The changing epidemiology of carbapenemase-producingKlebsiella pneumoniaein Italy: toward polyclonal evolution with emergence of high-risk lineages
Author:
Di Pilato Vincenzo1ORCID, Errico Giulia23, Monaco Monica2, Giani Tommaso14, Del Grosso Maria2, Antonelli Alberto1ORCID, David Sophia5, Lindh Erika23, Camilli Romina2, Aanensen David M56, Rossolini Gian Maria14, Pantosti Annalisa2, Manso E, Pedna M F, Mungiguerra M, Moscati Presidio Ospedaliero G, Mosca A, Vailati F, Aschbacher R, Imbriani A, Sartore P, di Cittadella Ospedale Civile, Giraldi C, di Cosenza Azienda Ospedaliera, Piana F, Pecile P, Careggi Ospedale, De Nittis R, Pini B, Manzoni Ospedale A, Mirri P, Bianchi E, Restelli A, Morelli D, Tumori Istituto, Catania M R, Barbaro A, Bernaschi P, Parisi G, Gualdi P, Dusi P A, Bona R, Paolo Ospedale S, D’Andrea M M, Cavallo R, Lanzafame P, Sartor A, Grandesso S, Milano F,
Affiliation:
1. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy 2. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy 3. European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden 4. Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy 5. Centre for Genomic Pathogen Surveillance, Wellcome Sanger Institute, Cambridge, UK 6. Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
Abstract
AbstractBackgroundPrevious studies showed that the epidemic of carbapenem-resistant Klebsiella pneumoniae (CR-KP) observed in Italy since 2010 was sustained mostly by strains of clonal group (CG) 258 producing KPC-type carbapenemases. In the framework of the National Antibiotic-Resistance Surveillance (AR-ISS), a countrywide survey was conducted in 2016 to explore the evolution of the phenotypic and genotypic characteristics of CR-KP isolates.MethodsFrom March to July 2016, hospital laboratories participating in AR-ISS were requested to provide consecutive, non-duplicated CR-KP (meropenem and/or imipenem MIC >1 mg/L) from invasive infections. Antibiotic susceptibility was determined according to EUCAST recommendations. A WGS approach was adopted to characterize the isolates by investigating phylogeny, resistome and virulome.ResultsTwenty-four laboratories provided 157 CR-KP isolates, of which 156 were confirmed as K. pneumoniae sensu stricto by WGS and found to carry at least one carbapenemase-encoding gene, corresponding in most cases (96.1%) to blaKPC. MLST- and SNP-based phylogeny revealed that 87.8% of the isolates clustered in four major lineages: CG258 (47.4%), with ST512 as the most common clone, CG307 (19.9%), ST101 (15.4%) and ST395 (5.1%). A close association was identified between lineages and antibiotic resistance phenotypes and genotypes, virulence traits and capsular types. Colistin resistance, mainly associated with mgrB mutations, was common in all major lineages except ST395.ConclusionsThis WGS-based survey showed that, although CG258 remained the most common CR-KP lineage in Italy, a polyclonal population has emerged with the spread of the new high-risk lineages CG307, ST101 and ST395, while KPC remained the most common carbapenemase.
Funder
Italian Ministry of Health-Centro Controllo Malattie
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)
Cited by
51 articles.
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