Journal of global antimicrobial resistance最新文献

{"title":"Clinical and molecular characteristics of KPC-producing Klebsiella pneumoniae bloodstream infections: Results of a multicentre study","authors":"Lucia Brescini ,&nbsp;Gloria D'Achille ,&nbsp;Chiara Papalini ,&nbsp;Francesco Pallotta ,&nbsp;Lucia Teodori ,&nbsp;Donatella Pietrella ,&nbsp;Antonella Mencacci ,&nbsp;Benedetta Canovari ,&nbsp;Barbara Pieretti ,&nbsp;Marina Mingoia ,&nbsp;Roberto Montalti ,&nbsp;Gianluca Morroni ,&nbsp;Maria Bruna Pasticci ,&nbsp;Francesco Barchiesi","doi":"10.1016/j.jgar.2025.01.009","DOIUrl":"10.1016/j.jgar.2025.01.009","url":null,"abstract":"<div><h3>Objective</h3><div><em>Klebsiella pneumoniae</em> carbapenemase-producing <em>K. pneumoniae</em> (KPC-Kp) is a great cause of concern and often associated with bloodstream infections (BSIs) and a high mortality rate. Here we identified the risk factors of KPC-Kp BSIs observed in three Italian hospitals and studied the epidemiology of KPC-Kp strains.</div></div><div><h3>Methods</h3><div>A retrospective analysis of KPC-Kp BSIs was performed from 2014 to 2019 at three hospitals in central Italy (Ancona, Pesaro-Fano, and Perugia). Uni- and multi-variable analyses were performed to evaluate the clinical variables associated with mortality. Pulsed-field gel electrophoresis assay and whole-genome sequencing analysis of KPC-Kp isolates was carried out to identify antibiotic resistance genes and epidemiological relationships among the strains.</div></div><div><h3>Results</h3><div>A total of 219 patients were considered. Mortality on day 30 was 32%, with older age, APACHE II score ≥11, Charlson Comorbidity Index ≥4, and solid tumours more frequent in patients with a negative outcome. Positive outcomes were related to combination therapy with at least two active drugs that also emerged in multivariate analysis. Most KPC-Kp strains belonged to three major sequence types (ST512, ST307, and ST101), while the most common carbapenem resistance gene variant was <em>bla</em>_KPC-3.</div></div><div><h3>Conclusions</h3><div>KPC-Kp BSIs remain a challenging infection with a high crude mortality rate. Patient conditions and comorbidities correlate with negative outcomes, while active drugs are correlated with better outcomes. Although collected from different hospitals, the KPC-Kp strains were epidemiologically related, suggesting inter-hospital diffusion. Timely and effective therapy, together with epidemiological surveillance, are crucial to reduce mortality and prevent the spread of nosocomial clones.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 216-223"},"PeriodicalIF":3.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial susceptibility of gram-negative bacteria: analysis from patients in a laboratory network in Brazil.","authors":"Amanda Azevedo Bittencourt, Thales José Polis, Vinicius Lima Faustino, Paula de Mendonça Batista, Ana Carolina Padula Ribeiro Pereira, Marina Della Negra de Paula, Darlan Augusto da Costa Rocha, Paola Cappellano Daher, Jorge Luiz Mello Sampaio","doi":"10.1016/j.jgar.2025.01.019","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.01.019","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to describe the epidemiology and antimicrobial susceptibility patterns of gram-negative pathogens in Brazil from 2018 to 2020, addressing the gap in national data on healthcare-associated infections, using information from a private laboratory network.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using a database from Fleury hospital network, a private laboratory in Brazil. The analysis included blood, urine, and lower respiratory tract samples collected from January 2018 to June 2020. The study included consecutive non-duplicated isolates of Enterobacterales or P. aeruginosa from inpatients aged ≥18 years old. Bacterial identification was performed using mass spectrometry, and antimicrobial susceptibility was determined following EUCAST/BrCAST guidelines.