
- Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Livia Tartaglione
- Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Marco Merli
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Chiara Vismara
- Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Roberta Migliavacca
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
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Giufrè M, Errico G, Del Grosso M, Pagnotta M, Palazzotti B, Ballardini M, Pantosti A, Meledandri M, Monaco M. Detection of KPC-216, a Novel KPC-3 Variant, in a Clinical Isolate of Klebsiella pneumoniae ST101 Co-Resistant to Ceftazidime-Avibactam and Cefiderocol. Antibiotics (Basel) 2024; 13:507. [PMID: 38927174 PMCID: PMC11200853 DOI: 10.3390/antibiotics13060507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/18/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Carbapenemase-producing Klebsiella pneumoniae (CP-KP) represents a global threat to public health, with limited antimicrobial therapeutic options. In this study, we analyzed a ceftazidime/avibactam (CAZ-AVI)-resistant K. pneumoniae isolate obtained from a patient previously exposed to CAZ-AVI expressing a novel K. pneumoniae carbapenemase (KPC)-3 variant. METHODS Antimicrobial susceptibility testing was performed using reference broth microdilution. Whole-genome sequencing (WGS) was performed using Illumina and Nanopore Technologies. Short- and long-reads were combined with Unicycler. Assemblies were investigated for multilocus sequence typing (MLST), antimicrobial resistance genes, porins, and plasmids. RESULTS The K. pneumoniae isolate (KP_RM_1) was resistant to CAZ-AVI, expanded-spectrum cephalosporins, amikacin, ertapenem, and cefiderocol (FDC) but was susceptible to tigecycline, colistin, trimethoprim/sulfamethoxazole, meropenem-vaborbactam, and imipenem-relebactam. WGS revealed that the KP_RM_1 genome is composed of a single chromosome of 5 Mbp and five circular plasmids. Further analysis showed the presence of novel blaKPC-216 located on a 72 kb plasmid. KPC-216 differs from KPC-3 by a Lysin (K) insertion at position 168 (+K168). CONCLUSIONS We report the identification of a new KPC-3 variant associated with CAZ-AVI resistance. The KPC variants associated with CAZ-AVI resistance should be determined to promptly inform clinicians and start the appropriate antimicrobial therapy.
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Affiliation(s)
- Maria Giufrè
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giulia Errico
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Maria Del Grosso
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Michela Pagnotta
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | | | - Annalisa Pantosti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | - Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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8
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Zhu J, Wang G, Li M. Outbreak of NDM-5-producing Klebsiella pneumoniae ST307: an emerging high-risk antimicrobial resistance clone in Shanghai, China. mSystems 2024; 9:e0136923. [PMID: 38506533 PMCID: PMC11019902 DOI: 10.1128/msystems.01369-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/08/2024] [Indexed: 03/21/2024] Open
Abstract
The high-risk clone Klebsiella pneumoniae ST307, associated with various carbapenem resistance genes, exhibits a global distribution and prevalence. However, in China, it has remained sporadic and has rarely been detected. In this study, we reported an outbreak caused by nine ST307 CRKP isolates harboring blaNDM-5 in Shanghai, China, in 2022. We employed antimicrobial susceptibility testing, conjugation assay, whole-genome sequencing (WGS) and comparative genomics, phylogenetic analysis, and fitness and virulence comparison to further characterize the isolates causing the outbreak. Besides blaNDM-5, these nine isolates co-carried blaCTX-M-15 and blaDHA-1, exhibiting nearly identical resistance profiles with high-level resistance to carbapenems and ceftazidime/avibactam, while showing susceptibility to colistin and tigecycline. blaNDM-5 was located on an IncX3 plasmid of 45,403 bp with a high frequency of conjugative ability. Phylogenetic and single-nucleotide polymorphism (SNP) analysis indicated the nature of clonal transmission with a maximum of five SNPs between these nine isolates, and they were closely related to strains obtained from the United States. ST307 isolates in our study showed a relatively lower virulence but higher growth rates and certain adaptability compared with ST11 isolates. Clinical investigation revealed that shared nursing staff in a mixed emergency intensive care unit ward and doctors' movement between wards might be responsible for the outbreak. The nonexistence before and sudden emergence of ST307 suggested that the currently circulating ST307 clone was a newly introduced superbug in our hospital. In conclusion, we revealed that blaNDM-5-producing ST307 CRKP isolates, a globally significant high-risk clone, are spreading in China, posing a substantial threat to public health.IMPORTANCEThe high-risk clone ST307, associated with various carbapenemases, including KPC, NDM, and OXA, has a global distribution. However, it is rarely reported in China, let alone causing outbreaks. Here, we found an outbreak caused by the clonal transmission of nine ST307 CRKP isolates. Clinical investigation revealed that shared nurses in a mixed emergency intensive care unit ward and doctors' movement between wards might be responsible for the outbreak. In our study, the nine NDM-5-producing ST307 isolates exhibited high-level resistance to carbapenems and ceftazidime-avibactam, high conjugative ability to Escherichia coli J53, and certain adaptability to environment, phylogenetically closet to the United States. All these features make ST307 clone the next successful clone comparable to ST11 clone in China. Therefore, it is imperative for us to vigilantly monitor the prevalence of carbapenem-resistant Klebsiella pneumoniae and promptly implement measures to control the spread of K. pneumoniae ST307 in China.
