Intensive Care Unit Outbreak of Extended-Spectrum <i>β</i>-Lactamase–Producing <i>Klebsiella Pneumoniae</i> Controlled by Cohorting Patients and Reinforcing Infection Control Measures

Laurent, C; Rodríguez-Villalobos, Hector; Rost, F.; Strale, H.; Vincent, Jean‐Louis; Deplano, Ariane; Struelens, Marc; Byl, Baudouin

doi:10.1086/588004

Cited by 67 publications

(76 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The latter intervention is costly and could not be continued due to economic constraints. Other potentially effective but costly interventions, which include the cohorting of carriers and staff or even closing of the units and the total removal of all environmental as well as patient reservoirs, were not undertaken (23).…”

Section: Resultsmentioning

confidence: 99%

Nosocomial Outbreak of VIM-1-Producing Klebsiella pneumoniae Isolates of Multilocus Sequence Type 15: Molecular Basis, Clinical Risk Factors, and Outcome

Sánchez-Romero

Asensio

Oteo

et al. 2012

Antimicrob Agents Chemother

View full text Add to dashboard Cite

We study the epidemiology, molecular basis, clinical risk factors, and outcome involved in the clonal dissemination of VIM-1-producing Klebsiella pneumoniae isolates in the hospital setting. All patients infected/colonized by carbapenem-nonsusceptible K. pneumoniae (CNSKP) in 2009 were included. Molecular epidemiology was studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Antibiotic resistance genes were analyzed by PCR and sequencing. Plasmids were studied by PFGE with S1 nuclease digestion and for incompatibility group by a PCR-based replicon typing scheme. Risk factors associated with CNSKP colonization/infection were assessed by an observational case-control study. All 55 patients studied were infected (n ‫؍‬ 28) or colonized (n ‫؍‬ 27) by VIM-1-producing K. pneumoniae. All but one acquired isolates of a single clone (PFGE cluster 1 [C1], sequence type 15 [ST15]), while another clone (PFGE C2, ST340) was detected in four patients. C1 isolates also produced the new extended-spectrum ␤-lactamase SHV-134. bla VIM-1 was carried in a class 1 integron and an untypeable plasmid of ϳ50 bp. The number of days that the patient received mechanical ventilation, the use of parenteral nutrition, previous treatment with linezolid, and treatment with extended-spectrum cephalosporins for more than 7 days were detected to be independent risk factors for CNSKP acquisition. The VIM-1-producing K. pneumoniae ST15 clone has a high capacity to spread among intensive care unit patients with severe underlying conditions. A high rate of associated mortality and great difficulty in controlling the spread of this clone, without permanent behavioral changes in the personnel, were observed.

show abstract

Section: Resultsmentioning

confidence: 99%

Nosocomial Outbreak of VIM-1-Producing Klebsiella pneumoniae Isolates of Multilocus Sequence Type 15: Molecular Basis, Clinical Risk Factors, and Outcome

Sánchez-Romero

Asensio

Oteo

et al. 2012

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…Reinforcement of infection control measures can hinder intrahospital dissemination of resistant isolates (38). In the current epidemic, diligent disinfection of inanimate surfaces, adherence to an intensified cleaning routine, and patient cohorting seem to have contributed to effective control of the outbreak after 7 months.…”

Section: Discussionmentioning

confidence: 99%

Outbreak Caused by an Ertapenem-Resistant, CTX-M-15-Producing Klebsiella pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant

et al. 2013

View full text Add to dashboard Cite

Although numerous studies have documented outbreaks of carbapenem-resistant Klebsiella pneumoniae (CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum ␤-lactamases (ESBLs) and/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal K. pneumoniae strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant K. pneumoniae isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining ␤-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the bla CTX-M-15 gene on a conjugative 100-kb plasmid, disruption in the expression of the ompK35 gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental K. pneumoniae isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak.

show abstract

“…The extendedspectrum ␤-lactamase (ESBL)-producing K. pneumoniae collection included 2 sets of strains: (i) CTX-M-15-producing K. pneumoniae strains (n ϭ 18) from an outbreak in the intensive care unit (ICU) of a university hospital (20) and ( (2,15). DiversiLab typing.…”

