Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak

Wiener-Well, Yonit; Rudensky, Bernard; Yinnon, Amos M.; Kopuit, P.; Schlesinger, Yechiel; Broide, Ellen; Lachish, Tamar; Raveh, David

doi:10.1016/j.jhin.2009.07.022

Cited by 119 publications

(132 citation statements)

References 15 publications

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“…These isolates were not genotyped. Our carriage rates were higher than those described in other studies, which varied from 5.4-9% (Ben-David et al 2010, Wiener-Well et al 2010. Our strategy of limiting surveillance to high-risk patients, predominantly in the ICU, haematology unit, may explain this.…”

contrasting

confidence: 71%

Outbreak of carbapenem-resistant Klebsiella pneumoniae: two-year epidemiologic follow-up in a tertiary hospital

Pereira

Garcia

Mostardeiro

et al. 2013

Mem. Inst. Oswaldo Cruz

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This study describes a carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak that occurred from October 2008-December 2010. Polymerase chain reaction assays were performed to detect the bla KPC gene and molecular typing was performed using pulsed-field gel electrophoresis (PFGE) The emergence of strains of multidrug-resistant Klebsiella pneumoniae has been reported with increasing frequency in several countries worldwide. Carbapenem-resistant K. pneumoniae (CRKP) can cause nosocomial infections and outbreaks with high mortality rates (Maltezou 2009). Such infections occur mainly in patients admitted to Intensive Care Units (ICU) with several underlying diseases and histories of having received prolonged courses of antibiotics (Maltezou 2009). Several resistance mechanisms have been described. Carbapenemase production (KPC), metallo-β-lactamase (MBL) and porin loss, combined with the production of extended-spectrum beta-lactamase (ESBL), are described as the most common mechanisms of carbapenem resistance (Souli et al. 2008, Peirano et al. 2009).Control measures, including contact precautions for infected or colonised patients and active surveillance in high-risk units, have been recommended as strategies to control CRKP outbreaks (Ben-David et al. 2010). In our hospital, CRKP had never been detected until October 2008. The objectives of this study were to describe the epidemiological findings in a CRKP outbreak and to verify the existence of clones that are present in other hospitals in the state of São Paulo (SP).Hospital Brigadeiro is a public, tertiary-care teaching hospital that is part of the Brazilian National Health Care System. It has the following specialised clinics: Oncology, Haematology, Bone Marrow Transplantation, Nephrology, Renal and Liver Transplant Units, ICU in The isolates evaluated in the hospital's laboratory were sent to the Adolfo Lutz Institute, a public health laboratory, to confirm our initial identification of CRKP, to assay for the production of carbapenemases and to determine the level of genetic relatedness between samples.K. pneumoniae was confirmed by classical phenotypic methods. Disk-diffusion tests were performed to determine susceptibility to antimicrobials, according to the Clinical and Laboratory Standards Institute (CLSI 2010). Isolates were screened for the ESBL phenotype by the standard double-disk synergy test and KPC was screened both by evaluating breakpoints and using modified Hodge test, again according to CLSI guidelines (2010).Minimal inhibitory concentrations (MICs) were determined by E-test (AB Biodisk, Solna, Sweden) for the following antimicrobial drugs: ceftazidime, cefotaxime, cefotaxime plus clavulanic acid, cefepime, aztreonam, ertapenem, imipenem, meropenem, piperacillin/tazobactam, gentamicin, amikacin, tigecycline tobramycin and polymyxin (CLSI 2010). Imipenem plus ethylenediamine tetraacetic acid (EDTA) strips were used to detect the presence of metallo-beta-lactamases. Tigecycline and polymyxin B were evaluated using breakpoints for Enterobacteri...

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contrasting

confidence: 71%

Outbreak of carbapenem-resistant Klebsiella pneumoniae: two-year epidemiologic follow-up in a tertiary hospital

Pereira

Garcia

Mostardeiro

et al. 2013

Mem. Inst. Oswaldo Cruz

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“…3,4,9,10,[26][27][28] These discrepancies might be related at least in part to different definitions of antimicrobial exposure and the possibility of uncontrolled confounders in retrospective studies. 29 In our study, the small number of patients who received each specific class of antibiotic limited our ability to find statistically significant associations.…”

Section: Discussionmentioning

confidence: 99%

“…Several case-control studies have identified healthcare-associated factors as predictors for isolation of CP-CRE among hospitalized patients. 3,9,10 Molecular studies have demonstrated how clonal expansion and horizontal plasmid dissemination, either within the same species or, rarely, between species, underlie the spread of these multidrug-resistant pathogens. [11][12][13][14] Strict contact isolation, physical separation of carriers from noncarriers, and use of dedicated staff are key components in containing CP-CRE in acute care hospitals.…”

mentioning

confidence: 99%

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.methods. A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.results. In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.conclusions. Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.

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“…Die Pflege von Risikopatienten oder positiven Patienten soll durch eigens zugeordnetes Personal erfolgen. Für den Nachweis Carbapenem-resistenter Klebsiellen hat die Untersuchung von Rektal-Abstrichen eine Sensitivität von 94 % ergeben [369]. Perianal-Abstriche haben eine Sensitivität von 53 % [370].…”

Section: Klebsiella Sppunclassified

Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen

2012

Bundesgesundheitsbl.

287

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Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak

Cited by 119 publications

References 15 publications

Outbreak of carbapenem-resistant Klebsiella pneumoniae: two-year epidemiologic follow-up in a tertiary hospital

Outbreak of carbapenem-resistant Klebsiella pneumoniae: two-year epidemiologic follow-up in a tertiary hospital

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen

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