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Ridolfo AL, Rimoldi SG, Pagani C, Marino AF, Piol A, Rimoldi M, Olivieri P, Galli M, Dolcetti L, Gismondo MR. Diffusion and transmission of carbapenem-resistant Klebsiella pneumoniae in the medical and surgical wards of a university hospital in Milan, Italy. J Infect Public Health 2015; 9:24-33. [PMID: 26116453 DOI: 10.1016/j.jiph.2015.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/04/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is emerging as a public health problem worldwide. In Italy, a remarkable increase in CRKP cases has been reported since 2010. In this study, CRKP diffusion, distribution and in-hospital transmission trends were evaluated in a university hospital in Milan, Italy, from January 2012 to December 2013. Isolates from 63 newly detected CRKP-positive patients were genotyped, and possible transmission was determined by combining the molecular results with data concerning the patients' admission and in-hospital transfers. Most of the cases (90.4%) were from general medical and surgery wards, and the remaining 9.6% were from the intensive care unit. Fifteen of the 46 hospital-associated cases (32.6%) were attributable to in-hospital transmission. After the introduction of targeted and hospital-wide control measures, the transmission index significantly decreased from 0.65 to 0.13 (p=0.01). There was also a decrease in the overall nosocomial case incidence, from 0.37 to 0.17 per 1000 person-days (p=0.07). Our findings indicate that the spread of CRKP in Northern Italy hospitals may go far beyond high-risk settings (i.e., intensive care units) and that strict surveillance should be extended to general areas of care.
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Affiliation(s)
- Anna L Ridolfo
- Direzione Medica di Presidio, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Via G.B. Grassi 74, 20156 Milano, Italy; Sezione di Malattie Infettive e Immunopatologia, Dipartimento di Scienze Cliniche, Ospedale Luigi Sacco, Università degli Studi di Milano, Via G.B. Grassi 74, 20156 Milano, Italy.
| | - Sara G Rimoldi
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica Bioemergenze, Ospedale Luigi Sacco, Università degli Studi di Milano, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Cristina Pagani
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica Bioemergenze, Ospedale Luigi Sacco, Università degli Studi di Milano, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Andrea F Marino
- Direzione Medica di Presidio, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Anna Piol
- Direzione Medica di Presidio, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Matteo Rimoldi
- Direzione Medica di Presidio, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Pietro Olivieri
- Direzione Medica di Presidio, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Massimo Galli
- Sezione di Malattie Infettive e Immunopatologia, Dipartimento di Scienze Cliniche, Ospedale Luigi Sacco, Università degli Studi di Milano, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Lucia Dolcetti
- Direzione Medica di Presidio, Azienda Ospedaliera-Polo Universitario Luigi Sacco, Via G.B. Grassi 74, 20156 Milano, Italy
| | - Maria R Gismondo
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica Bioemergenze, Ospedale Luigi Sacco, Università degli Studi di Milano, Via G.B. Grassi 74, 20156 Milano, Italy
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