Containment of an Outbreak of KPC-3-Producing Klebsiella pneumoniae in Italy

Agodi, Antonella; Voulgari, Evangelia; Barchitta, Martina; Politi, Lida; Koumaki, Vasiliki; Spanakis, Nicholas; Giaquinta, L.; Valenti, Giovanna; Romeo, Maria Antonietta; Tsakris, Athanassios

doi:10.1128/jcm.01242-11

Cited by 83 publications

(53 citation statements)

References 22 publications

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“…7 Previous reports have described the epidemic spread of KPC-Kp ST258 in different healthcare settings in Sicily. 8,9 However, to the best of our knowledge, this is the first report of an outbreak of colonization by KPC-Kp in NICU. Interestingly, the emergence of the outbreak strain coincided with the admission of two neonates referred from elsewhere, but the most prominent role as the source of transmission was likely played by the third long-stay patient with malformation.…”

Section: Discussionmentioning

confidence: 80%

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Giuffrè

Bonura

Geraci

et al. 2013

Journal of Hospital Infection

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This article reports an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) sequence type (ST) 258 in a neonatal intensive care unit (NICU) in Palermo, Italy. KPC-Kp ST258 was detected by an active surveillance culture programme. Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 out of 54 neonates admitted in the outbreak period. No cases of infection were recorded. Male sex was associated with colonization, whereas administration of ampicilline-sulbactam plus gentamicin was protective. Infection control interventions interrupted the spread of KPC-Kp without the need to close the NICU to new admissions. (C) 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved

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Section: Discussionmentioning

confidence: 80%

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Giuffrè

Bonura

Geraci

et al. 2013

Journal of Hospital Infection

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“…␤-Lactamase genes were amplified in single PCRs using a panel of primers for detection of all types of ESBL (SHV, TEM, CTX-M, GES. and PER), carbapenemase (KPC, SME, VIM, NDM, IMP, and OXA-48), and plasmidic AmpC genes (23)(24)(25)(26)(27). Among Enterobacter aerogenes and Enterobacter cloacae isolates, total RNA from logarithmic-phase-grown cultures was extracted with TRI reagent (Ambion, Austin, TX), and reverse transcription (RT) of 1 g of total RNA was performed with the ThermoScript RT-PCR system (Invitrogen, Carlsbad, CA).…”

Section: Methodsmentioning

confidence: 99%

Modified CLSI Extended-Spectrum β-Lactamase (ESBL) Confirmatory Test for Phenotypic Detection of ESBLs among Enterobacteriaceae Producing Various β-Lactamases

et al. 2014

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The worldwide dissemination of Enterobacteriaceae producing AmpC ␤-lactamases and carbapenemases makes difficult the phenotypic detection of extended-spectrum ␤-lactamases (ESBLs), as they may be masked by these additional enzymes. A modification of the CLSI ESBL confirmatory test was developed and evaluated in a comparative study for its ability to successfully detect ESBLs among Enterobacteriaceae producing various carbapenemases (Klebsiella pneumoniae carbapenemase [KPC], VIM, NDM, and OXA-48) and plasmidic or derepressed AmpCs. The modified CLSI ESBL confirmatory test was performed with cefotaxime and ceftazidime disks with and without clavulanate, on which both boronic acid (BA) and EDTA were dispensed. A total of 162 genotypically confirmed ESBL-positive Enterobacteriaceae isolates (83 carbapenemase/ESBL producers, 25 AmpC/ ESBL producers, and 54 ESBL-only producers) were examined. For comparison, 139 genotypically confirmed ESBL-negative Enterobacteriaceae isolates (94 of them possessed carbapenemases and 20 possessed AmpCs) were also tested. The standard CLSI ESBL confirmatory test was positive for 106 of the 162 ESBL producers (sensitivity, 65.4%) and showed false-positive results for 4 of the 139 non-ESBL producers (specificity, 97.1%). The modified CLSI ESBL confirmatory test detected 158 of 162 ESBL producers (sensitivity, 97.5%) and showed no false-positive results for non-ESBL producers (specificity, 100%). The findings of the study demonstrate that the modified CLSI ESBL confirmatory test using antibiotic disks containing both BA and EDTA accurately detects ESBLs in Enterobacteriaceae regardless of the coexistence of additional ␤-lactam resistance mechanisms.

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“…Interestingly, as already reported by others [16], rapidly isolating index patients with barrier precautions was not always sufficient to avoid secondary cases and these occurred in six of 55 events (Table 2). Dedicated nursing staff is probably one of the most relevant measure to avoid cross transmission [15,[17][18][19]. In the context of an epidemic, cohorting patients with dedicated nursing staff in three different groups (cases, contacts and newly admitted patients) was shown to be effective in controlling the outbreak [6,11,17].…”

Section: Number Of Events Proportion Of Outbreaks Among Eventsmentioning

confidence: 99%

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

et al. 2014

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In 2009, following the occurrence of several outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a programme for controlling the spread of CPE was implemented in the 38 hospitals of the Assistance Publique-Hôpitaux de Paris, a 21,000-bed institution. This programme included recommendations to isolate, and screen for CPE, patients previously hospitalised abroad, and bundled measures to control cross transmission (barrier precautions, dedicated staff and screening of contact patients). From 2004 to 2012, 140 CPE index cases were identified, 17 leading to outbreaks. After application of the programme, in spite of an increase in the number of CPE index cases epidemiologically linked with a recent stay or hospitalisation abroad, the proportion of cases followed by outbreaks, which was 40% (4/10) before 2009, decreased to 10% (13/130) (p=0.02), and the proportion of secondary cases among all CPE cases decreased from 69% (22/32) to 23% (38/168), (p<0.001). The number of secondary cases varied significantly depending on the speed and strength of the measures implemented around the CPE index case: quick (within two days of patient admission at the hospital) setting of nursing staff dedicated to the patient, quick setting of simple barrier precautions, or delayed measures of control (p=0.001). A sustained and coordinated strategy can lead to control CPE at the level of a large regional multi-hospital institution in a country where CPE are at an emerging stage.

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Containment of an Outbreak of KPC-3-Producing Klebsiella pneumoniae in Italy

Cited by 83 publications

References 22 publications

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Modified CLSI Extended-Spectrum β-Lactamase (ESBL) Confirmatory Test for Phenotypic Detection of ESBLs among Enterobacteriaceae Producing Various β-Lactamases

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

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