Section: Methodsmentioning

confidence: 99%

Controlled Performance Evaluation of the DiversiLab Repetitive-Sequence-Based Genotyping System for Typing Multidrug-Resistant Health Care-Associated Bacterial Pathogens

Deplano¹,

Denis²,

Rodríguez-Villalobos³

et al. 2011

J Clin Microbiol

View full text Add to dashboard Cite

Fast, reliable, and versatile typing tools are essential to differentiate among related bacterial strains for epidemiological investigation and surveillance of health care-associated infection with multidrug-resistant (MDR) pathogens. The DiversiLab (DL) system is a semiautomated repetitive-sequence-based PCR system designed for rapid genotyping. The DL system performance was assessed by comparing its reproducibility, typeability, discriminatory power, and concordance with those of pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and by assessing its epidemiological concordance on well-characterized MDR bacterial strains (n ‫؍‬ 165). These included vanA Enterococcus faecium, extended-spectrum ␤-lactamase (ESBL)-producing strains of Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, and ESBL-or metallo-␤-lactamase (MBL)-producing Pseudomonas aeruginosa strains. The DL system showed very good performance for E. faecium and K. pneumoniae and good performance for other species, except for a discrimination index of <95% for A. baumannii and E. coli (93.9% and 93.5%, respectively) and incomplete concordance with MLST for P. aeruginosa (78.6%) and E. coli (97.0%). Occasional violations of MLST assignment by DL types were noted for E. coli. Complete epidemiological concordance was observed for all pathogens, as all outbreak-associated strains clustered in identical DL types that were distinct from those of unrelated strains. In conclusion, the DL system showed good to excellent performance, making it a reliable typing tool for investigation of outbreaks caused by study pathogens, even though it was generally less discriminating than PFGE analysis. For E. coli and P. aeruginosa, MLST cannot be reliably inferred from DL type due to phylogenetic group violation or discordance.Rapid assessment of microbial clonal relationships enables the tracking of the spread of multidrug-resistant (MDR) pathogens and guides transmission control measures in the hospital setting. The ideal typing method should be rapid, easy to perform, high throughput, and applicable to a wide range of microorganisms and should meet performance criteria, such as full typeability, reproducibility, high discriminatory power, and concordance with validated typing methods as well as consistency with underlying subspecies genetic population structures (29, 31). In the hospital setting, identification of epidemic strains is usually based on fingerprinting methods, such as pulsed-field gel electrophoresis (PFGE), a labor-intensive method that requires 3 to 4 days to produce results. The DiversiLab (DL) system (bioMérieux, Marcy l'Etoile, France) is a repetitive-sequence-based PCR (rep-PCR) technology which offers semiautomated, easy-to-use, high-throughput, and rapid bacterial strain typing. It could be a suitable alternative to PFGE analysis for outbreak investigation of health care-associated pathogens. This method was recently validated for typing of Acinetobacter spp., Escherichia coli, and Klebsiella spp., but...

show abstract

Intensive Care Unit Outbreak of Extended-Spectrum β-Lactamase–Producing Klebsiella Pneumoniae Controlled by Cohorting Patients and Reinforcing Infection Control Measures

Abstract: These data indicate that, in an intensive care department in which routine screening and contact precautions failed to prevent and interrupt an outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures controlled the outbreak without major disruption of medical care.

Cited by 67 publications

References 25 publications

Nosocomial Outbreak of VIM-1-Producing Klebsiella pneumoniae Isolates of Multilocus Sequence Type 15: Molecular Basis, Clinical Risk Factors, and Outcome

Nosocomial Outbreak of VIM-1-Producing Klebsiella pneumoniae Isolates of Multilocus Sequence Type 15: Molecular Basis, Clinical Risk Factors, and Outcome

Outbreak Caused by an Ertapenem-Resistant, CTX-M-15-Producing Klebsiella pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant

Controlled Performance Evaluation of the DiversiLab Repetitive-Sequence-Based Genotyping System for Typing Multidrug-Resistant Health Care-Associated Bacterial Pathogens

Contact Info

Product

Resources

About