Eurosurveillance - Volume 17, Issue 33, 16 August 2012

Carbapenem-resistant Klebsiella pneumoniae has recently been reported as a new, multidrug-resistant nosocomial pathogen in several hospitals from various Italian regions. Through Micronet, a new Italian sentinel laboratory-based surveillance network, we studied the trend of non-susceptibility of K. pneumoniae to selected carbapenems (imipenem and/or meropenem) in 14 of the 15 hospitals participating in the network. Analysis of data from 1 January 2009 to 30 April 2012 revealed a statistically significant increasing trend (p<0.01) in the proportion of carbapenem non-susceptible K. pneumoniae isolates from clinical specimens (from 2.2 % in 2009 to 19.4% in 2012). The increase in the proportion of non-susceptibility was very large for isolates from the respiratory tract (from 5.3% in 2009 to 38.5% in 2012) and blood (from 5.4% in 2009 to 29.2% in 2012). The results demonstrate the urgent need in Italy for infection control, guidelines, antibiotic stewardship programmes and utilisation of surveillance systems, such as Micronet, which are capable of receiving data from hospitals in real time for many pathogens and types of clinical specimens.

We describe polyclonal spread of colistin-resistant Klebsiella pneumoniae in an acute general hospital in Italy. Between June and December 2011, 58 colistin-resistant K. pneumoniae isolates were recovered from 28 patients admitted to different wards, but mainly in the intensive care units. All isolates were tested for drug susceptibility and the presence of beta-lactamase (bla) genes. Clonality was investigated by repetitive extragenic palindromic (rep)-PCR and multilocus sequence typing (MLST). Fifty-two isolates had minimum inhibitory concentrations (MICs) for colistin of 6-128 mg/L, carried bla_KPC3 and were attributed to sequence type ST258. The remaining six isolates were susceptible to carbapenems, exhibited MICs for colistin of 3-32 mg/L, and belonged to two different types, ST15 and ST273. Rep-PCR included all isolates in three clusters, one containing all ST258 KPC-3-producing isolates and two containing ST15 and ST273 isolates. Cross-transmission containment measures and intensification of staff and environmental hygiene could not stop the outbreak. Selective pressure and horizontal transmission probably contributed to emergence and spread of three different strains of colistin-resistant K. pneumoniae in the hospital. Strict implementation of the above measures and a wider awareness of the antimicrobial resistance threat are crucial to preserve the last therapeutic options of the multidrug-resistant Gram-negative infections. .

The impact of influenza on work absenteeism is poorly documented. We used data from the national registry and Norway Post AS (>14,000 employees) to explore sickness absence patterns from 2005/06 through 2009/10 in Norway. Annually, an estimated 2.868% (mean 95% confidence interval (CI): 2.405-4.820%) of the working population obtained sick leave for influenza, of whom 0.915% (mean 95% CI: 0.453-1.590%) had diagnoses for other respiratory illnesses with influenza as underlying cause. In the 2009/10 pandemic season, the absence rate increased 1.5-fold, mainly due to a 73% increase in influenza-diagnosed sick leaves. At Norway Post AS, absence related to seasonal influenza accounted for 0.351% (mean 95% CI: 0.126-0.704%) of total person-days annually (excluding parental care absence), of which 32-43% were estimated to be self-certified. Medically certified sick leave increased 1.3-fold in the pandemic season to 0.458% (95% CI: 0.176-0.856), while self-certified sick leave remained at a level typical for seasonal influenza. We found a significant four-fold increase in work loss to care for sick children, 0.048% (95% CI: 0.031-0.070%) of person-days, compared with 0.012% (95% CI: 0.004-0.028%) in 2008/09. In conclusion, GP-certified and parental care work absence were higher in the pandemic season. More studies are needed to quantify the burden of self-certified sick leave. .