Annalisa Pantosti

Istituto Superiore di Sanità

Rome

Stockholm, 12 February 2015

3rd Joint Meeting of the ARHAI Networks

Experiences from Member States: Italy

• 50 laboratories in 2013

• Annalisa Pantosti, Dep of Infectious Diseases,

ISS

• Paolo D’Ancona, Center for Epidemiology, ISS

• Gian Maria Rossolini, University of Siena and

University of Florence

AR-ISS network

European category

(6-highest AMR to 1-lowest AMR)

2013 EARS-net (bacteremias)

Italy% non

susceptible

Trend 2006-13

5th

5th3rd gen ceph-R E.coli 26.2 *

FQ R E.coli 42.2 *

5th

6thCarbapenem-R Acinetobacter 79.5 n.r.

Carbapenem-R Pseudomonas 27.2 *

6th55.1 3rd gen ceph-R Klebsiella

5thCarbapenem-R Klebsiella 34.3

MRSA 5th35.8 =

4thMacrolide NS S. pneumoniae 24.6 =

Vanco-R Enterococcus faecium 2th4.4 =

Antibiotic-resistance in Italy: data from EARS-Net

Carbapenem-

resistant

K. pneumoniae

2009

EARS-NET database

K. pneumoniae producing KPC-type

carbapenemase

Giani et al – JCM 2009

Antibiotic MIC mg/L(S/I/R)

Amp/Sulb >32 R

Pip/Tazo >128 R

Ceftriaxone >64 R

Ceftazidime >64 R

Cefepime >64 R

Ertapenem >32 R

Imipenem >32 R

Meropenem >32 R

Aztreonam >64 R

Amikacin >64 R

Gentamicin 2 S

Tobramycin >16 R

Ciprofloxacin >4 R

Tigecycline 1.5 I

Colistin 0.4 S

2011-2012: 26 lab 114 K. pneumoniae + 4 E. coli

2013: 29 lab 128 K. pneumoniae + 1 E. coli

98% of K. pneumoniae were KPC-positive

Characterization of carbapenem-nonsusceptible

Enterobacteriaceae

from bloodstream infections (2011-2013)

• Laboratories participating to AR-ISS

• Isolates with meropenem MIC ≥ 0.5 mg/L

Study on clonality of K. pneumoniae-KPC

PFGE profiles (KbaI)

MLST

CC258

Conte V et al, ECCMID 2014

1

2

6

13

14

7

15

1116

ST-512

ST-258

3

ST-307

4

5

ST-258LIKE

ST-101

ST-15

ST-11

12

178

NO ISOLATES

9

10

Geographic distribution of K. pneumoniae-KPC clones

in 2011 and in 2013

Conte V et al, ECCMID 2014

21 hospital laboratories

10 CPE isolates from each laboratory

(any clinical sample)

in Italy

Number of isolates per type of carbapenemase

Species KPC VIM NDM OXA-48 None Total

Klebsiella

pneumoniae178 3 1 1 4 197

Escherichia

coli3 1 - - - 4

ANTIBIOTIC S I R

n° % n° % n° %

Antibiotic susceptibility of 179K. pneumoniae-KPC isolates

(EuSCAPE-Italy)

Colistin resistance in K. pneumoniae-KPC(% of Col/Res in each hospital laboratory)

EuSCAPE-Italy

Actions at the National level

• Implementation of the National Surveillance of

Carbapenemase-producing Enterobacteriaceae

(CPE)

• AMR and HAI included in the National plan for

prevention 2014-2018

Control of CPE bacteremia

• Active screening of :

– Contacts of patients with CPE

infection

– Patients from endemic countries

– Patients with recent hospital

admission or from nursing homes

– Patients admitted to high risk wards

• Isolation of infected/colonized

patients

• Implementation of contact

precautions and hygiene

measures

The national plan for prevention

2014-2018

• Inclusion of AMR and HAI among the objectives of the plan

• Each Region must develop a Regional Plan for Prevention to

achieve the objectives

• Objectives for :

– To implement the CPE surveillance

– Monitor the use of antibiotics in hospital and in the community

– Promote the correct use of antibiotics

– Define a programme of surveillance and control of HAI

This is an acknowledgement that AMR is

a public heath priority

Open questions

• Will these late measures succeed in

curbing carbapenem resistance?

• Is KPC increase in Italy heralding

epidemics in other countries?