Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

1. Annalisa Pantosti
Istituto Superiore di Sanità
Rome
Stockholm, 12 February 2015
3rd Joint Meeting of the ARHAI Networks
Experiences from Member States: Italy

2. • 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

3. 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 *
6th
55.1 3rd gen ceph-R Klebsiella
5th
Carbapenem-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

4. Carbapenem-
resistant
K. pneumoniae
2009
EARS-NET database

5. 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

6. 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

7. Study on clonality of K. pneumoniae-KPC
PFGE profiles (KbaI)
MLST
CC258
Conte V et al, ECCMID 2014

8. 1
2
6
13
14
7
15
11
16
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

9. 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
pneumoniae
178 3 1 1 4 197
Escherichia
coli
3 1 - - - 4

10. ANTIBIOTIC S I R
n° % n° % n° %
Antibiotic susceptibility of 179
K. pneumoniae-KPC isolates
(EuSCAPE-Italy)

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

12. 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

13. 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

14. 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

16. Open questions
• Will these late measures succeed in
curbing carbapenem resistance?
• Is KPC increase in Italy heralding
epidemics in other countries?