1. 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)

2. 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

3. 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

4. Worldwide Distribution of Klebsiella pneumoniae carbapenemase producers
Kumarasamy et al., Lancet Infect Dis :

5. Spread of NDM-Mediated Carbapenem Resistance
Johnson and Woodford J Med Micro 2013; doi: /jmm

6. Klebsiella pneumoniae: percentage of invasive isolates with resistance to carbapenems.
2010
2011

7. KPC-producing K. pneumoniae - Italian experience
early 2011
late 2012
late 2008
The first reported cases of KPC-Kp
(ST258)
ST258, ST512 (CC258)
ST512
ST258
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Rossolini GM – unpublished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ARISS-CoSA study – unpublished
Giani et al – JCM 2009
Rossolini GM – unpublished

8. Carbapenen-resistant K. pneumoniae
AMCLI-CoSA – Italian National CRE Surveillance 2011

9. AMCLI-CoSA – Italian National CRE Surveillance 2011

10. Israel’s KPC Outbreak and Intensive IPC Intervention

11. Antimicrobial Resistance spread into and within the UK
CRO colonized residents
or visitors
Hospital treatment or
travel overseas
Non-human
reservoirs: foodstuffs
(domestic or imported)
Medical Tourism
Elective & cosmetic
Non-human
reservoirs: animals
and environment
Military and civilian
casualties from
conflict zones
Community
Carriage?
Inter-hospital
transfers (UK)