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Affiliation(s)
- Junying Zhu
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Medical Laboratory Science, College of Health Science and Technology, School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangyu Wang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Min Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Medical Laboratory Science, College of Health Science and Technology, School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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Castillo-Polo JA, Hernández-García M, Maruri-Aransolo A, de la Vega C, Ruiz-Garbajosa P, Cantón R. Evolution of ceftazidime-avibactam and cefiderocol resistance in ST131-H30R1- Escherichia coli isolates with KPC-3 mutants and application of FTIR biotyping. Microbiol Spectr 2024; 12:e0277623. [PMID: 38415657 PMCID: PMC10986490 DOI: 10.1128/spectrum.02776-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
Ceftazidime-avibactam and cefiderocol represent two of the few alternatives for infections by KPC-producing Enterobacterales. We reported the emergence of resistance to both ceftazidime-avibactam and cefiderocol in a KPC-producing ST131-Escherichia coli (KPC-ST131-Ec) clinical isolate. Antimicrobial susceptibility testing, Fourier-transform infrared (FTIR) spectroscopy, whole-genome sequencing, and cloning experiments were performed. A KPC-49-Ec isolate resistant to ceftazidime-avibactam (MICCZA > 16/4 mg/L) and susceptible to cefiderocol (MICFDC: 2 mg/L) was recovered in a blood sample from an oncologic patient hospitalized in the medical ICU (June 2019) during ceftazidime-avibactam treatment. After 44 days, a KPC-31-Ec resistant to both ceftazidime-avibactam and cefiderocol (MICCZA > 16/4 mg/L, MICFDC: 8 mg/L) was found in a rectal sample during a second cycle of ceftazidime-avibactam treatment. Both KPC-49 (R163S) and KPC-31 (D179Y) were detected in the epidemic ST131-H30R1-Ec high-risk clone and showed a phenotype resembling that of ESBL producers. FTIR spectroscopy managed to differentiate cefiderocol-susceptible and resistant ST131-Ec isolates, and these from others belonging to different clones. After cloning and transformation experiments, KPC-49 and KPC-31 were responsible for ceftazidime-avibactam resistance (MICCZA > 16/4 mg/L) and decreased carbapenem MICs (MICMER ≤ 0.12 mg/L, MICIMI ≤ 1 mg/L). KPC-31 was also shown to be associated with increased MICs of cefiderocol (twofold and threefold dilutions over KPC-3 and KPC-49, respectively). However, mutations in proteins participating in outer membrane stability and integrity, such as TolR, could have a more relevant role in cefiderocol resistance. The effects of ceftazidime-avibactam and cefiderocol co-resistance in clinical isolates of Enterobacterales producing KPC mutants make their identification challenging for clinical laboratories.IMPORTANCEThroughout four admissions in our hospital of a single patient, different KPC-3 variants (KPC-3, KPC-49, and KPC-31) were found in surveillance and clinical ST131-Escherichia coli isolates, after prolonged therapies with meropenem and ceftazidime-avibactam. Different patterns of resistance to cefiderocol and ceftazidime-avibactam emerged, accompanied by restored carbapenem susceptibility. The inability to detect these variants with some phenotypic methods, especially KPC-31 by immunochromatography, and the expression of a phenotype similar to that of ESBL producers, posed challenge to identify these variants in the clinical microbiology laboratory. Molecular methods and whole-genome sequencing are necessary and new techniques able to cluster or differentiate related isolates could also be helpful; this is the case of Fourier-transform infrared spectroscopy, which managed in our study to discriminate isolates by cefiderocol susceptibility within ST131, and those from the non-ST131 ones.
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Affiliation(s)
- Juan Antonio Castillo-Polo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marta Hernández-García
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ainhize Maruri-Aransolo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Carmen de la Vega
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Patricia Ruiz-Garbajosa
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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10
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Luna-Pineda VM, Rodríguez-Martínez G, Salazar-García M, Romo-Castillo M. Plant-Origin Components: New Players to Combat Antibiotic Resistance in Klebsiella pneumoniae. Int J Mol Sci 2024; 25:2134. [PMID: 38396811 PMCID: PMC10888558 DOI: 10.3390/ijms25042134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
Klebsiella pneumoniae (Kpn) is an opportunistic pathogen that causes intrahospital complications such as pneumonia, liver abscesses, soft tissue infections, urinary infections, bacteraemia, and, in some cases, death. Since this bacterium has a higher frequency than other Gram-negative pathogens, it has become an important pathogen to the health sector. The adaptative genome of Kpn likely facilitates increased survival of the pathogen in diverse situations. Therefore, several studies have been focused on developing new molecules, synergistic formulations, and biomaterials that make it possible to combat and control infections with and dispersion of this pathogen. Note that the uncontrolled antibiotic administration that occurred during the pandemic led to the emergence of new multidrug-resistant strains, and scientists were challenged to overcome them. This review aims to compile the latest information on Kpn that generates intrahospital infections, specifically their pathogenicity-associated factors. Furthermore, it explains the natural-product-based treatments (extracts and essential oils) developed for Kpn infection and dispersion control.
