NDM-producing Klebsiella pneumoniae in St-Petersburg, Russia. Svetlana Egorova, Lidiia Kaftyreva, Mariia Makarova

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1 NDM-producing Klebsiella pneumoniae in St-Petersburg, Russia Svetlana Egorova, Lidiia Kaftyreva, Mariia Makarova

2 Russian participants of BEEp St-Pb hospitals St-Pb Pasteur Institute 1. Hospital 40 Lidia Lipskaya Bacteriologists Lidiia Kaftyreva, Svetlana Egorova, Mariia Makarova 2. Hospital 31 Irina Konovalenko 3. Hospital 16 Marina Smirnova 4. Hospital 4 Natalia Vedernikova 5. Children hospital 17 Tatiana Kurchikova 6. Children hospital 5 Mariia Piasetskaia 7. Children hospital 1 Olga Morozova In all hospitals E.coli and Klebsiella pneumoniae resistant to C III were isolated

3 ESBL-producing E.coli and K.pneumoniae in St-Pb hospitals, January-May 2012 Total in 8 hospitals: 1418 isolates E.coli and K.pneumoniae Resistant to CIII E.coli: 7,8-50,0% K.pneumoniae: 25,4-88,4% СТХ-М group 1 (> 90,0%), 2 и ,2 66, ,4 7,8 50,7 21,2 25,4 8,1 66, ,2 26,9 61,7 23,1 66,7 I II III IV V VI VII В среднем In two multidepartment hospitals for adults 17 K.pneumoniae, resistant to carbapenems, were isolated E.coli K.pneumoniae

4 «KPC+MBL Confirm ID Kit» (Rosco Diagnostica, Дания) Meropenem Meropenem + dipicolinic acid Meropenem + cloxacillin Meropenem + boronic acid MBL Increasing zone around MR+ Dp All 17 isolates produced MBL

5 NDM-producing K.pneumoniae BEEp-project: 17 isolates in 2 hospitals for adults (2012) Outside of the BEEp: : 26 isolates (+ 2 hospitals for adults) Total in isolates of K.pneumoniae resistant to carbapenems by NDM (4 hospitals for adults).

6 Clinical samples (n= 43) blood 3 7% pus 3 cateter 3 bile 1 urine 23 53% sputum 10 23%

7 18 16 MIC imipenem for NDM-producing K.pneumoniae (n=43) n of isolates cut off 4 S ,5 2,0 3,0 4,0 8,0 >32 MIC of imipenem, mg/l

8 Inhibition zones, mm S n of isolates meropenem imipenem cut off imipenem cut off meropenem zone of ingibition, mm

9 Break-points for carbapenems EUCAST, 2013 Russia, 2004 S R ECOFF S R meropenem 2,0 mg/l 22 mm > 8,0 mg/l < 16 mm > 0,125 mg/l < 25 mm 4,0 mg/l 16 mm 16 mg/l 13 mm imipenem 2,0 mg/l 22 mm > 8,0 mg/l < 16 mm > 1,0 mg/l < 23 mm 4,0 mg/l 16 mm 16 mg/l 13 mm ertapenem 0,5 mg/l 25 mm > 1,0 mg/l < 22 mm > 0,125 mg/l < 25 mm 2,0 mg/l 19 mm 2,0 mg/l 19 mm In Russian national guideline there isn t screening criteria or confirmation tests

10 screening Hospital Hospital 2 2 Hospital 3 15 Hospital 4 1 BEEp Reidentification Confirmation of MBL PCR, PFGE Tartu University 15 Pasteur Institute 17 Research Institute of Epidemiology, Moscow 17 Research Institute of Antimicrobial Chemotherapy, Smolensk NDM-1

11 MBL: VIM -group IMP -group NDM- group Positive control Russian kits for for carbapanamase detection in multiplex real-time PCR (Central Research Institute of Epidemiology, Moscow) KPC / OXA-48: KPC -group OXA-48 -like Positive control OXA-carbapenemases Acinetobacter spp.: OXA-23 -like OXA-58 -like OXA-40 -like marker A.baumannii (OXA-51 -like) Positive control 1,5-3 hours For examination of isolates and different clinical samples: blood culture, faces, urine, sputum.

12 NDM-producing K. pneumoniae in 4 hospitals (n= 43) City hospitals All cases haven t travel history abroad Hospital 1 (25) Hospital 2 (15) Hospital 3 (2) Hospital 4 (1) Hospital for rehabilitation the patients from other hospitals after severe operations, stroke, heart attack Emergency hospital; for septic patients from other hospitals, other cities Oncology hematology hospital, Immunosuppresed patients with chemotherapy, transplantation Boxes, strict infection control measures

13 Activites 1. Bacteriologists informed the hospital epidemiologists and the heads of the hospitals about NDM-producing strains. 2. Lidiia Kaftyreva as main bacteriologist of Public Health Committee presented the results of the project to Public Health Committee 3. Results also were presented to city hospitals epidemiologists and bacteriologists on the meeting in PHC 4. First epidemiological investigation hasn t revealed any travel connections. Hospital epidemiologists improved infection control measures.

14 (WHONET, 5.4) Pathogens in SPb hospitals Микроорганизмы абс. % абс. % абс. % абс. % 1.S. aureus , , , ,06 2. E. coli , , , ,03 3. S.epidermidis , , , ,79 4. K. pneumoniae , , , ,68 5. E. fаecalis , , , ,38 6. S.viridans , , , ,59 7. P.aeruginosa , , , ,56 8. A.baumanii , , , ,08 9. C.albicans , , , ,79 Всего ведущих микроорганизмов Всего штаммов штаммов , , , ,

15 Resistance to other antimicrobials of K.pneumoniae, resistant to 3GC На 100 исследуемых штаммов ,4 88,4 87,4 86,1 74,3 70,3 64,8 81,5 76,8 86, ,0 6,9 0

16 Resistance to other antimicrobials of E.coli, resistant to 3GC На 100 исследуемых штаммов ,7 70,2 69,4 63,8 36,5 36,2 35,9 86,6 85,8 80, ,5 5,9 0

17 Carbapenem-resistant K.pneumoniae and E.coli 43 NDM-producing K.pneumoniae in 4 hospitals, other hospitals (not included in BEEP)? 2 KPC-producing K.pneumoniae in one hospital 10 isolates of carbapenem-resistant K.pneumoniae (negative for NDM, VIM, IMP, KPC, OXA-48) 2 isolates of carbapenem-resistant E.coli (negative for NDM, VIM, IMP, KPC, OXA-48)

18 Carbapenem-resistant K.pneumoniae and E.coli Dissociation of populations in hospitals: if use only ESBL-media = can miss CRE if use ESBL-media + KPC-media= CRE Carbapenem Resistance mechanism: ESBL+??? (not NDM, VIM, IMP, KPC, OXA-48)

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