Multicenter study on the prevalence of colonization due to carbapenem-resistant Enterobacterales strains before and during the first year of COVID-19, Italy 2018-2020.

Autor:	Fasciana T; Department of Health Promotion, Maternal and Child Health, Internal Medicine and Medical Specialies 'G. D'Alessandro', University of Palermo, Palermo, Italy., Antonelli A; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy., Bianco G; University Hospital Città della Salute e della Scienza di Torino, Turin, Italy., Lombardo D; Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Codda G; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy., Roscetto E; Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy., Perez M; Department of Biomedical and Biotechnological Sciences, University Hospital Policlinico Rodolico San Marco, Catania, Italy., Lipari D; Department of Health Promotion, Maternal and Child Health, Internal Medicine and Medical Specialies 'G. D'Alessandro', University of Palermo, Palermo, Italy., Arrigo I; Department of Health Promotion, Maternal and Child Health, Internal Medicine and Medical Specialies 'G. D'Alessandro', University of Palermo, Palermo, Italy., Galia E; Department of Health Promotion, Maternal and Child Health, Internal Medicine and Medical Specialies 'G. D'Alessandro', University of Palermo, Palermo, Italy., Tricoli MR; Department of Health Promotion, Maternal and Child Health, Internal Medicine and Medical Specialies 'G. D'Alessandro', University of Palermo, Palermo, Italy., Calvo M; Department of Biomedical and Biotechnological Sciences, University Hospital Policlinico Rodolico San Marco, Catania, Italy., Niccolai C; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy., Morecchiato F; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Errico G; Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy., Stefani S; Department of Biomedical and Biotechnological Sciences, University Hospital Policlinico Rodolico San Marco, Catania, Italy., Cavallo R; University Hospital Città della Salute e della Scienza di Torino, Turin, Italy., Marchese A; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy.; Microbiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Catania MR; Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy., Ambretti S; Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Rossolini GM; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy., Pantosti A; Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy., Palamara AT; Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.; Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy., Sabbatucci M; Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.; Directorate General for Health Prevention, Ministry of Health, Rome, Italy., Serra N; Department of Public Health, University Hospital Federico II, Naples, Italy., Giammanco A; Department of Health Promotion, Maternal and Child Health, Internal Medicine and Medical Specialies 'G. D'Alessandro', University of Palermo, Palermo, Italy.
Jazyk:	angličtina
Zdroj:	Frontiers in public health [Front Public Health] 2023 Dec 19; Vol. 11, pp. 1270924. Date of Electronic Publication: 2023 Dec 19 (Print Publication: 2023).
DOI:	10.3389/fpubh.2023.1270924
Abstrakt:	Background: Among multidrug-resistant (MDR) bacteria able to threaten human health, carbapenem-resistant Enterobacterales (CRE) have become a major public health threat globally. National and international guidelines point out the importance of active routine surveillance policies to prevent CRE transmission. Therefore, defining lines of intervention and strategies capable of containing and controlling the spread of CRE is considered determinant. CRE screening is one of the main actions to curb transmission and control outbreaks, outlining the presence and also the prevalence and types of carbapenemase enzymes circulating locally. Objective: The purpose of this study was to outline the epidemiology of CRE colonization in Italy, detecting CRE-colonized patients at admission and during hospitalization, before and during the first year of COVID-19. Materials and Methods: A total of 11,063 patients admitted to seven different hospitals (Bologna, Catania, Florence, Genoa, Naples, Palermo, and Turin) in Intensive Care Units (ICU) and other wards (non-ICU) located in the North, Center, and South of Italy were enrolled and screened for CRE carriage at admission (T0) and during the first 3 weeks of hospitalization (T1-T3). The study spanned two periods, before (September 2018-Septemeber 2019, I observational period) and during the COVID-19 pandemic (October 2019-September 2020, II observational period). Results: Overall, the prevalence of CRE-colonized patients at admission in ICU or in other ward, ranged from 3.9 to 11.5%, while a percentage from 5.1 to 15.5% of patients acquired CRE during hospital stay. There were large differences between the I and II period of study according to the different geographical areas and enrolling centers. Overall, comparison of prevalence of CRE-positive patients showed a significant increased trend between I and II observational periods both in ICU and non-ICU wards, mostly in the Southern participating centers. KPC-producing Klebsiella pneumoniae was the most frequent CRE species-carbapenemase combination reported in this study. In particular, the presence of KPC-producing K. pneumoniae was reported in period I during hospitalization in all the CRE-positive patients enrolled in ICU in Turin (North Italy), while in period II at admission in all the CRE-positive patients enrolled in ICU in Catania and in 58.3% of non-ICU CRE-positive patients in Naples (both centers in South Italy). Conclusion: The prevalence of CRE in Italy highly increased during the COVID-19 pandemic, mostly in the Southern hospital centers. KPC-producing K. pneumoniae was the most frequent colonizing CRE species reported. The results of our study confirmed the crucial value of active surveillance as well as the importance of multicenter studies representing diverse geographical areas even in endemic countries. Differences in CRE colonization prevalence among centers suggest the need for diversified and center-specific interventions as well as for strengthening efforts in infection prevention and control practices and policies. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Fasciana, Antonelli, Bianco, Lombardo, Codda, Roscetto, Perez, Lipari, Arrigo, Galia, Tricoli, Calvo, Niccolai, Morecchiato, Errico, Stefani, Cavallo, Marchese, Catania, Ambretti, Rossolini, Pantosti, Palamara, Sabbatucci, Serra and Giammanco.)
Databáze:	MEDLINE
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