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Affiliation(s)
- Victor M. Luna-Pineda
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico; (V.M.L.-P.); (G.R.-M.)
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Griselda Rodríguez-Martínez
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico; (V.M.L.-P.); (G.R.-M.)
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Marcela Salazar-García
- Departamento de Investigación Biomédica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico;
| | - Mariana Romo-Castillo
- IxM/CONAHCYT-HIMFG, Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
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11
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Boattini M, Bianco G, Bastos P, Comini S, Corcione S, Almeida A, Costa C, De Rosa FG, Cavallo R. Prevalence and mortality of ceftazidime/avibactam-resistant KPC-producing Klebsiella pneumoniae bloodstream infections (2018-2022). Eur J Clin Microbiol Infect Dis 2024; 43:155-166. [PMID: 37985552 PMCID: PMC10774640 DOI: 10.1007/s10096-023-04712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Ceftazidime/avibactam-resistance in Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) is a topic of great interest for epidemiological, diagnostic, and therapeutical reasons. However, data on its prevalence and burden on mortality in patients with bloodstream infection (BSI) are lacking. This study was aimed at identifying risk factors for mortality in patients suffering from ceftazidime/avibactam-resistant KPC-Kp BSI. METHODS An observational retrospective study (January 2018-December 2022) was conducted at a tertiary hospital including all consecutive hospitalized adult patients with a ceftazidime/avibactam-resistant KPC-Kp BSI. Data on baseline clinical features, management, and admission outcomes were analyzed. RESULTS Over the study period, among all the KPC-Kp BSI events recorded, 38 (10.5%) were caused by ceftazidime/avibactam-resistant KPC-Kp strains, 37 events being finally included. The ceftazidime/avibactam-resistant KPC-Kp strains revealed susceptibility restoration to at least one carbapenem in more than 60% of cases. In-hospital and 30-day all-cause mortality rates were 22% and 16.2%, respectively. Non-survivors suffered from more baseline comorbidities and experienced a more severe ceftazidime/avibactam-resistant KPC-Kp BSI presentation (i.e., both the Pitt Bacteremia and INCREMENT-CPE scores were significantly higher). Presenting with a higher Charlson Comorbidity Index, chronic kidney disease-KDIGO stage 3A or worse-having recently gone through renal replacement therapy, having suffered from an acute kidney injury following the ceftazidime/avibactam-resistant KPC-Kp BSI, and being admitted for cardiac surgery were the strongest predictors of mortality. CONCLUSION Ceftazidime/avibactam resistance in KPC-Kp BSI easily emerged in our highly KPC-Kp endemic area with remarkable mortality rates. Our findings might provide physicians possibly actionable information when managing patients with a ceftazidime/avibactam-resistant KPC-Kp BSI.
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Affiliation(s)
- Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città Della Salute E Della Scienza Di Torino, Corso Bramante 88/90, 10126, Turin, Italy.
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy.
- Lisbon Academic Medical Centre, Lisbon, Portugal.
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città Della Salute E Della Scienza Di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - Paulo Bastos
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Lisbon, Portugal
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città Della Salute E Della Scienza Di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126, Turin, Italy
| | - André Almeida
- Department of Internal Medicine 4, Hospital de Santa Marta, Central Lisbon Hospital Centre, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città Della Salute E Della Scienza Di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126, Turin, Italy
- Unit of Infectious Diseases, Cardinal Massaia, 14100, Asti, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città Della Salute E Della Scienza Di Torino, Corso Bramante 88/90, 10126, Turin, Italy
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
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12
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Ding L, Shen S, Chen J, Tian Z, Shi Q, Han R, Guo Y, Hu F. Klebsiella pneumoniae carbapenemase variants: the new threat to global public health. Clin Microbiol Rev 2023; 36:e0000823. [PMID: 37937997 PMCID: PMC10732083 DOI: 10.1128/cmr.00008-23] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/31/2023] [Indexed: 11/09/2023] Open
Abstract
Klebsiella pneumoniae carbapenemase (KPC) variants, which refer to the substitution, insertion, or deletion of amino acid sequence compared to wild blaKPC type, have reduced utility of ceftazidime-avibactam (CZA), a pioneer antimicrobial agent in treating carbapenem-resistant Enterobacterales infections. So far, more than 150 blaKPC variants have been reported worldwide, and most of the new variants were discovered in the past 3 years, which calls for public alarm. The KPC variant protein enhances the affinity to ceftazidime and weakens the affinity to avibactam by changing the KPC structure, thereby mediating bacterial resistance to CZA. At present, there are still no guidelines or expert consensus to make recommendations for the diagnosis and treatment of infections caused by KPC variants. In addition, meropenem-vaborbactam, imipenem-relebactam, and other new β-lactam-β-lactamase inhibitor combinations have little discussion on KPC variants. This review aims to discuss the clinical characteristics, risk factors, epidemiological characteristics, antimicrobial susceptibility profiles, methods for detecting blaKPC variants, treatment options, and future perspectives of blaKPC variants worldwide to alert this new great public health threat.
