Emergence of carbapenem-resistant Klebsiella Pneumoniae strains producing KPC-3 in Brescia Hospital, Italy

Abstract

Carbapenem-resistant K. pneumoniae has recently been reported as a new multidrug-resistant nosocomial pathogen. This study reports the emergence of carbapenem-resistant K. pneumoniae strains in Brescia Civic Hospital, Italy. Different samples, collected from April 2012 to February 2013, showed that 29 patients presented infections from multidrug-resistant K. pneumoniae and three of these patients were intestinal carriers. In total, 40 carbapenem-resistant K. pneumoniae strains were isolated from multiple specimens of these patients. In 39 out of 40 samples, we identified the bla(KPC-3) carbapenemase gene variant responsible for bacterial carbapenem resistance. The DiversiLab analysis showed four different genetic patterns within multidrug-resistant K. pneumoniae isolates, with pattern 1 and 2 including 95% of the bacterial strains. Carbapenem-resistant K. pneumoniae strains belonging to patterns 1 and 2 were also detected in the intestinal tract of the three asymptomatic carriers. Moreover, isolation of the same strains in other body sites of the same patients and in bronchial fluid of a non-colonized patient in the same ward indicates an initial dissemination of this pathogen. Our results highlight the emergence of carbapenemase-producing K. pneumoniae strains in different hospital wards and the urgent need for infection control, antibiotic stewardship programmes and utilization of a surveillance and prevention system.