Infections caused by OXA-48-producing Klebsiella pneumoniae in a tertiary hospital in Spain in the setting of a prolonged, hospital-wide outbreak

Paño‐Pardo, José Ramón; Ruiz-Carrascoso, Guillermo; Francisco, Carolina Navarro-San; Gómez-Gil, Rosa; Mora-Rillo, Marta; Romero-Gómez, María Pilar; Fernández-Romero, Natalia; García-Rodríguez, Julio; Pérez-Blanco, Verónica; Moreno-Ramos, Francisco; Mingorance, Jesús

doi:10.1093/jac/dks364

Cited by 79 publications

(63 citation statements)

References 35 publications

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“…Similar to previous reports from Europe (7)(8)(9)(10), the main mechanism of this outbreak was the monoclonal spread of K. pneumoniae. The epidemic clone, ST39, was previously reported as a VIM-producing strain in a nosocomial outbreak in Spain (25) but has never been associated with OPE outbreaks.…”

Section: Discussionsupporting

confidence: 88%

“…Another unique feature of OPE in Israel and worldwide is the location of bla OXA-48 inside a Tn1999 transposon, harbored by a unique 62-kb IncL/M plasmid that is capable of interspecies self-conjugation (3,6). In recent years, outbreaks of OPE were reported in several European countries (7)(8)(9)(10). These outbreaks were caused mainly by the monoclonal spread of K. pneumoniae strains that coproduce CTX-M-15, conferring resistance also to all cephalosporins.…”

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confidence: 99%

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Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

et al. 2013

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dThis study describes the course of an OXA-48-producing Enterobacteriaceae (OPE) outbreak that started in March 2012 in a neonatal intensive care unit (NICU) in Jerusalem, Israel. During the peak of the outbreak (January to August 2012), there were 49 patients who had proven or suspected acquisition of OPE in the NICU, including 16 with invasive infections, out of a total of 156 patients who were hospitalized during that period. Three children hospitalized in the pediatric ICU were identified as carriers of OPE. Three patients with a previous stay in the affected NICU were identified as OPE carriers upon admission to another hospital. The Ministry of Health was notified and then intervened in July 2012. Intervention included cohorting colonized patients, conducting frequent rectal-culture surveillance, and improving the implementation of infection control practices. As a result, the incidence of OPE acquisition declined to 5 cases in the first 4 months, followed by no new cases in the next 3 months. Thirty-one patient-unique isolates were available for analysis: 29 Klebsiella pneumoniae isolates, all belonging to a single clone (sequence type 39 [ST39]), and 2 isolates from Enterobacter cloacae. All isolates possessed the bla OXA-48 and bla CTX-M-14 genes, which are located on the same plasmid. This plasmid, similar to the global bla OXA-48 -harboring vector, has now acquired bla CTX-M-14 , leading to resistance to all ␤-lactam agents.

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Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

et al. 2013

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“…While the patient with Klebsiella pneumoniae septicaemia recovered, the other patient expired. Many patients with infections caused by OXA producers have significant comorbidity and a prolonged hospital stay, as has been observed in this study [13].…”

Section: Discussionsupporting

confidence: 73%

“…In such infections, treatment with carbapenems results in adverse outcomes. Their detection is therefore crucial for institution of appropriate therapy and to initiate preventive measures [13].…”

Section: Discussionmentioning

confidence: 99%

OXA-181 Beta Lactamase is not a Major Mediator of Carbapenem Resistance in Enterobacteriaceae

Shanthi

Sekar²,

Hg³

2013

JCDR

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Background: Detection of carbapenem hydrolyzing class D beta lactamase OXA-181, (a variant of OXA-48) in Enterobacteriaceae, is important, to institute appropriate therapy and to initiate preventive measures. This study was done to determine the presence of OXA 48 and its derivative OXA-181 in Enterobacteriaceae of pathogenic significance. Material and Methods:One hundred and eleven non-repetitive Enterobacteriaceae isolates which were resistant to any of the cephalosporin subclasses III and which exhibited reduced susceptibility to carbapenems were included in the study. Minimum inhibitory concentrations (MICs) to imipenem and meropenem was determined by broth microdilution. Production of carbapenamase was screened by Modified Hodge test (MHT).Polymerase Chain Reaction (PCR) was done to detect the presence of bla OXA-181 and bla OXA-48 .Coexistence of other carbapenemase encoding genes, namely, NDM-1, VIM, IMP and KPC were also looked for, by PCR.Results: Of all the isolates which were tested, only 2 (1.8%) revealed the presence of OXA-181 and OXA-48. These were Klebsiella pneumoniae and Citrobacter freundii. MICs of imipenem and meropenem for Klebsiella pneumoniae were 128mg/l and 64 mg/l and for Citrobacter freundii, they were 32mg/l and 16mg/l respectively. MHT was positive in both isolates. Conclusion:Production of OXA-48 / OXA-181 is not a major mechanism of carbapenem resistance. PCR is the gold standard for its routine identification in clinical microbiology laboratory.

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“…In the Mediterranean area, outbreaks involving OXA-48-producing isolates have implicated diverse sequence types, such as ST1853, ST15, ST11, ST39, ST405, ST395, and ST101 ( Fig. 1) (13,(19)(20)(21)(22)(23)(24)(25). However, in this investigation, the outbreak was due to the pandemic ST101, which was detected for the first time in Algeria.…”

mentioning

confidence: 60%

Outbreak of OXA-48-Producing Klebsiella pneumoniae Involving a Sequence Type 101 Clone in Batna University Hospital, Algeria

Loucif

Kassah-Laouar

et al. 2016

Antimicrob Agents Chemother

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Seven nonredundant ertapenem-resistant Klebsiella pneumoniae isolates were collected between May 2014 and 19 January 2015 in the nephrology and hematology units of Batna University Hospital in Algeria. All strains coproduced the bla OXA-48 , bla CTX-M-15 , bla SHV-1 , and bla TEM-1D genes. Six of these isolates belonged to the pandemic clone sequence type 101 (ST101). The bla OXA-48 gene was located on a conjugative IncL/M-type plasmid. This is the first known outbreak of OXA-48-producing K. pneumoniae isolates involving an ST101 clone in Batna University Hospital.

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Infections caused by OXA-48-producing Klebsiella pneumoniae in a tertiary hospital in Spain in the setting of a prolonged, hospital-wide outbreak

Abstract: To our knowledge, this is the largest reported series of infections caused by O48KP in the setting of a single-centre outbreak and provides further input on the clinical relevance of infections caused by O48KP and the difficulties associated with its detection and control.

Cited by 79 publications

References 35 publications

Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

OXA-181 Beta Lactamase is not a Major Mediator of Carbapenem Resistance in Enterobacteriaceae

Outbreak of OXA-48-Producing Klebsiella pneumoniae Involving a Sequence Type 101 Clone in Batna University Hospital, Algeria

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