Management of Klebsiella pneumoniae KPC outbreak in internal medicine

Introduction: Italy has a high incidence of Klebsiella pneumoniae producing carbapenemase (CRKP) infections. We report and discuss the experience of our Centre, an Internal Medicine Unit in North-Western Italy, focusing on the high clinical challenge dealing with this infections in year 2012 with data expanded over three years of surveillance Materials and methods: we retrospectively analyzed data of patients with isolation of CRKP during years 2011-2013. Results: In 2011 2 patients had positive cultures for CRKP; in 2012 CRKP was isolated in 21 patients. The mean age of the cohort was 77,6 (range 52-89). Cultures were positive in different specimens: urines 71,4%, blood 9.52%, upper respiratory tract 9.52%, wounds 9,52%. Most relevant infection-associated risk factors were identified in presence of devices such as urinary catheter (UC) (76% of patients) or central venous catheter (CVC) (47% of patients). In 2013 we observed 6 cases. Cultures were positive on urines, blood and abdominal drainage, blood, sputum and bronchial-alveolar lavage. In conclusion, in three years of surveillance we observed 29 patients with CRKP isolation: 17 urinary tract infections (response 6/13), 4 blood stream infections (response 1/3), 4 respiratory tract infections (response 1/3), 4 skin and soft tissue infections/colonization (not treated); crude mortality was 51% and global response to therapy was 42,1% on 19 treated patients. Conclusions: the 2012 outbreak was contained and the major awareness of the problem produced systematic new measures for infection control: screening with rectal swab for CRKP for patients admitted from other Hospitals or wards, sudden isolation of colonizedlinfected patients, more accurate attention to environmental and personal hygiene. CRPK is an important cause of morbidity and mortality; efficiency of single agent antibiotic therapy against CRPK seems to be not satisfying. Dedicated guidelines of new combination therapy are required.