Fig. 1.
Fig. 2.
Antimicrobial resistance profiles of the studied K_ pneumoniae isolates_
| Patient ID/Isolate no. | 3 | 6965 | 6976/1 | 6976/2 | 1 | 6968 | 2 | 4 | 154/25428 | 7/25804 | 11/25808 | 13/25810 | 6 | 7 | 5 | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Antibiotics: | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | MIC (pg/ml) | R/I/S | |
| Penicillins | Amoxicillin/Clavulanic acid | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R |
| Ampicillin | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | |
| Cephalosporins | Cefaclor | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R |
| Cefuroxime | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | |
| Cefotaxime | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | |
| Cefotaxime/Cefotaxime + clavulanic acid | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | >16/>1 | R | |
| Ceftazidime | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | |
| Ceftazidime/Ceftazidime + clavulanic acid | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | 34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | >34/>4 | R | |
| Cefepime | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | |
| Carbapenems | Doripenem | >32 | R | 16 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R |
| Ertapenem | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | |
| Imipenem | >32 | R | >32 | R | 16 | R | 16 | R | >32 | R | >32 | R | >32 | R | >32 | R | >12 | R | 4 | S | 4 | S | 8 | I | >32 | R | >32 | R | >32 | R | |
| Meropenem | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | |
| Quinolone | Ciprofloxacin | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R |
| Aminoglycosides | Amikacin | 4 | S | 8 | S | 32 | R | 32 | R | 8 | S | 12 | R | 6 | S | 4 | S | 8 | S | 8 | S | 8 | S | 8 | S | 12 | R | 6 | S | 6 | S |
| Gentamycin | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | |
| Netylmycin | 128 | R | 4 | I | 64 | R | 64 | R | 128 | R | 32 | R | 16 | R | 16 | R | 12 | R | 16 | R | 16 | R | 16 | R | 32 | R | 16 | R | 16 | R | |
| Tobramycin | 64 | R | 64 | R | 32 | R | 32 | R | 64 | R | 64 | R | 64 | R | 64 | R | 32 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | 64 | R | |
| Other | Aztreonam | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R |
| Colistin | 0.50 | S | 0.75 | S | 0.125 | S | 0.125 | S | 0.50 | S | 0.50 | S | 0.50 | S | 0.50 | S | 0.50 | S | 0.50 | S | 0.75 | S | 0.50 | S | 0.50 | S | 0.50 | S | 0.50 | S | |
| Tetracycline | 32 | R | 128 | R | 8 | R | 8 | R | 32 | R | 32 | R | 32 | R | 8 | R | >256 | R | >256 | R | >256 | R | >256 | R | 8 | R | 8 | R | 128 | R | |
| Tigecycline | 2 | R | 8 | R | 4 | R | 4 | R | 2 | R | 2 | R | 2 | R | 4 | R | 0.75 | R | 0.75 | R | 1.0 | R | 2 | R | 4 | R | 4 | R | 8 | R | |
| Trimethoprim/Sulfamethoxazole | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | >32 | R | |
| Fosfomycin | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | >256 | R | R>256 | R | >256 | R | >256 | R | >256 | R | >256 | R | |
Demographic data and characteristics of the fourteen patients with K_ pneumoniae co-producing KPC-2, OXA-48, VIM-1 and CTX-M-15 during the outbreak_
| Patient ID/Isolate no. | Age (years)/sex | Hospital ward(s) | Date of isolation | Type of specimen | Status (type) of colonization/infection | Duration of hospitalization (days) | Underlying conditions | Antimicrobial used prior to isolation of carbapenemase producer(s) | Antimicrobial used as treatment for infections | Outcome Alive/Dead |
|---|---|---|---|---|---|---|---|---|---|---|
| 3 | 74/M | OAIT | 08/03/2018 | Rectal swab | Colonization | 03/01-14/04/2018 (102 days) | Abdominal Aortic Aneurysm (AAA) | Ciprofloxacin + Gentamycin + Itraconazole | Metronidazole | Dead |
| 6965 | 60/F | OAIT | 28/02/2018 | Rectal swab | Colonization | 08/02-01/04/2018 (53 days) | Tuberculosis, Chronic Obstructive Pulmonary Disease (COPD) | Colistin + Voriconazole | – | Dead |
| 6976/1 | 45/M | OAIT | 01/03/2018 | Rectal swab | Colonization | 21/02-29/03/2018 (37 days) | Guillain-Barré Syndrome (GBS) | Colistin + Linezolid | Ampicillin/sulbactam + Amikacin | Alive |
| 1 | 67/F | OAIT | 07/03/2018 | Rectal swab | Colonization | 02/03-29/06/2018 (112 days) | COPD, diabetes, hypertension | Ceftriaxone + Levofloxacin | – | Dead |
| 6968 (index case) | 63/M | NR | 28/02/2018 | Rectal swab | Colonization | 16/02-31/03/2018 (44 days) | Hypertension, atherosclerosis | Ceftriaxone + Metronidazole | – | Alive |
| 2 | 69/M | NR | 07/03/2018 | Rectal swab | Colonization | 23/02-28/03/2018 (34 days) | Post-stroke conditions | – | – | Alive |
| 4 | 43/M | NR | 08/03/2018 | Rectal swab | Colonization | 26/02-12/03/2018 (15 days) | Hypertension | Ceftriaxone + Metronidazole | – | Dead |
| 154/25428 | 61/M | NR | 30/07/2018 | Rectal swab | Colonization | 04/07-06/08/2018 (34 days) | Stroke | – | – | Dead |
| 7/25804 | 70/M | NR | 04/08/2018 | Rectal swab | Colonization | 25/07-02/08/2018 (9 days) | Stroke | Amoxicillin/clavulanic acid | – | Alive |
| 11/25808 | 50/F | NR | 04/08/2018 | Rectal swab | Colonization | 23/07-03/08/2018 (12 days) | Stroke | – | – | Alive |
| 13/25810 | 77/M | NR | 04/08/2018 | Rectal swab | Colonization | 22/07-09/08/2018 (19 days) | Hypertension, ischemic heart disease | Amoxicillin/clavulanic acid | – | Alive |
| 6 | 70/F | REU | 09/03/2018 | Rectal swab | Colonization | 26/02-14/03/2018 (17 days) | Diabetes, metastatic lung cancer | – | – | Alive |
| 7 | 78/F | REU | 09/03/2018 | Rectal swab | Colonization | 27/02-16/03/2018(18 days) | Rheumatoid Arthritis (RA), hemorrhagic diathesis, coronary disease, peptic ulcer disease, hypertension, atherosclerosis, gout | Imipenem | Vancomycin | Alive |
| 5 | 90/F | REU | 08/03/2018 | Rectal swab | Colonization | 03.03-17.03.2018 (14 days) | Atherosclerosis, acute arterial thrombosis of the lower extremity | Meropenem + Amikacin | – | Alive |