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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, [email protected]
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