First outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany

Abstract

We report the first outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany. The presence of KPC was confirmed by polymerase chain reaction (PCR). The KPC-encoding plasmid was analysed by transconjugation experiments, DNA sequencing, Southern blotting and isoelectric focussing. Typing was performed by pulsed-field gel electrophoresis (PFGE). An ertapenem-resistant K. pneumoniae with low minimum inhibitory concentrations (MIC) to other cabapenems (tested by the Vitek system) was isolated from the index patient in January 2008. A KPC-2 was identified after K. pneumoniae with identical susceptibility patterns had been isolated from two more patients. Despite the introduction of infection control measures, transmission occurred in five additional patients and three of the patients died from infections. The source of the outbreak strain remained unclear; however, the Tn4401-containing bla (KPC-2) gene was similar to previously described isolates from Greece. Five months after the end of the outbreak, a KPC-K. pneumoniae was isolated from a patient who had been treated in Greece previously. Retrospectively, this patient was treated in November 2007 on the same unit as the index case. Typing revealed that all patients were colonised by the same strain. KPC-K. pneumoniae has been introduced to Germany possibly from Greece and transmission to other institutions is likely.

Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review

“…use of gowns/gloves, hand hygiene) may impact on effectiveness. Indeed, the contaminated hands of healthcare staff likely play a key role in the transmission of gram-negative bacteria 58,59 , emphasizing the importance of ensuring optimal compliance. Although all but one of the seven studies (Ben-David et al 2010 39 ) reported attempts to enhance staff knowledge/compliance with infection control measures, few reported on levels of compliance.…”

Rapid Detection of bla KPC Carbapenemase Genes by Internally Controlled Real-Time PCR Assay Using Bactec Blood Culture Bottles

“…The high mortality rate may be attributed to multiple resistance mechanisms that are associated with bla KPC -positive bacteria (21). bla KPC -positive bacteria have been implicated in many cases of hospital-acquired infections, which mandates the rapid detection of these pathogens by the clinical laboratory in order to control their spread (16,20,30). The bla KPC enzymes are encoded in large plasmids that vary in size and structure.…”

Genetic similarity and antimicrobial susceptibility of Klebsiella pneumoniae producing carbapenemase (KPC-2) isolated in different clinical specimens received from University Hospitals in Northeastern Poland

“…In conclusion, KPC-positive K. pneumoniae is an increasing problem in many hospitals in Poland (Baraniak et al, 2009;Zacharczuk et al, 2011), and in other countries near Poland (Hrabák et al, 2011;Richter et al, 2011;Wendt et al, 2010). Many strains are often resistant to all antibiotics except polymyxins and tigecycline.…”