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Affiliation(s)
- Li Ding
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Siquan Shen
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Jing Chen
- Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, Zhejiang, China
| | - Zhen Tian
- Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, Zhejiang, China
| | - Qingyu Shi
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Renru Han
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Yan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
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13
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Gracia-Ahufinger I, López-González L, Vasallo FJ, Galar A, Siller M, Pitart C, Bloise I, Torrecillas M, Gijón-Cordero D, Viñado B, Castillo-García J, Campo R, Mulet X, Madueño-Alonso A, Chamizo-López FJ, Arrastia-Erviti M, Galán-Sánchez F, Fernández-Quejo M, Rodríguez-Díaz JC, Gutiérrez-Zufiaurre MN, Rodríguez-Maresca MA, Ortega-Lafont MDP, Yagüe-Guirao G, Chaves-Blanco L, Colomina-Rodríguez J, Vidal-Acuña MR, Portillo ME, Franco-Álvarez de Luna F, Centelles-Serrano MJ, Azcona-Gutiérrez JM, Delgado-Iribarren García Campero A, Rey-Cao S, Muñoz P, Calvo-Montes J, Zboromyrska Y, Grandioso D, Càmara J, Cantón R, Larrosa-Escartín N, Díaz-Regañón J, Martínez-Martínez L. The CARBA-MAP study: national mapping of carbapenemases in Spain (2014-2018). Front Microbiol 2023; 14:1247804. [PMID: 37744921 PMCID: PMC10516297 DOI: 10.3389/fmicb.2023.1247804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018. Methods A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0. Results A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017-2018 compared to 2014-2016. Discussion Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.
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Affiliation(s)
- Irene Gracia-Ahufinger
- Unit of Microbiology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Laura López-González
- Clinical Microbiology Service, IML, San Carlos Clinical University Hospital, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco José Vasallo
- Microbiology Service, Vigo University Hospital Complex (CHUVI), Vigo, Spain
- Health Research Institute Galicia Sur (IISGS), Vigo, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Health Research Institute Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain
| | - María Siller
- Microbiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Marqués de Valdecilla Health Research Institute (IDIVAL), Santander, Spain
| | - Cristina Pitart
- Microbiology Service, Hospital Clinic, Barcelona, Spain
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
- Institute of Global Health of Barcelona, Barcelona, Spain
| | - Iván Bloise
- Clinical Microbiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Miriam Torrecillas
- Clinical Microbiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Desirée Gijón-Cordero
- Microbiology Service, Ramón y Cajal University Hospital, Madrid, Spain
- Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | - Belén Viñado
- Microbiology Service, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Javier Castillo-García
- Microbiology Service, Lozano Blesa Clinical University Hospital, Zaragoza, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Rainer Campo
- Microbiology Service, Asturias Central University Hospital, Oviedo, Spain
| | - Xavier Mulet
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Son Espases University Hospital, Palma de Mallorca, Spain
- Institute for Health Research Illes Balears (IdISBa), Palma, Spain
| | - Ana Madueño-Alonso
- Microbiology Service, University Hospital of the Canary Islands, Tenerife, Spain
| | | | | | | | | | - Juan Carlos Rodríguez-Díaz
- Microbiology Service, General University Hospital Dr. Balmis, Alicante, Spain
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | | | | | | | - Genoveva Yagüe-Guirao
- Virgen de la Arrixaca University Hospital, Murcia, Spain
- Department of Genetics and Microbiology, University of Murcia, Murcia, Spain
- Murcian Institute for Biomedical Research (IMIB), Murcia, Spain
| | - Lucía Chaves-Blanco
- Microbiology Service, San Cecilio Clinical University Hospital, Granada, Spain
| | | | | | - María Eugenia Portillo
- Clinical Microbiology Service, University Hospital of Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | | | - María José Centelles-Serrano
- Microbiology Area, Clinical Laboratory, Hospital of Tortosa Virgen de la Cinta, Tortosa, Spain
- Institute for Health Research Pere Virgili, Tortosa, Spain
| | | | | | - Sonia Rey-Cao
- Microbiology Service, Vigo University Hospital Complex (CHUVI), Vigo, Spain
- Health Research Institute Galicia Sur (IISGS), Vigo, Spain
| | - Patricia Muñoz
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Health Research Institute Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Calvo-Montes
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Marqués de Valdecilla Health Research Institute (IDIVAL), Santander, Spain
| | - Yuliya Zboromyrska
- Microbiology Service, Hospital Clinic, Barcelona, Spain
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - David Grandioso
- Clinical Microbiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Jordi Càmara
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
- Clinical Microbiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Institut Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Rafael Cantón
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Ramón y Cajal University Hospital, Madrid, Spain
- Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | - Nieves Larrosa-Escartín
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - Luis Martínez-Martínez
- Unit of Microbiology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain
