NDM-producing Klebsiella pneumoniaein St-Petersburg, Russia

Svetlana Egorova,Lidiia Kaftyreva,

Mariia Makarova

Russian participants of BEEpSt-Pb hospitals Bacteriologists

St-Pb Pasteur Institute Lidiia Kaftyreva, Svetlana Egorova, Mariia Makarova

1. Hospital № 40 Lidia Lipskaya

2. Hospital № 31 Irina Konovalenko

3. Hospital № 16 Marina Smirnova

4. Hospital № 4 Natalia Vedernikova

5. Children hospital №17 Tatiana Kurchikova

6. Children hospital № 5 Mariia Piasetskaia

7. Children hospital № 1 Olga Morozova

In all hospitals E.coli and Klebsiella pneumoniae resistant to C III were isolated

ESBL-producing E.coli and K.pneumoniae in St-Pb hospitals, January-May 2012

Total in 8 hospitals: 1418 isolates E.coli and K.pneumoniae

Resistant to CIIIE.coli: 7,8 - 50,0%

K.pneumoniae: 25,4 - 88,4%

СТХ-М group 1 (> 90,0%), 2 и 9.

In two multidepartment hospitals for adults 17 K.pneumoniae, resistant to carbapenems, were isolated

27,2

66,7

50

88,4

7,8

50,7

21,225,4

8,1

66,7

30

83,2

26,9

61,7

23,1

66,7

0102030405060708090

I II III IV V VI VII Всреднем

E.coli K.pneumoniae

«KPC+MBL Confirm ID Kit» (Rosco Diagnostica, Дания)

Increasing zone around MR+ DpAll 17 isolates produced MBL

MeropenemMeropenem + dipicolinic acidMeropenem + cloxacillinMeropenem + boronic acid

MBL

NDM-producing K.pneumoniae

• BEEp-project: 17 isolates in 2 hospitals for adults (2012)

• Outside of the BEEp: 2012 – 2013: 26 isolates (+ 2 hospitals for adults)

Total in 2012-13 - 43 isolates of K.pneumoniae resistant to carbapenems by NDM

(4 hospitals for adults).

Clinical samples (n= 43)

urine23

53%

sputum10

23%

blood3

7%

pus3

cateter3

bile1

MIC imipenem for NDM-producing K.pneumoniae (n=43)

46 6

8

2

17

0

2

4

6

8

10

12

14

16

18

1 1,5 2,0 3,0 4,0 8,0 >32

n of

isol

ates

MIC of imipenem, mg/l

cut off

S

cut off

Inhibition zones, mm

14

23

7

11

3 3

19

2 2

5 5

3

6

1

0

2

4

6

8

10

12

14

16

18

20

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

n of

isol

ates

zone of ingibition, mm

meropenem

imipenem

S

cut off imipenem

cut off meropenem

Break-points for carbapenemsEUCAST, 2013 Russia, 2004

S R ECOFF S R

meropenem ≤ 2,0 mg/l≥ 22 mm

> 8,0 mg/l< 16 mm

> 0,125 mg/l< 25 mm

≤ 4,0 mg/l≥ 16 mm

≥ 16 mg/l≤ 13 mm

imipenem ≤ 2,0 mg/l≥ 22 mm

> 8,0 mg/l< 16 mm

> 1,0 mg/l< 23 mm

≤ 4,0 mg/l≥ 16 mm

≥ 16 mg/l≤ 13 mm

ertapenem ≤ 0,5 mg/l≥ 25 mm

> 1,0 mg/l< 22 mm

> 0,125 mg/l< 25 mm

≤ 2,0 mg/l≥ 19 mm

≥ 2,0 mg/l≤ 19 mm

In Russian national guideline – there isn’t screening criteria or confirmation tests

Hospital 115+10

Hospital 22

Hospital 315

Hospital 41

Pasteur Institute

TartuUniversity

Research Institute of Epidemiology,

Moscow

Research Institute of Antimicrobial Chemotherapy,

Smolensk

BEEp

screening

ReidentificationConfirmation of MBLPCR, PFGE

15 1717

NDM-1

Russian kits for for carbapanamase detection in multiplex real-time PCR

(Central Research Institute of Epidemiology, Moscow)

KPC / OXA-48:• KPC -group• OXA-48 -like• Positive control

MBL:• VIM -group• IMP -group• NDM- group• Positive control

1,5-3 hoursFor examination of isolates and different clinical

samples: blood culture, faces, urine, sputum….

