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Evolving beta-lactamase epidemiology in Enterobacteriaceae from Italian nationwide surveillance, October 2013: KPC-carbapenemase spreading among outpatients
- Tommaso Giani1,2 , Alberto Antonelli2,3 , Mariasofia Caltagirone4 , Carola Mauri5 , Jessica Nicchi3 , Fabio Arena1 , Elisabetta Nucleo4 , Silvia Bracco5 , Annalisa Pantosti6 , The AMCLI-CoSA survey participants7 , Francesco Luzzaro5 , Laura Pagani4 , Gian Maria Rossolini1,3,8
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View Affiliations Hide AffiliationsAffiliations: 1 Department of Medical Biotechnologies, University of Siena, Siena, Italy 2 These authors contributed equally to this work 3 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy 4 Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, Section of Microbiology, University of Pavia, Pavia, Italy 5 Microbiology and Virology Unit, Department of Laboratory Medicine, A. Manzoni Hospital, Lecco, Italy 6 Department of Infectious, Parasitic and Immune-Mediated Diseases, Italian National Health Institute, Rome, Italy 7 The AMCLI-CoSA survey participants are listed at the end of the article 8 Clinical Microbiology, Virology and Serology Unit, Florence Careggi University Hospital, Florence, ItalyGian Maria Rossolinigianmaria.rossolini unifi.it
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Citation style for this article: Giani Tommaso, Antonelli Alberto, Caltagirone Mariasofia, Mauri Carola, Nicchi Jessica, Arena Fabio, Nucleo Elisabetta, Bracco Silvia, Pantosti Annalisa, The AMCLI-CoSA survey participants, Luzzaro Francesco, Pagani Laura, Rossolini Gian Maria. Evolving beta-lactamase epidemiology in Enterobacteriaceae from Italian nationwide surveillance, October 2013: KPC-carbapenemase spreading among outpatients. Euro Surveill. 2017;22(31):pii=30583. https://doi.org/10.2807/1560-7917.ES.2017.22.31.30583 Received: 28 Jun 2016; Accepted: 20 Dec 2016
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Abstract
Extended-spectrum beta-lactamases (ESBLs), AmpC-type beta-lactamases (ACBLs) and carbapenemases are among the most important resistance mechanisms in Enterobacteriaceae. This study investigated the presence of these resistance mechanisms in consecutive non-replicate isolates of Escherichia coli (n = 2,352), Klebsiella pneumoniae (n = 697), and Proteus mirabilis (n = 275) from an Italian nationwide cross-sectional survey carried out in October 2013. Overall, 15.3% of isolates were non-susceptible to extended-spectrum cephalosporins but susceptible to carbapenems (ESCR-carbaS), while 4.3% were also non-susceptible to carbapenems (ESCR-carbaR). ESCR-carbaS isolates were contributed by all three species, with higher proportions among isolates from inpatients (20.3%) but remarkable proportions also among those from outpatients (11.1%). Most ESCR-carbaS isolates were ESBL-positive (90.5%), and most of them were contributed by E. coli carrying blaCTX-M group 1 genes. Acquired ACBLs were less common and mostly detected in P. mirabilis. ESCR-carbaR isolates were mostly contributed by K. pneumoniae (25.1% and 7.7% among K. pneumoniae isolates from inpatients and outpatients, respectively), with blaKPC as the most common carbapenemase gene. Results showed an increasing trend for both ESBL and carbapenemase producers in comparison with previous Italian surveys, also among outpatients.
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