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14
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Errico G, Del Grosso M, Pagnotta M, Marra M, Carollo M, Cerquetti M, Fogato E, Cesana E, Gentiloni Silverj F, Zabzuni D, Rossini A, Pantosti A, Tinelli M, Monaco M, Giufrè M. Whole-Genome Sequencing and Molecular Analysis of Ceftazidime-Avibactam-Resistant KPC-Producing Klebsiella pneumoniae from Intestinal Colonization in Elderly Patients. Antibiotics (Basel) 2023; 12:1282. [PMID: 37627702 PMCID: PMC10451778 DOI: 10.3390/antibiotics12081282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Ceftazidime-avibactam (CAZ-AVI) is an active antibiotic combination of a β-lactam-β-lactamase inhibitor against carbapenemase-producing Enterobacterales. Reports of resistance to CAZ-AVI other than metallo-β-lactamases have increased in recent years. The aim of this study was to analyze KPC-Klebsiella pneumoniae (KP) isolates resistant to CAZ-AVI from the intestinal carriage of hospitalized elderly patients in Italy, in February 2018-January 2020. Characterization of CAZ-AVI-resistant KP isolates, including MLST, resistome, virulome and plasmid content, was performed by WGS analysis. Out of six CAZ-AVI-resistant KP isolates, three belonged to ST101 and three to ST512; two isolates produced KPC-3 (both ST512), four had mutated KPC-3 (KPC-31, in ST101 and ST512, and KPC-46, both ST101). All CAZ-AVI-resistant KP isolates were multidrug-resistant and carried several resistance genes. The yersiniabactin ybt9 gene cluster was present in all ST101 isolates, while, in ST512 isolates, no virulence genes were detected. Several plasmids were detected: IncF was present in all isolates, as well as IncR and Col440 in ST101 and IncX3 in ST512 isolates. In conclusion, it is important to monitor the circulation of K. pneumoniae resistant to CAZ-AVI to prevent the spread of clones causing difficult-to-treat infections. The presence of mutated KPC-3 in high-risk K. pneumoniae clones resistant to CAZ-AVI in hospitalized patients deserves attention.
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Affiliation(s)
- Giulia Errico
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Maria Del Grosso
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Michela Pagnotta
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Manuela Marra
- Core Facilities Technical-Scientific Service (FAST), Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Maria Carollo
- Core Facilities Technical-Scientific Service (FAST), Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Marina Cerquetti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Elena Fogato
- Laboratory of Clinical Microbiology, ASP ‘Golgi-Redaelli’, 20146 Milan, Italy
| | - Elisabetta Cesana
- IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | | | - Dorjan Zabzuni
- IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | | | - Annalisa Pantosti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Marco Tinelli
- IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Maria Giufrè
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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15
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Campogiani L, Vitale P, Lodi A, Imeneo A, Fontana C, D'Agostini C, Compagno M, Coppola L, Spalliera I, Malagnino V, Teti E, Iannetta M, Andreoni M, Sarmati L. Resistance to Ceftazidime/Avibactam in Klebsiella pneumoniae KPC-Producing Isolates: A Real-Life Observational Study. Antibiotics (Basel) 2023; 12:antibiotics12050820. [PMID: 37237722 DOI: 10.3390/antibiotics12050820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Ceftazidime/avibactam (CAZ-AVI) resistance amongst Enterobacterales is worryingly increasing worldwide. Objectives: The aim of this study was to collect and describe real-life data on CAZ-AVI-resistant Klebsiella pneumoniae (KP) isolates in our University Hospital, with the ultimate goal of evaluating possible risk factors related to the acquisition of resistance. Methods: This is a retrospective observational study, including unique Klebsiella pneumoniae (KP) isolates resistant to CAZ-AVI (CAZ-AVI-R) and producing only KPC, collected from July 2019 to August 2021 at Policlinico Tor Vergata, Rome, Italy. The pathogen's list was obtained from the microbiology laboratory; clinical charts of the corresponding patients were reviewed to collect demographic and clinical data. Subjects treated as outpatients or hospitalized for <48 h were excluded. Patients were then divided into two groups: S group, if they had a prior isolate of CAZ-AVI-susceptible KP-KPC, and R group, if the first documented isolate of KP-KPC was resistant to CAZ-AVI. Results: Forty-six unique isolates corresponding to 46 patients were included in the study. The majority of patients (60.9%) were hospitalized in an intensive care unit, 32.6% in internal medicine wards and 6.5% in surgical wards. A total of 15 (32.6%) isolates were collected from rectal swabs, representing a colonization. Amongst clinically relevant infections, pneumonia and urinary tract infections were the most commonly found (5/46, 10.9% each). Half of the patients received CAZ-AVI prior to isolation of the KP-KPC CAZ-AVI-R (23/46). This percentage was significantly higher in patients in the S group compared to patients in the R group (69.3% S group vs. 25% R group, p = 0.003). No differences between the two groups were documented in the use of renal replacement therapy or in the infection site. The clinically relevant CAZ-AVI-R KP infections (22/46, 47.8%) were all treated with a combination therapy, 65% including colistin and 55% including CAZ-AVI, with an overall clinical success of 38.1%. Conclusions: Prior use of CAZ-AVI was associated with the emergence of drug resistance.
