Early (2008–2010) hospital outbreak of Klebsiella pneumoniae producing OXA-48 carbapenemase in the UK

Thomas, Claire; Moore, Luke; Elamin, Nazik; Doumith, Michel; Zhang, Jiancheng; Maharjan, Sunil; Warner, Marina; Perry, Claire; Turton, Jane F.; Johnstone, Clare; Jepson, Annette; Duncan, Neill; Holmes, Alison; Livermore, David M.; Woodford, Neil

doi:10.1016/j.ijantimicag.2013.08.020

Cited by 45 publications

(33 citation statements)

References 22 publications

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“…Many of these reports involve patients previously treated in Middle Eastern and North African countries (51). Nonetheless, an early outbreak of OXA-48-producing K. pneumoniae in England was not linked to known regions of endemicity (52). More concerning, however, was a retrospective analysis that uncovered an outbreak of OXA-48-producing Enterobacteriaceae in a Dutch hospital that had been ongoing for 2 years (53).…”

Section: Current Status Of Carbapenemasesmentioning

confidence: 99%

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

et al. 2016

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SUMMARYCarbapenemases have become a significant mechanism for broad-spectrum β-lactam resistance inEnterobacteriaceaeand other Gram-negative bacteria such asPseudomonasandAcinetobacterspp. Intestinal carriage of carbapenemase-producing organisms (CPOs) is an important source of transmission. Isolation of carriers is one strategy that can be used to limit the spread of these bacteria. In this review, we critically examine the clinical performance, advantages, and disadvantages of methods available for the detection of intestinal carriage of CPOs. Culture-based methods (Centers for Disease Control and Prevention [CDC] protocols, chromogenic media, specialized agars, and double-disk synergy tests) for detecting carriage of CPOs are convenient due to their ready availability and low cost, but their limited sensitivity and long turnaround time may not always be optimal for infection control practices. Contemporary nucleic acid amplification techniques (NAATs) such as real-time PCR, hybridization assays, loop-mediated isothermal amplification (LAMP), or a combined culture and NAAT approach may provide fast results and/or added sensitivity and specificity compared with culture-based methods. Infection control practitioners and clinical microbiologists should be aware of the strengths and limitations of available methods to determine the most suitable approach for their medical facility to fit their infection control needs.

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Section: Current Status Of Carbapenemasesmentioning

confidence: 99%

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

et al. 2016

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“…OXA-48 prevalence is also increasing in other European countries, such as France, Germany, Belgium, and the United Kingdom, where increasing numbers of outbreaks have been described (1,(17)(18)(19)(20)(21). However, OXA-48 is rarely identified in North America (22).…”

Section: Bacterial Isolates and Carbapenemase Typesmentioning

confidence: 99%

Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals High In Vitro Susceptibility to Colistin and Meropenem

Oteo

Ortega

Bartolomé

et al. 2015

Antimicrob Agents Chemother

129

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hospitals (about 40,000 hospital beds) prospectively collected nonduplicate Enterobacteriaceae using the screening cutoff recommended by EUCAST. Carbapenemase characterization was performed by phenotypic methods and confirmed by PCR and sequencing. Multilocus sequencing types (MLST) were determined for Klebsiella pneumoniae and Escherichia coli. A total of 702 Enterobacteriaceae isolates met the inclusion criteria; 379 (54%) were CPE. OXA-48 (71.5%) and VIM-1 (25.3%) were the most frequent carbapenemases, and K. pneumoniae (74.4%), Enterobacter cloacae (10.3%), and E. coli (8.4%) were the species most affected. Susceptibility to colistin, amikacin, and meropenem was 95.5%, 81.3%, and 74.7%, respectively. The most prevalent sequence types (STs) were ST11 and ST405 for K. pneumoniae and ST131 for E. coli. Forty-five (54.1%) of the hospitals had at least one CPE case. For K. pneumoniae, ST11/OXA-48, ST15/OXA-48, ST405/ OXA-48, and ST11/VIM-1 were detected in two or more Spanish provinces. ST11 isolates carried four carbapenemases (VIM-1, OXA-48, KPC-2, and OXA-245), but ST405 isolates carried OXA-48 only. A wide interregional spread of CPE in Spain was observed, mainly due to a few successful clones of OXA-48-producing K. pneumoniae (e.g., ST11 and ST405). The dissemination of OXA-48-producing E. coli is a new finding of public health concern. According to the susceptibilities determined in vitro, most of the CPE (94.5%) had three or more options for antibiotic treatment. C arbapenemase-producing Enterobacteriaceae (CPE), mainly Klebsiella pneumoniae, are an emerging threat to public and individual health worldwide. These microorganisms are often resistant to almost all available antibiotics (1, 2), so there are few alternative treatment options. The most common carbapenemases are KPC (class A); VIM, IMP, and NDM (class B); and the OXA-48 types (class D). However, the extent to which health care systems have been affected and the carbapenemase types that are predominant differ substantially from country to country (3).A multicenter study performed in Spain in 2009 revealed 43 (0.04%) cases of CPE, which were mostly VIM-1 and IMP-22 (4). After that, we reported a rapid increase in the number of cases of CPE, mainly OXA-48-producing K. pneumoniae, in this country from 2010 to 2012 (5-7).Because previous studies (5, 6) were based on voluntary reports without taking into account key important issues, in this paper, we present data on the impact of CPE as obtained from a prospective, multicenter, and population-based study. We show that carbapenemase production in this country is widely and irregularly distributed; however, the rates of susceptibility to meropenem and colistin were still high.(The preliminary results of this study were presented in part at the 24th European Congress of Clinical Microbiology and Infectious Diseases Annual Meeting, 10 to 13 May 2014 in Barcelona, Spain,).

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“…Since the KPC-producing bacteria present a resistance profile to different classes of antibiotics, such as monobactams, carbapenems and broad spectrum cephalosporins, the last therapeutic options that remain is polymyxin B, colistin and fosfomycin [3,13,19]. A serious prophylactic action in the health centers with focus on control measure of the environment, contact precautions, hand hygiene, early identification of asymptomatic carriers, antimicrobial stewardship and the implementation of the infection control guideline, are obligatory to prevent, control or at least to reduce the risks of dissemination of those virulent clones [20]. Preventive measures are necessary to avoid the dissemination of these highly pathogenic clones among hospitals and KPC producing K. pneumoniae positive patients, should be isolated and treated according standard guidelines.…”

Section: Textmentioning

confidence: 99%

Molecular Epidemiology of KPC-2 Producing Klebsiella pneumoniae

Ferreira¹

2017

SOJMID

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We describe the molecular epidemiology of the KPC-2 K. pneumoniae among public hospitals in the Amazon State, Brazil. A total of 4.4% (5/113) of the K. pneumoniae isolates were identified as KPC-producing and CTX-M-109 beta-lactamase. Further, MultiLocus Sequence Typing identified three clones STs11, 40 and 2230. To the best of our knowledge, the present study demonstrates for the very first time, detection of the multidrug resistant K. pneumoniae (KPC-2), ST2230 clone, in Brazil.

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Early (2008–2010) hospital outbreak of Klebsiella pneumoniae producing OXA-48 carbapenemase in the UK

Cited by 45 publications

References 22 publications

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals High In Vitro Susceptibility to Colistin and Meropenem

Molecular Epidemiology of KPC-2 Producing Klebsiella pneumoniae

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