More Not-Good News About CREs

I’m old enough to remember when we used to say things like, “We are nearing a time when we won’t be able to treat infections with any antibiotic.” Well, this report out of Italy tells us that time has arrived (boldface mine):

Consecutive non-replicate clinical isolates (n=191) of carbapenem non-susceptible Enterobacteriaceae were collected from 21 hospital laboratories across Italy from November 2013 to April 2014 as part of the European Survey on Carbapenemase-producing Enterobacteriaceae (EuSCAPE) project. Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) represented 178 (93%) isolates with 76 (43%) respectively resistant to colistin, a key drug for treating carbapenamase-producing Enterobacteriaceae. KPC-KP colistin-resistant isolates were detected in all participating laboratories. This underscores a concerning evolution of colistin resistance in a setting of high KPC-KP endemicity.

To translate this into English, 42% of carbapenem-resistant K. pneumoniae–bacteria that cause infections such as urinary tract and bloodstream infections and which can’t be treated with any traditional antibiotics–are now also resistant to the drug of last resort, colistin. Colistin isn’t a great drug, as it can cause kidney failure, and it’s also not clear how well it works on these infections anyway.

It’s also disconcerting that these colistin-resistant KPC-KP (say that at snazzy parties, you’ll sound smart!) are widespread in Italy: it’s not confined to one region or hospital. Either colistin resistance is evolving rapidly after use, or these colistin-resistant strains are spreading rapidly.

Not good news.

It’s worth noting that there’s an initiative to try to do something about this; let’s see how it survives the inevitable political and pundit hackery.

Cited article: Monaco M, Giani T, Raffone M, Arena F, Garcia-Fernandez A, Pollini S, Network EuSCAPE-Italy, Grundmann H, Pantosti A, Rossolini GM. Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill. 2014;19(42):pii=20939. Available online:

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