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>1. Carbapenem resistance in Gram-negative opportunistic pathogens: local prevalence and characterization of carbapenemase-producers in an Italian teaching hospital
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1. Carbapenem resistance in Gram-negative opportunistic pathogens: local prevalence and characterization of carbapenemase-producers in an Italian teaching hospital
The prevalence of carbapenem resistance in Entero-bacterales and non-fermenting Gram-negative clinical isolates has recently dramatically increased. A major mechanism of carbapenem resistance relies on the production of a carbapenemaset including the widespread active serine KPC-type, OXA-23-, OXA-40 or OXA-48-like variants, as well as metallo-β-lactamases, such as IMP-, VIM- and NDM-type enzymes. In this work, the prevalence of carbapenemase-producing Gram-negative clinical isolates at the Siena (Tuscany, Italy) Teaching University Hospital ("Azienda Ospedaliera Universitaria Senese”)was analyzed over the last 24 months, revealing an overall increasing trend, especially of NDM-producing Klebsiella pneumoniae that caused a regional outbreak during 2019, prompting increased patient screening and infection control procedures. The broadest resistance profiles were observed among K. pneumoniae and Acinetobacter baumannii isolates. In addition, resistance to last-generation antibacterial drugs, such as ceftazidime-avibactam, was also detected in K.pneumoniae isolates and involved a variety of resistance mechanisms, including the production of a metallo-β-lactamase, or of a combination of ESBL and a KPC-type carbapenemase. Furthermore, there was an increased detection of isolates co-producing a serine- (KPC-type) and metallo-carbapenemase. In conclusion, the increasing local prevalence of carbapenemase-producing Gram-negative isolates in our setting is worrisome and underlines the need for new antibacterial drugs active on XDR/PDR opportunistic pathogens.
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