Ten years of surveillance and control of Klebsiella pneumoniae hospital

acquired bloodstream infections: the experience from San Martino Policlinic

Teaching Hospital in Genoa, North-West Italy

Dr. Andrea Orsi1,2, Dr. Federico Tassinari1, Dr. Ilaria Barberis1, Dr. Sara Schenone1, Dr. Daniela De Florentiis2, Dr. Angela Battistini2,

Dr. Barbara Guglielmi2, Dr. Dorotea Bellina2, Dr. Daniele Roberto Giacobbe1,3, Prof. Claudio Viscoli1,3, Prof. Giancarlo Icardi1,2

1 Department of Health Sciences, University of Genoa, Genoa, Italy

2 Hygiene Unit, San Martino Policlinic Teaching Hospital, Genoa, Italy

3 Infectious Diseases Unit, San Martino Policlinic Teaching Hospital, Genoa, Italy

Poster 159

Copyright © 2018 Andrea Orsi, andrea.orsi@unige.it

Background. Effective strategies are needed to reduce the burden of multidrug resistant Klebsiella pneumoniae, particularly in intensive

care units (ICUs).

Results. During the study period 909 HA-BSIs were reported, 576 caused by carbapenem resistant Klebsiella pneumonia (CR-Kp) and 333

by non-carbapenem resistant Klebsiella pneumonia (nCR-Kp). Trends of CR-Kp and nCR-Kp incidence rates were different: while CR-Kp

HA-BSIs increased from 0.00 cases per 10,000 patients-days in 2008 to 2.12 in 2015 and then decreased up to 0.89 in 2017, nCR-Kp

incidence remained stable from 0.62 in 2008 to 0.78 in 2014, with a little increase in the last 3 years (1.17 in 2017). Incidence trends were

also different considering total hospital and ICUs: the incidence peak of HA-BSIs caused by CR-Kp in the entire hospital was registered in

2015, while for ICUs the highest value was observed in 2010 (25.47/10,000 patients-days), with a marked decrease in the last years (7.53 in

2017).

Inci

denc

e of

BS

I cau

sed

by K

lebs

iella

pne

umon

iae

per

10.0

00 p

atie

nt d

ays.

Conclusions. Intensified infection control measures, in particular routine rectal surveillance cultures (from 2012), mandatory CR-Kp HA-

BSIs notification (from 2013) and a program of antimicrobial stewardship (from 2014), resulted effective in reducing the circulation of CR-Kp,

especially in ICUs..

Methods. We conducted a retrospective observational study at the 1200 acute-care beds San Martino Policlinic Hospital, located in Genoa,

North-West Italy. We analyzed data of all patients with an hospital acquired bloodstream infection (HA-BSI) caused by Klebsiella pneumoniae

from January 2008 to December 2017.

Aims. To assess Klebsiella pneumoniae antimicrobial resistance over time and impact of different infection control interventions.

HIS 2018 26 – 28 November 2018 ACC Liverpool

0,62

1,27

1,53

2,04

2,50

2,17

2,50

3,12

2,20 2,06

0,44 0,38

0,66 0,61 0,63 0,78

1,00 1,09

1,17

0,00

0,83

1,14

1,38

1,89

1,54 1,72

2,12

1,11

0,89

0,00

0,50

1,00

1,50

2,00

2,50

3,00

3,50

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Total nCRKP CRKP

Bacteremia

notification

system

Antimicrobial

stewardship

Opening ICU and introducing

washes with chlorhexidine-

soaked wipes in ICU

Rectal swab

screening entering

an ICU

9,75

4,42 4,74

8,64

5,64

2,14

5,59 6,81

4,55

9,54 9,75

22,08

30,21 31,32

29,35

21,91 22,34

27,22

14,15

17,07 17,66

25,47

22,68 23,70

19,77

16,76

20,42

9,60

7,53

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

ICU

Cases

Overall C

ases