</p><p><strong>Results: </strong>A total of 25,180 isolates were included in the analysis. Most of the sample consisted of female patients (57.9%), with a mean age of 70 years (SD 18.1). Enterobacterales were the most prevalent pathogens found (76.2%), while P. aeruginosa was present in the remaining 23.8%. In terms of antimicrobial susceptibility, Enterobacterales exhibited a higher susceptibility rate to ceftazidime/avibactam (97.1%) and amikacin (95.6%), while P. aeruginosa showed a higher susceptibility rate to polymyxin B (97.1%) and ceftolozane/tazobactam (86.6%). Among carbapenem-resistant P. aeruginosa isolates, 75% were susceptible to ceftolozane/tazobactam. Additionally, 24.2% of K. pneumoniae complex samples were identified.</p><p><strong>Conclusion: </strong>Enterobacterales was the most frequently encountered group in Brazil. Ceftazidime/avibactam and amikacin demonstrated the highest efficacy against this group, while ceftolozane/tazobactam and polymyxin had the highest efficacy against P. aeruginosa. This highlights the importance of new β-lactam-β-lactamase inhibitor combinations for the treatment of gram-negative infections.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal septicemia caused by Francisella philomiragia in an immunocompetent patient.","authors":"Junghyeon Yun, Kyung-Wook Hong, Jung-Hyun Byun","doi":"10.1016/j.jgar.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.01.005","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of blaIMP-4 dissemination across diverse carbapenem-resistant clinical isolates","authors":"Ying Fu ,&nbsp;Faye C. Morris ,&nbsp;Stephanie C. Pereira ,&nbsp;Xenia Kostoulias ,&nbsp;Yan Jiang ,&nbsp;Callum Vidor ,&nbsp;Galain Williams ,&nbsp;Yogi Srikhanta ,&nbsp;Nenad Macesic ,&nbsp;Yunsong Yu ,&nbsp;Dena Lyras ,&nbsp;Anton Y. Peleg","doi":"10.1016/j.jgar.2025.01.003","DOIUrl":"10.1016/j.jgar.2025.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>The IMP-4 carbapenemase is an endemic cause of carbapenem resistance in the Asia-Pacific region. Our aim was to determine the dissemination mechanism of the <em>bla</em>_IMP-4 gene.</div></div><div><h3>Methods</h3><div>Twelve representative Australian IMP-4 clinical isolates from The Alfred Hospital (Victoria, Australia) were characterised using antimicrobial susceptibility testing, with their genome and plasmid assemblies analysed. The conjugation efficiencies of different plasmids were investigated using filter mating with four recipient strains across two species.</div></div><div><h3>Results</h3><div>Selected IMP-4 isolates included six species and four genera (<em>Enterobacter, Klebsiella, Serratia</em>, and <em>Acinetobacter</em>), whereby isolates of the same species belonged to the same sequence type and were closely related. Four IMP-4 plasmid types were noted: IncHI2A types 1 and 2 (<em>Klebsiella</em> spp. and <em>Enterobacter hormaechei</em>, respectively), IncC (<em>Serratia marcescens</em> and <em>Klebsiella pneumoniae</em>), and a novel type in <em>Acinetobacter pittii</em>. Sequence homology was observed across all plasmids at the <em>bla</em>_IMP-4 location, termed Region I, with IS<em>26</em> on IncHI2A, and IS<em>5075</em> and Tn<em>3</em> resistance gene cassettes present on IncC plasmids. Genomic rearrangements mediated by IS<em>26</em> or Tn<em>3</em> and IS<em>5075</em> were identified in Region I of plasmids from the same Inc type. The plasmids of each Inc type were capable of conjugative transfer with varying efficiency. IncH12A plasmids and <em>K. pneumoniae</em> IncC displayed higher transfer efficiencies than other plasmids examined in this study when using the recipient <em>E. coli</em> strain J53 (with conjugation efficiencies of 1.17×10⁻² to 5.02×10⁻⁵, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Clonal spread, Inc type, homologous region, and insertion sequences are important mobility factors in the dissemination and evolution of <em>bla</em>_IMP-4 plasmids.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 189-194"},"PeriodicalIF":3.7,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic insights into a multidrug-resistant pandoraea apista clinical isolate carrying blaOXA-153 from China","authors":"Lirong Li ,&nbsp;Yawen Zhang ,&nbsp;Fang He ,&nbsp;Ningjun wu","doi":"10.1016/j.jgar.2025.01.002","DOIUrl":"10.1016/j.jgar.2025.01.002","url":null,"abstract":"<div><h3>Objectives</h3><div><em>Pandoraea apista</em> is notable for its multidrug resistance and is frequently identified in patients with cystic fibrosis or other chronic lung diseases, where it contributes to persistent lung infections. In this study, we describe a strain of <em>P. apista</em> harboring the <em>bla</em>_OXA-153, isolated from the bronchoalveolar lavage (BAL) fluid of an inpatient in China.