RESUMO
BACKGROUND: During the last decade, the spread of Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) has increased dramatically worldwide. In this scenario, growing interest has been addressed to genotyping of KPC-Kp strains, which emerged as an important tool for a better understanding of the epidemiological and clinical characteristics of the outbreaks. METHODS: We performed a retrospective cohort study on patients infected with KPC-Kp during a 28-month outbreak period (January 2010-April 2012) at San Gerardo Hospital (Monza, Italy), investigating KPC-Kp genotypes by means of repetitive element sequence-based polymerase chain reaction (Rep-PCR). RESULTS: We enrolled 97 patients infected with KPC-Kp. Rep-PCR analysis identified 5 distinct clone types, with different distribution over time. During the first 12 months of the outbreak period, only 1 clone was detected (clone A, in 47 patients), while the 4 other clones were identified over the remaining 16 months (clones C, E, and F/L in 23, 24, and 3 patients respectively). Mechanical ventilation was less frequent in patients infected with clones C/E/F/L (OR = 0.14; 95% CI: 0.05-0.37) compared to clone A, and the Charlson comorbidity index (CI) was more likely to have a score >5 in patients infected with clones C/E/F/L (OR = 7.21; 95% CI: 2.24-23.14) compared to clone A.Overall mortality was higher in patients infected with clones C/E/F/L (13/20 patients, 65%) compared to those infected with clone A (7/20, 35%). Mortality in patients infected with clones C/E/F/L remained significantly higher even after adjusting for the potential confounding effect of comorbidities (ie, CI), with a hazard ratio (HR) of 4.65 (95% CI: 1.83-11.89). CONCLUSIONS: Our results suggested a close relationship between strain genotype and clinical outcome.
RESUMO
Acinetobacter baumannii is a Gram-negative organism reported worldwide as a cause of health-care-associated infections, particularly in intensive care units (ICUs). The aim of this study is to describe the emergence and spread of carbapenem-resistant A. baumannii (CRAB) isolates in hospitalized patients. From March to November 2009, multidrug-resistant CRAB isolates were obtained from 21 patients hospitalized in different wards (mostly ICUs). Antimicrobial susceptibility was determined by using the Etest method. Carbapenem and aminoglycoside resistance determinants were studied by PCR and sequencing. Genetic relatedness was investigated by pulsed-field gel electrophoresis and multiplex PCR identification of sequence groups. Clinical records of patients were examined retrospectively. CRAB isolates were consistently resistant to multiple drugs including fluoroquinolones and aminoglycosides, whereas they retained a susceptibility to colistin. Molecular analysis revealed that 19 of the 21 CRAB isolates belonged to a single clone producing both the carbapenemase OXA-23 and the 16S rRNA methylase ArmA. Based on clinical data, the patients included in the study were classified as infected (n=13) or colonized (n=8). Colistin alone or in combination with ampicillin-sulbactam was administered to 11 of the 13 infected patients. A complete or partial response was obtained in eight cases, whereas a failure to respond was observed in one patient and a relapse was observed in two patients. An A. baumannii clone producing both OXA-23 and ArmA has been identified as an emerging and rapidly spreading pathogen. To our knowledge, this is the first report of the ArmA enzyme in A. baumannii in Italy and is the first report of hospital dissemination of A. baumannii carrying both bla(OXA-23) and armA genes.