Eurosurveillance - Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy

[Gert van der Hoek]

Colistin increasingly is being used intravenously for otherwise multiresistant (nosocomial) infections. Colistin is one of the drugs of "last resort". Now we see the evolution of colistin resistance.

Eurosurveillance, Volume 19, Issue 42, 23 October 2014

Rapid communications

COLISTIN RESISTANCE SUPERIMPOSED TO ENDEMIC CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE: A RAPIDLY EVOLVING PROBLEM IN ITALY, NOVEMBER 2013 TO APRIL 2014

M. Monaco1,2, T Giani2,3, M Raffone1,4, F Arena3, A Garcia-Fernandez1, S Pollini3, Network EuSCAPE-Italy5, H Grundmann6, A Pantosti ()1, G M Rossolini3,7,8
Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
MM and TG have equally contributed to this work
Department of Medical Biotechnologies, University of Siena, Siena, Italy
Federico II University Hospital, Neaples, Italy

The network EuSCAPE-Italy participants are listed at the end of this article
Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
Citation style for this article: Monaco M, Giani T, Raffone M, Arena F, Garcia-Fernandez A, Pollini S, Network EuSCAPE-Italy, Grundmann H, Pantosti A, Rossolini GM.

Date of submission: 08 October 2014

Consecutive non-replicate clinical isolates (n=191) of carbapenem non-susceptible Enterobacteriaceae were collected from 21 hospital laboratories across Italy from November 2013 to April 2014 as part of the European Survey on Carbapenemase-producing Enterobacteriaceae (EuSCAPE) project. Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) represented 178 (93%) isolates with 76 (43%) respectively resistant to colistin, a key drug for treating carbapenamase-producing Enterobacteriaceae. KPC-KP colistin-resistant isolates were detected in all participating laboratories. This underscores a concerning evolution of colistin resistance in a setting of high KPC-KP endemicity.

Although most recent data from April 2014 to date are not available at this time, the results of this survey confirmed the widespread endemicity of KPC-KP in Italian healthcare facilities, and their predominant role among CPE. Infections with KPC-KP affect mostly older patients hospitalised in medical or surgical wards with a known history of previous hospital admission in the country. The results of this present study also reveal a concerning percentage of resistance to colistin, which is a matter of major concern given the dearth of treatment options against CPE.

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