</div></div><div><h3>Methods</h3><div>The genomic DNA of <em>P. apista</em> strain PA167 was sequenced using the Illumina NovaSeq 6000 system and assembled with SPAdes v.3.13.0. Antimicrobial resistance genes (ARGs) were identified using ResFinder v.3.2 within the ABRicate v.0.9.0. Phylogenetic analysis was performed using the Snippy v.4.6.0.</div></div><div><h3>Results</h3><div>The genome sequence of <em>P. apista</em> strain PA167 comprises 5,580,873 bp, with 4,926 protein-coding sequences, 4 ncRNAs, 59 tRNAs, and 3 rRNA operons. Only one ARG was identified: <em>bla</em>_OXA-153. PA167 exhibited resistance to multiple antibiotics, including cephalosporins and carbapenems, and was susceptible only to sulfamethoxazole/trimethoprim. Twenty-four <em>P. apista</em> strains, including PA167, could be retrieved from the NCBI database, all carrying the <em>bla</em>_OXA-153. Complete genomic sequencing of five strains confirmed the chromosomal presence of <em>bla</em>_OXA-153. The isolation sources of these 24 strains were predominantly clinical samples, mainly respiratory specimens, with some strains isolated from environmental sources.</div></div><div><h3>Conclusion</h3><div>Here, we present the genome sequence of a <em>P. apista</em> strain carrying the <em>bla</em>_OXA-153, marking the first isolation of this strain from a clinical setting in China. The potential for future epidemic spread highlights the necessity for targeted antimicrobial strategies.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 159-161"},"PeriodicalIF":3.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial susceptibility and epidemiological types of Legionella pneumophila human isolates from Italy (1987–2020)","authors":"Maria Scaturro ,&nbsp;Alessio Lanni ,&nbsp;Fabiola Mancini ,&nbsp;Antonietta Girolamo ,&nbsp;Silvia Fillo ,&nbsp;Andrea Ciammaruconi ,&nbsp;Florigio Lista ,&nbsp;Clementina Elvezia Cocuzza ,&nbsp;Rosario Musumeci ,&nbsp;Christophe Ginevra ,&nbsp;Ghislaine Descours ,&nbsp;Sophie Jarraud ,&nbsp;Jessica Iera ,&nbsp;Paolo Visca ,&nbsp;Maria Luisa Ricci","doi":"10.1016/j.jgar.2024.12.030","DOIUrl":"10.1016/j.jgar.2024.12.030","url":null,"abstract":"<div><h3>Objectives</h3><div>Although antimicrobial resistance has not yet emerged as an overarching problem for <em>Legionella pneumophila</em> (<em>L. pneumophila</em>) infection, the description of clinical and environmental strains resistant to fluoroquinolones and macrolides is a cause of concern. This study aimed to investigate the antimicrobial susceptibility of <em>L. pneumophila</em> human isolates in Italy.</div></div><div><h3>Methods</h3><div>A total of 204 <em>L. pneumophila</em> clinical isolates were tested for sensitivity to 9 antibiotics using the broth microdilution assay (BMD). All isolates were typed by sequence-based typing, and <em>Legionella pneumophila</em> serogroup 1 (Lp1) isolates by monoclonal antibody subgrouping. Minimum inhibitory concentration (MIC) data were correlated with the possible source of infection and geographical distribution. The presence of the <em>lpeAB</em> efflux pump genes was also investigated. The genome sequences of a subpopulation of isolates showing reduced susceptibility to azithromycin were also analysed.</div></div><div><h3>Results</h3><div>The <em>L. pneumophila</em> isolates did not show significant resistance to the tested antibiotics, although a trend toward reduced sensitivity to azithromycin was observed in a subpopulation of 46 strains, most of which belonged to sequence type 1 (ST1), the second most widespread ST in Italy. An amplicon of the expected size overlapping the <em>lpeAB</em> genes was obtained only in the 46-subpopulation above mentioned. In 4 of the 46 isolates, sequencing analysis showed the occurrence of amino-acid substitutions already described in other strains. No further mutation was found<em>.