Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla IMP-4 and bla DHA-1 in a neonatal intensive care unit in China

Yu, Fangyou; Ying, Qunhua; Chen, Chun; Li, Tingjian; Ding, Baixing; Liu, Ying; Lu, Yuanyuan; Qin, Zhiqiang; Parsons, Chris; Salgado, Cassandra D.; Qu, Di; Pan, Jingye; Wang, Liangxing

doi:10.1099/jmm.0.043000-0

Cited by 38 publications

(29 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In fact, only sporadic cases and a few small outbreaks caused by similar strains have been described for NICU settings (15)(16)(17). This probably reflects the overall lower prevalence of pACBLs versus ESBLs among Enterobacteriaceae, although the difficulties in pACBL detection encountered in the clinical microbiology laboratory also could contribute to underestimation of the circulation of these resistance determinants.…”

Section: Discussionmentioning

confidence: 91%

“…Production of other ␤-lactamases, such as AmpC-type ␤-lactamases (ACBLs), can also be responsible for ESC-resistant phenotypes in K. pneumoniae, but the number of reported outbreaks caused by AmpCproducing ESCRKP is considerably more limited. Thus far, only ESCRKP strains producing DHA-type or CMY-type ACBLs, coproduced with ESBLs or metallo-␤-lactamases, have been involved in a minority of NICU outbreaks of relatively small dimensions (15)(16)(17). Due to their rare occurrence, outbreaks caused by ACBL-producing K. pneumoniae have been less studied, and scarce information is available on incidence, clonal relationships between isolates, clinical impact, and containment measures (18).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Large Oligoclonal Outbreak Due to Klebsiella pneumoniae ST14 and ST26 Producing the FOX-7 AmpC β-Lactamase in a Neonatal Intensive Care Unit

et al. 2013

View full text Add to dashboard Cite

A large outbreak caused by expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCRKP) was observed in a neonatal intensive care unit (NICU) in central Italy. The outbreak involved 127 neonates (99 colonizations and 28 infections, with seven cases of sepsis and two deaths) over a period of more than 2 years (February 2008 to April 2010). Characterization of the 92 nonredundant isolates that were available for further investigation revealed that all of them except one produced the FOX-7 AmpC-type ␤-lactamase and belonged to either sequence type 14 (ST14) or ST26. All of the FOX-7-positive isolates were resistant to cefotaxime, ceftazidime, and piperacillin-tazobactam, while 76% were susceptible to cefepime, 98% to ertapenem, 99% to meropenem, and 100% to imipenem. The two carbapenem-nonsusceptible isolates had alterations in the genes encoding outer membrane proteins K35 and K36, which resulted in truncated and likely nonfunctional proteins. The outbreak was eventually controlled by the reinforcement of infection control measures based on a multitiered interventional approach. This is the first report of a large NICU outbreak caused by ESCRKP producing an AmpC-type enzyme. This study demonstrates that AmpCtype enzyme-producing strains can cause large outbreaks with significant morbidity and mortality effects (the mortality rate at 14 days was 28.5% for episodes of sepsis), and it underscores the role of laboratory-based surveillance and infection control measures to contain similar episodes.

show abstract

Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

Large Oligoclonal Outbreak Due to Klebsiella pneumoniae ST14 and ST26 Producing the FOX-7 AmpC β-Lactamase in a Neonatal Intensive Care Unit

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Although cases from other cities in China have been reported, all of these reports were individually IMP-4 or IMP-8 genotype, and the number of cases were small 16,[24][25][26][27][28] . This occurrence included a variety of Enterobacteriaceae, which was mainly K. pneumoniae.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital

Pang¹,

Jia²,

Song³

et al. 2016

Afr H. Sci.

View full text Add to dashboard Cite

Background: The emergence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases is rare. We report an occurrence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases in a Chinese tertiary care hospital from November 2010 to December 2012. Methods: The clinical characteristics of 30 patients were described. The genetic relationship of isolates was determined by pulsed-field gel electrophoresis (PFGE). Carbapenemases were detected by modified Hodge test (MHT) and polymerase chain reactions (PCRs). Amplicons were sequenced and blasted to determine the genotype. Results: Most infected patients were from intensive care unit and had complex and serious underlying illnesses requiring mechanical ventilation. PFGE revealed that Klebsiella pneumoniae showed two major PFGE types. Two Klebsiella oxytoca had an indistinguishable PFGE pattern, while four Enterobacter cloacae were different strains. The sequencing studies showed Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in the 23 infected patients. The majority of patients had infections with the carbapenemase-producing Enterobacteriaceae (CPE) strain, most were successfully treated with a range of antibiotics and discharged. Conclusion: It is important to maintain a high index of suspicion to screen for carbapenemase-producing Enterobacteriaceae strains. Rapid identification of these strains and implementation of stringent procedures are the key to prevent major outbreaks in a hospital setting.

show abstract

“…For most bacterial species, the technique was adopted as an epidemiological tool in the 1990s [3][4][5][6]. Today, it is still the most frequently used approach to characterise bacterial isolates in outbreaks [7,8] as revealed by a PubMed database search with a restriction to articles published between January 2011 and the present day. In total, 183 hits were obtained for the terms 'PFGE AND outbreak', while searches for all other methods in combination with the term 'outbreak' invariably resulted in less than 100 hits.…”

Section: Pulsed-field Gel Electrophoresismentioning

confidence: 99%

Overview of molecular typing methods for outbreak detection and epidemiological surveillance

et al. 2013

View full text Add to dashboard Cite

Typing methods for discriminating different bacterial isolates of the same species are essential epidemiological tools in infection prevention and control. Traditional typing systems based on phenotypes, such as serotype, biotype, phage-type, or antibiogram, have been used for many years. However, more recent methods that examine the relatedness of isolates at a molecular level have revolutionised our ability to differentiate among bacterial types and subtypes. Importantly, the development of molecular methods has provided new tools for enhanced surveillance and outbreak detection. This has resulted in better implementation of rational infection control programmes and efficient allocation of resources across Europe. The emergence of benchtop sequencers using next generation sequencing technology makes bacterial whole genome sequencing (WGS) feasible even in small research and clinical laboratories. WGS has already been used for the characterisation of bacterial isolates in several large outbreaks in Europe and, in the near future, is likely to replace currently used typing methodologies due to its ultimate resolution. However, WGS is still too laborious and time-consuming to obtain useful data in routine surveillance. Also, a largely unresolved question is how genome sequences must be examined for epidemiological characterisation. In the coming years, the lessons learnt from currently used molecular methods will allow us to condense the WGS data into epidemiologically useful information. On this basis, we have reviewed current and new molecular typing methods for outbreak detection and epidemiological surveillance of bacterial pathogens in clinical practice, aiming to give an overview of their specific advantages and disadvantages.

show abstract

Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla IMP-4 and bla DHA-1 in a neonatal intensive care unit in China

Cited by 38 publications

References 29 publications

Large Oligoclonal Outbreak Due to Klebsiella pneumoniae ST14 and ST26 Producing the FOX-7 AmpC β-Lactamase in a Neonatal Intensive Care Unit

Large Oligoclonal Outbreak Due to Klebsiella pneumoniae ST14 and ST26 Producing the FOX-7 AmpC β-Lactamase in a Neonatal Intensive Care Unit

Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital

Overview of molecular typing methods for outbreak detection and epidemiological surveillance

Contact Info

Product

Resources

About