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Affiliation(s)
- Laura Campogiani
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Pietro Vitale
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Alessandra Lodi
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Alessandra Imeneo
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Carla Fontana
- Microbiology and BioBank, INMI Lazzaro Spallanzani, 00133 Rome, Italy
| | - Cartesio D'Agostini
- Laboratory of Clinical Microbiology, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Mirko Compagno
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Luigi Coppola
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Ilaria Spalliera
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Vincenzo Malagnino
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Elisabetta Teti
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Marco Iannetta
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Massimo Andreoni
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Loredana Sarmati
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy
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16
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Boattini M, Bianco G, Charrier L, Comini S, Iannaccone M, Almeida A, Cavallo R, De Rosa FG, Costa C. Rapid diagnostics and ceftazidime/avibactam for KPC-producing Klebsiella pneumoniae bloodstream infections: impact on mortality and role of combination therapy. Eur J Clin Microbiol Infect Dis 2023; 42:431-439. [PMID: 36806056 DOI: 10.1007/s10096-023-04577-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
This study was aimed at investigating risk factors for mortality in patients suffering from KPC-producing Klebsiella pneumoniae (KPC-Kp) bloodstream infections (BSIs), evaluating the impact of rapid diagnostics and ceftazidime/avibactam use. This observational retrospective study (January 2017-May 2021) included all patients with a KPC-Kp BSI. Uni-multivariable analyses were carried out to evaluate the effect of clinical variables on both in-hospital death (IHD) and 30-day all-cause mortality, and the role of the combination of ceftazidime/avibactam plus polymyxin. One hundred and ninety-six patients met the study's inclusion criteria. Older age, having undergone renal replacement therapy during the 30 days preceding the KPC-Kp BSI onset, having an INCREMENT-CPE score ≥ 8, and having suffered from a superimposed and/or following KPC-Kp BSI treatment candidemia were found to be the main factors associated with both mortality rates. Among protective factors, the centrality of ceftazidime/avibactam in monotherapy (IHD: OR: 0.34; CI 95%: 0.11-1.00-30-day all-cause mortality: OR: 0.18; CI 95%: 0.04-0.77) or combination (IHD: OR: 0.51; CI 95%: 0.22-1.19-30-day all-cause mortality: OR: 0.62; CI 95%: 0.21-1.84) emerged and became even more evident once the effect of ceftazidime/avibactam plus polymyxin was removed. Rapid diagnostics may be useful to adopt more effective strategies for the treatment of KPC-Kp BSI patients and implement infection control measures, even if not associated with higher patient survival. Ceftazidime/avibactam, even when used alone, represents an important option against KPC-Kp, while combined use with polymyxin might not have altered its efficacy. Patient comorbidities, severity of BSI, and complications such as candidemia were confirmed to have a significant burden on survival.
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Affiliation(s)
- Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy. .,Department of Public Health and Paediatrics, University of Torino, Turin, Italy.
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Sara Comini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - André Almeida
- Department of Internal Medicine 4, Hospital de Santa Marta, Central Lisbon Hospital Centre, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126, Turin, Italy.,Unit of Infectious Diseases, Cardinal Massaia, 14100, Asti, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy.,Department of Public Health and Paediatrics, University of Torino, Turin, Italy
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17
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Retamar-Gentil P, Cantón R, de Medrano VAL, Barberán J, Blasco AC, Gutiérrez CD, García-Vidal C, Escartín NL, Lora-Tamayo J, Marcos FJM, Ruíz CM, Liaño JP, Rascado P, Peláez ÓS, Girao GY, Horcajada JP. Antimicrobial resistance in Gram-negative bacilli in Spain: an experts' view. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:65-81. [PMID: 36510684 PMCID: PMC9910669 DOI: 10.37201/req/119.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antibiotic resistance in Gram-negative bacilli poses a serious problem for public health. In hospitals, in addition to high mortality rates, the emergence and spread of resistance to practically all antibiotics restricts therapeutic options against serious and frequent infections. OBJECTIVE The aim of this work is to present the views of a group of experts on the following aspects regarding resistance to antimicrobial agents in Gram-negative bacilli: 1) the current epidemiology in Spain, 2) how it is related to local clinical practice and 3) new therapies in this area, based on currently available evidence. METHODS After reviewing the most noteworthy evidence, the most relevant data on these three aspects were presented at a national meeting to 99 experts in infectious diseases, clinical microbiology, internal medicine, intensive care medicine, anaesthesiology and hospital pharmacy. RESULTS AND CONCLUSIONS Subsequent local debates among these experts led to conclusions in this matter, including the opinion that the approval of new antibiotics makes it necessary to train the specialists involved in order to optimise how they use them and improve health outcomes; microbiology laboratories in hospitals must be available throughout a continuous timetable; all antibiotics must be available when needed and it is necessary to learn to use them correctly; and the Antimicrobial Stewardship Programs (ASP) play a key role in quickly allocating the new antibiotics within the guidelines and ensure appropriate use of them.