</em></div></div><div><h3>Conclusions</h3><div>The presence of <em>L. pneumophila</em> strains with reduced susceptibility or resistance to azithromycin should be monitored to predict future trends and suggest to physicians a combined therapy with fluoroquinolones when a poor response to azithromycin is observed. © 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 181-188"},"PeriodicalIF":3.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-resistant tuberculosis is an important challenge in long COVID patients","authors":"Masoud Mohammadi ,&nbsp;Seyed Hassan Faghihi","doi":"10.1016/j.jgar.2024.12.027","DOIUrl":"10.1016/j.jgar.2024.12.027","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Page 162"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of meropenem exposure on fluoroquinolone and carbapenem resistance in Pseudomonas aeruginosa infection in inpatients in a Japanese university hospital: Insights into oprD mutations and efflux pump overexpression","authors":"Tadanori Yamochi ,&nbsp;Kazuhisa Ugajin ,&nbsp;Rintaro On ,&nbsp;Sho Inoue ,&nbsp;Hiromi Ikeda ,&nbsp;Toshiko Yamochi ,&nbsp;Masafumi Takimoto ,&nbsp;Issei Tokimatsu","doi":"10.1016/j.jgar.2024.12.029","DOIUrl":"10.1016/j.jgar.2024.12.029","url":null,"abstract":"<div><h3>Objectives</h3><div>In <em>Pseudomonas aeruginosa</em> isolates, emerging meropenem resistance beyond imipenem resistance has become a problem. In this study, we aimed to investigate the relationship between the <em>in vivo</em> acquisition of antimicrobial resistance in fluoroquinolone- and carbapenem-resistant <em>P. aeruginosa</em> clinical isolates, the underlying molecular mechanisms, and exposure to antimicrobial agents.</div></div><div><h3>Methods</h3><div>Pulsed-field gel electrophoreses were performed to study the molecular relatedness of nine clinical isolates from a Japanese hospital. The minimal inhibitory concentrations of clinically relevant antibiotics were determined<em>.</em> Quantitative PCR was performed to analyze <em>oprD, mexB, mexC, mexE</em>, and <em>mexY</em> expression. DNA sequencing was performed to identify mutations.</div></div><div><h3>Results</h3><div>Eight of nine strains were metallo-β-lactamase (MBL) negative, and one strain was MBL positive. All eight non-MBL-resistant strains harbored mutations in the quinoline-resistance-determining regions (QRDR) of <em>gyrA, gyrB</em>, or p<em>arC</em>. Five of the eight non-MBL strains had T83I, two had D87N, and one had both T83I and D87N mutations in <em>gyrA</em>. Of these eight strains, three carrying <em>gyrA</em> mutations had another QRDR mutation in subunits, <em>gyrB</em> or <em>parC</em>, associated with <em>mexY</em> overexpression. Additionally, seven of eight dual fluoroquinolone and carbapenem-resistant isolates carried a premature termination codon within <em>oprD</em>, containing either F170L or L7 shortening.</div></div><div><h3>Conclusions</h3><div>In dual fluoroquinolone- and carbapenem-resistant <em>P. aeruginosa</em>, alterations in the OprD porin and the presence of an active EP are primary resistance mechanisms. Meropenem exposure within the past 59 days may have contributed to the selection of the <em>oprD</em> mutant overexpressing <em>mexB</em>, and meropenem exposure within the past 6 months may have contributed to meropenem resistance.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 163-168"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of various antimicrobial susceptibility testing methods for piperacillin/tazobactam in challenging Escherichia coli isolates","authors":"Faruk Demirocak,&nbsp;Diana Langerak,&nbsp;Erlangga Yusuf","doi":"10.1016/j.jgar.2024.12.028","DOIUrl":"10.1016/j.jgar.2024.12.028","url":null,"abstract":"<div><h3>Objective</h3><div>Piperacillin/tazobactam antimicrobial susceptibility testing (AST) against Enterobacterales can be challenging. The aim of this study was to assess the reproducibility of various automated (VITEK 2) and nonautomated AST methods (broth microdilution (BMD), minimum inhibitory concentration (MIC) test strip, and disk diffusion) for piperacillin/tazobactam in ‘challenging’ <em>E. coli</em> isolates.