OXA-carbapenemasesAcinetobacter spp.:• OXA-23 -like• OXA-58 -like• OXA-40 -like • marker A.baumannii

(OXA-51 -like) • Positive control

NDM-producing K. pneumoniae in 4 hospitals (n= 43)

Hospital 1(25)

City hospitals

Hospital 2(15)

Hospital 3(2)

Hospital 4(1)

Hospital for rehabilitationthe patients from other hospitalsafter severe operations, stroke,heart attack

Emergency hospital;for septic

patients from other hospitals, other cities

Oncology hematology hospital, Immunosuppresed patients with chemotherapy,transplantation

Boxes, strict infection control measures

All cases haven’t travel history abroad

Activites

• 1. Bacteriologists informed the hospital epidemiologists and the heads of the hospitals about NDM-producing strains.

• 2. Lidiia Kaftyreva as main bacteriologist of Public Health Committee presented the results of the project to Public Health Committee

• 3. Results also were presented to city hospitals epidemiologists and bacteriologists on the meeting in PHC

• 4. First epidemiological investigation hasn’t revealed any travel connections. Hospital epidemiologists improved infection control measures.

•

(WHONET, 5.4) Pathogens in SPb hospitals

Микроорганизмы2012 2011 2010 2009

абс. % абс. % абс. % абс. %

1.S. aureus 6966 12,6 6625 13,2 5633 21,5 3259 14,06

2. E. coli 5106 9,2 4429 8,8 3380 12,9 3266 14,03

3. S.epidermidis 2857 5,2 2800 5,6 1809 6,9 1577 6,79

4. K. pneumoniae 3371 6,1 2359 4,7 1486 5,6 1249 5,685. E. fаecalis 2119 3,8 2054 4,1 1338 5,1 1318 5,38

6. S.viridans 2571 4,6 1884 3,8 1237 4,7 1066 4,59

7. P.aeruginosa 2539 4,6 2191 4,4 1180 4,5 1058 4,56

8. A.baumanii 2259 4,1 1771 3,5 887 3,4 948 4,08

9. C.albicans 1142 2,1 1127 2,2 760 2,9 881 3,79

Всего ведущих микроорганизмов 28930 52,3 25240 50,4 17710 67,5 14622 63,0

Всего штаммов штаммов

55 414 100 50 096 100 26 179 100 23 221 100

Resistance to other antimicrobials of K.pneumoniae, resistant to 3GC

0

10

20

30

40

50

60

70

80

90

100

43,4

88,4

74,3 76,8

100 100

9,0

87,4

70,3

81,5

6,9

86,1

64,8

86,0

На

100

иссл

едуе

мы

х ш

там

мов

201020112012

Resistance to other antimicrobials of E.coli, resistant to 3GC

0

10

20

30

40

50

60

70

80

90

100

32,7

70,2

36,5

86,6

100 100

11,5

69,4

36,2

85,8

5,9

63,8

35,9

80,4

На

100

иссл

едуе

мы

х ш

там

мов

201020112012

Carbapenem-resistant K.pneumoniae and E.coli

• 43 NDM-producing K.pneumoniae in 4 hospitals, other hospitals (not included in BEEP) ?

• 2 KPC-producing K.pneumoniae –in one hospital• 10 isolates of carbapenem-resistant K.pneumoniae

(negative for NDM, VIM, IMP, KPC, OXA-48) • 2 isolates of carbapenem-resistant E.coli

(negative for NDM, VIM, IMP, KPC, OXA-48)

Carbapenem-resistant K.pneumoniae and E.coli

• Dissociation of populations in hospitals: if use only ESBL-media = can miss CREif use ESBL-media + KPC-media= CRE

• Carbapenem Resistance mechanism: ESBL+ ??? (not NDM, VIM, IMP, KPC, OXA-48)