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Affiliation(s)
- Pilar Retamar-Gentil
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla. Departamento de Medicina, Universidad de Sevilla/ IBiS /CSIC. Sevilla. Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III. Madrid. Spain
| | - Rafael Cantón
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III. Madrid. Spain.,Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid. Spain.,Correspondence: Rafael Cantón. Servicio de Microbiología. Hospital Universitario Ramón y Cajal-IRYCIS. Madrid. Phone: (+34) 91336883030; (+34) 913368832. E-mail:
| | | | - José Barberán
- Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital Universitario HM Montepríncipe. Universidad San Pablo CEU. Madrid. Spain
| | - Andrés Canut Blasco
- Servicio de Microbiología, Hospital Universitario de Álava. Vitoria-Gasteiz. Spain
| | - Carlos Dueñas Gutiérrez
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario. Valladolid. Spain
| | - Carolina García-Vidal
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario de Barcelona. Barcelona. Spain
| | - Nieves Larrosa Escartín
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III. Madrid. Spain.,Servicio de Microbiología, Hospital Universitario Vall d’Hebron de Barcelona and Vall d’Hebron Institut de Recerca (VHIR). Barcelona. Spain
| | - Jaime Lora-Tamayo
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III. Madrid. Spain.,Servicio de Medicina Interna. Hospital Universitario 12 de Octubre. Instituto de Investigación Biomédica “imas12” Hospital 12 de Octubre. Madrid. Spain
| | | | - Carlos Martín Ruíz
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Cáceres. Cáceres. Spain
| | - Juan Pasquau Liaño
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves. Granada. Spain
| | - Pedro Rascado
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Santiago Compostela. Santiago de Compostela. Spain
| | - Óscar Sanz Peláez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Dr. Negrín. Las Palmas de Gran Canaria. Spain
| | - Genoveva Yagüe Girao
- Servicio de Microbiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigaciones Biomédicas (IMIB). Universidad de Murcia. Murcia. Spain
| | - Juan P. Horcajada
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III. Madrid. Spain.,Servicio de Enfermedades Infecciosas. Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM). Universitat Pompeu Fabra (UPF). Barcelona. Spain
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18
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Vidal-Cortés P, Martin-Loeches I, Rodríguez A, Bou G, Cantón R, Diaz E, De la Fuente C, Torre-Cisneros J, Nuvials FX, Salavert M, Aguilar G, Nieto M, Ramírez P, Borges M, Soriano C, Ferrer R, Maseda E, Zaragoza R. Current Positioning against Severe Infections Due to Klebsiella pneumoniae in Hospitalized Adults. Antibiotics (Basel) 2022; 11:antibiotics11091160. [PMID: 36139940 PMCID: PMC9495006 DOI: 10.3390/antibiotics11091160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Infections due to Klebsiella pneumoniae have been increasing in intensive care units (ICUs) in the last decade. Such infections pose a serious problem, especially when antimicrobial resistance is present. We created a task force of experts, including specialists in intensive care medicine, anaesthesia, microbiology and infectious diseases, selected on the basis of their varied experience in the field of nosocomial infections, who conducted a comprehensive review of the recently published literature on the management of carbapenemase-producing Enterobacterales (CPE) infections in the intensive care setting from 2012 to 2022 to summarize the best available treatment. The group established priorities regarding management, based on both the risk of developing infections caused by K. pneumoniae and the risk of poor outcome. Moreover, we reviewed and updated the most important clinical entities and the new antibiotic treatments recently developed. After analysis of the priorities outlined, this group of experts established a series of recommendations and designed a management algorithm.