</div></div><div><h3>Methods</h3><div>We performed 20 repeated ASTs for seven clinical <em>E. coli</em> isolates: Two resistant to piperacillin/tazobactam but susceptible to amoxicillin/clavulanic acid, four isolates with various β-lactamase coding genes (two <em>bla</em>_TEM-1, one <em>bla</em>_OXA-1, and one with plasmidal <em>bla</em>_ampC), and one isolate where VITEK 2 initially could not produce MIC measurements for piperacillin/tazobactam (i.e. no results generated).</div></div><div><h3>Results</h3><div>Upon repetition, the same MIC as the mode value (i.e. the most frequent MIC value of each AST method) was found between 21% and 87% (BMD), 46% and 100% (VITEK 2), and 48% and 100% (gradient test) of the repetitions. The range of essential agreement percentage (i.e. ±1 doubling dilution from this mode value) was 53–100% (BMD), 63–100% (VITEK 2), and 100% (gradient test). Percent categorical agreement (same susceptible of resistant category using EUCAST breakpoint v. 14.0) was 71–100% (BMD), 85–92% (VITEK 2), 76–100% (gradient test) and 100% (disk diffusion).</div></div><div><h3>Conclusions</h3><div><em>:</em> In conclusion, this study provides insight on the reliability of AST results for piperacillin/tazobactam in challenging <em>E. coli</em> isolates. While the results indicate that most methods are generally reproducible, certain isolates may present inconsistent MIC results.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 211-215"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital","authors":"Maria Grazia Silvotti ,&nbsp;Erika Scaltriti ,&nbsp;Luca Bolzoni ,&nbsp;Beatrice Zerbi ,&nbsp;Gabriella Tocci ,&nbsp;Andrea Zappavigna ,&nbsp;Gianfranco Lamberti ,&nbsp;Federico Donati ,&nbsp;Franco Federici ,&nbsp;Stefano Pongolini ,&nbsp;Giuliana Lo Cascio","doi":"10.1016/j.jgar.2025.01.001","DOIUrl":"10.1016/j.jgar.2025.01.001","url":null,"abstract":"<div><h3>Objectives</h3><div>Infections by carbapenem-resistant Enterobacterales (CRE) in hospitals represent a severe threat but little is known on outbreaks in rehabilitation wards caused by <em>Klebsiella pneumoniae</em> producing <em>Klebsiella pneumoniae</em> Carbapenemase (KPC-Kp). We report an outbreak by KPC-Kp, in a neurorehabilitation unit in Italy, analysed through whole-genome sequencing (WGS) for transmission routes reconstruction to improve management of KPC-Kp infections in rehabilitation units.</div></div><div><h3>Methods</h3><div>We investigated cases and KPC-Kp isolates collected from February to October 2022 from hospital surveillance. Carbapenem resistance was identified with disk diffusion and minimum inhibitory concentration tests, carbapenemase production through immunochromatographic lateral flow assays. All isolates were genotyped through WGS to highlight possible phylogenetic relationships. The most likely transmission networks of KPC-Kp were reconstructed with Bayesian discrete-time stochastic models.</div></div><div><h3>Results</h3><div>Nineteen patients were colonized by KPC-Kp. Two isolates belonged to sporadic sequence types (STs; ST348 and ST219) whereas 9 of 19 and 8 of 19 isolates belonged to ST307 and ST716, respectively. Among the ST307 isolates, we identified two genomically distinct clusters of five and two cases. All ST716 isolates were highly similar. Genotyping and the reconstruction of transmission networks of KPC-Kp based on genomic data identified seven independent introductions into the neurorehabilitation unit rather than a single outbreak as initially hypothesized before genomic investigation. Three of the seven introductions generated chains of secondary infections, whereas the remaining four remained single cases.</div></div><div><h3>Conclusions</h3><div>The outbreak root-causes were identified in temporary staff shortage and insufficient microbiological surveillance. Measures were adopted accordingly and the outbreak ended. The study highlights the critical role of genomic epidemiology in hospital outbreaks. © 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 195-201"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}