The Rise of Carbapenem
Resistant Organisms
RUSI/STFC workshop on Antimicrobial
Resistance
6th February 2013
Professor Mike Sharland
Professor of Paediatric Infectious Diseases
St George’s, University of London
Chair of the DH advisory committee on Antimicrobial
Resistance and Healthcare Associated Infections
(ARHAI)
Carbapenem Resistant
Organisms (CRO’s)





Extremely Resistant Gram Negative
Bacteria
Complex names – KPC, NDM, VIM,
OXA – enzymes and bacteria
Rapid global Spread
Resistant to last decent antibiotic class
– carbapenems (meropenem)
With inadequate treatment can
become pan-resistant
CRO – Serious Adverse Outcomes
Mortality 20-40% - associated with:
 Extended Hospital Stay
– Esp ICU

Exposure to Invasive Devices
– E.g. Ventilators, Central Venous Catheters

Comorbidities assoc with Advanced Age
– E.g. immunosupression, cardiac disease,
chronic airway disease – also premature
Worldwide Distribution of Klebsiella
pneumoniae carbapenemase producers
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Kumarasamy et al., Lancet Infect Dis 2010 10:597-602
Spread of NDM-Mediated
Carbapenem Resistance
Johnson and Woodford J Med Micro 2013; doi: 10.1099/jmm.0.052555-0
Klebsiella pneumoniae: percentage of invasive
isolates with resistance to carbapenems.
2010
2011
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KPC-producing K. pneumoniae - Italian experience
late 2008
early 2011
late 2012
The first reported cases of
KPC-Kp
(ST258)
ST258, ST512 (CC258)
ST512
ST258
Giani et al – JCM 2009
Rossolini GM – unpublished
Fontana et al – BMC Res Notes 2010
Marchese et al – J Chemother 2010
Ambretti et al – New Microb 2010
Gaibani et al – Eurosurv 2011
Mezzatesta et al – CMI 2011
Agodi et al – JCM 2011
Richter et al – JCM 2011
Di Carlo et al – BMC Gastroenterol
2011
Rossolini GM – unpublished
ST101
ST15
ST147-like
AMCLI – CoSA CRE network
Frasson et al – JCM 2012
ARISS-CoSA study –
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unpublished
Carbapenen-resistant K. pneumoniae
AMCLI-CoSA – Italian National CRE Surveillance 2011
AMCLI-CoSA – Italian National CRE Surveillance 2011
Israel’s KPC Outbreak and Intensive IPC Intervention
Antimicrobial Resistance spread into and
within the UK
CRO colonized residents
or visitors
Non-human
reservoirs: foodstuffs
(domestic or imported)
Non-human
reservoirs: animals
and environment
Community
Carriage?
Hospital treatment or
travel overseas
Medical Tourism
•Elective & cosmetic
Military and civilian
casualties from
conflict zones
Inter-hospital
transfers (UK)
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