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Affiliation(s)
| | - Ignacio Martin-Loeches
- ICU, Trinity Centre for Health Science HRB-Welcome Trust, St. James’s Hospital Dublin, D08 NHY1 Dublin, Ireland
| | - Alejandro Rodríguez
- ICU, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
- Institut d’Investigació Sanitària Pere Virgil, 43007 Tarragona, Spain
- Departament Medicina I Ciruurgia, Universitat Rovira i Virgili, 43003 Tarragona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Germán Bou
- Microbiology Department, Complejo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Rafael Cantón
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Microbiology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Emili Diaz
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Critical Care Department, Corporació Sanitària Parc Taulí, 08208 Sabadell, Spain
- Department of Medicine, Universitat Autonoma de Barcelona (UAB), 08193 Barcelona, Spain
| | | | - Julián Torre-Cisneros
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Service, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain
| | | | - Miguel Salavert
- Infectious Diseases Department, Hospital Universitari I Politecnic La Fe, 46026 Valencia, Spain
| | - Gerardo Aguilar
- SICU, Department of Anesthesiology and Critical Care, Hospital Clínico Universitario Valencia, 46014 Valencia, Spain
- School of Medicine, Universitat de Valencia, 46010 Valencia, Spain
| | - Mercedes Nieto
- ICU, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Paula Ramírez
- ICU, Hospital Universitari I Politecnic La Fe, 46026 Valencia, Spain
| | - Marcio Borges
- ICU, Hospital Universitario Son Llázter, 07198 Palma de Mallorca, Spain
- Fundación Micellium, 46183 Valencia, Spain
| | - Cruz Soriano
- ICU, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | | | - Emilio Maseda
- Fundación Micellium, 46183 Valencia, Spain
- SICU, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Rafael Zaragoza
- Fundación Micellium, 46183 Valencia, Spain
- ICU, Hospital Universitario Dr. Peset, 46017 Valencia, Spain
- Correspondence:
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19
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Gaibani P, Bianco G, Amadesi S, Boattini M, Ambretti S, Costa C. Increased blaKPC Copy Number and OmpK35 and OmpK36 Porins Disruption Mediated Resistance to Imipenem/Relebactam and Meropenem/Vaborbactam in a KPC-Producing Klebsiella pneumoniae Clinical Isolate. Antimicrob Agents Chemother 2022; 66:e0019122. [PMID: 35416711 PMCID: PMC9112950 DOI: 10.1128/aac.00191-22] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/23/2022] [Indexed: 12/31/2022] Open
Abstract
Herein, we report the in vivo evolution of imipenem/relebactam-resistance in KPC-producing K. pneumoniae (KPC-Kp) isolated from a critically-ill patient treated with multiple combination therapies based on ceftazidime-avibactam or meropenem-vaborbactam. Imipenem/relebactam-resistance was associated to meropenem-vaborbactam cross-resistance and was due to truncated OmpK35 and OmpK36 porins and increased copy of blaKPC copy number. Genome analysis demonstrated that imipenem/relebactam-resistant KPC-Kp harbored a second copy of blaKPC-carrying Tn4401 in a ColRNAI plasmid as a consequence of a transposition event.
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Affiliation(s)
- Paolo Gaibani
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriele Bianco
- Division of Microbiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano Amadesi
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Boattini
- Division of Microbiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Simone Ambretti
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Costa
- Division of Microbiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- University of Torino, Torino, Italy
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20
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Risk factors for and clinical outcomes of ceftazidime-avibactam-resistant carbapenem-resistant Klebsiella pneumoniae nosocomial infections: a single-center retrospective study. Infection 2022; 50:1147-1154. [PMID: 35182356 DOI: 10.1007/s15010-022-01781-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/09/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The emergence of ceftazidime-avibactam (CZA) resistance in carbapenem-resistant Klebsiella pneumoniae (CRKP) has been increasingly reported in recent years. We aimed to identify the risk factors of CZA-resistant CRKP infection and assess clinical outcomes of the patients. METHODS The study retrospectively analyzed the clinical and microbiological data of patients with CRKP infection to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis. RESULTS A total of 103 patients with CRKP infection were enrolled in this study. Multivariate analysis showed previous renal replacement therapy (OR 3.966, 95% CI 1.301-12.090, P = 0.015) was an independent risk factor for CZA-resistant CRKP infection. The 28-day mortality was higher in patients infected with CZA-resistant CRKP (27.9%) than those with CZA-susceptible CRKP (7.1%) (P = 0.009). CZA-resistant CRKP infection (OR 20.308, 95% CI 1.461-282.293, P = 0.025), and mechanical ventilation (OR 14.950, 95% CI 1.034-216.212, P = 0.047) were independent predictors for 28-day mortality in patients with CRKP infection. Lower level of platelet count (OR 0.987, 95% CI 0.975-0.999, P = 0.032) on the day of CRKP infection onset was related to 28-day mortality. Kaplan-Meier curves showed that the CZA-resistant CRKP group had a shorter survival time than the CZA-susceptible CRKP group. CONCLUSION The prevalence and mortality of CZA-resistant CRKP are still increasing. Strengthening the hospital infection control of renal replacement therapy and mechanical ventilation may help to prevent CZA-resistant CRKP.
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