Rapid containment of coincident outbreaks with 2 carbapenem-resistant Klebsiella pneumoniae strains in an intensive care unit

Meybeck, Agnès; Laurans, C.; Broucqsault-Dedrie, Céline; Vanbaelinghem, Clément; Verheyde, Isabelle; Ledez, R.; Nyunga, Martine; Nottebaert, Sandrine; Waes, Sylvaine; Vachée, Anne

doi:10.1016/j.ajic.2014.04.015

Cited by 3 publications

(2 citation statements)

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“…Carbapenems constitute the last line of defense against infections caused by multidrug-resistant (MDR) Gram-negative organisms. The first case of carbapenem-resistant Klebsiella pneumoniae (CRKP) was reported in MacKenzie et al (1997), after which it spread worldwide and outbreaks were reported in several countries (Meybeck et al, 2014; Zweigner et al, 2014; Matsumura et al, 2015; Stillwell et al, 2015). In China, the prevalence of CRPK has rapidly increased from 2.9% in 2005 to 13.4% in 2014 (Hu F.-P. et al, 2016) and the distribution differed greatly by region, with the lowest prevalence in the northeast and the highest prevalence in the eastern region of China (Xu et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

et al. 2017

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Background: The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses an immediate threat to treatment worldwide. This retrospective study assessed the molecular epidemiology and determined the risk factors for and outcomes of CRKP infections in a general teaching hospital in Shanghai, China.Methods: From January 2013 to July 2015, 100 consecutive unique CRKP isolates isolated from hospitalized patients were collected. Isolates were screened for antibiotic resistance genes by polymerase chain reaction and molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Patients infected with CRKP comprised the case group and were compared to the control group of patients infected with carbapenem-susceptible Klebsiella pneumoniae. Therapeutic effects were compared in the CRKP infection group.Results: Among the 100 CRKP isolates, the percentages of multidrug-resistant, extensively drug-resistant (XDR), and pandrug-resistant were 50.0, 50.0, and 0%, respectively. All the CRKP isolates produced KPC-2 and could be divided into 18 PFGE clusters (A–O) and 70 subtypes. No dominant intra-hospital PFGE type was detected using a cutoff of 80% similarity. The ratio of CRKP infection to colonization was 51 to 49. Risk factors correlated with CRKP infection included pulmonary disease (p = 0.038), ICU stay (p = 0.002), invasive ventilation (p = 0.009), blood transfusion (p = 0.028), parenteral nutrition (p = 0.004), sputum suction (p = 0.006), medical history of previous hospitalization (p = 0.022), exposure to antibiotics 90 days before infection (p = 0.030), and antibiotic exposure during hospital stay including carbapenems (p = 0.013), enzyme inhibitors (p = 0.021), nitroimidazoles (p = 0.029), and glycopeptides (p = 0.000). Multivariable analysis showed that sputum suction (odds ratio 3.090, 95% confidence intervals 1.004–9.518, p = 0.049) was an independent risk factor for CRKP infections. Patients infected with CRKP with longer carbapenems treatment course (p = 0.002) showed better outcome.Conclusion: This study showed the severity of CRKP infection in eastern China. Sputum suction was an independent risk factor for CRKP infection. Prolonged duration of treatment with carbapenems benefited the patients infected with CRKP.

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Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

et al. 2017

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“…Recent outbreaks of multidrug resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), − Acinetobacter baumannii , − carbapenem-resistant enterobacteriaceae , and Klebsiella pneumoniae − have prompted the need to rapidly and accurately identify microbial species. At present, conventional microbiological techniques and commercially available biosensing − and microscopic − tools lack either in sensitivity, specificity, speed, accessibility, or affordability.…”

Section: Introductionmentioning

confidence: 99%

Surface Chemistry of Bacteriophage and Laser Ablated Nanoparticle Complexes for Pathogen Detection

et al. 2015

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We report the synthesis of colloidal nanoparticles, produced by the femtosecond laser ablation of a gold target, and their subsequent use in the formation of S. aureus phage−nanoparticle complexes for biodetection purposes. A detailed X-ray photoelectron spectroscopic analysis shows that the negatively charged nanoparticles that are formed interact with and subsequently internalize into the positively charged bacteriophages. These complexes render possible the specific detection of a single S. aureus bacterium in a heterogeneous sample, using dark field microscopy without complex sample treatment or amplification.

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A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae

Loon

holt

Vos

2018

Antimicrob Agents Chemother

202

138

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Carbapenem-resistant (CRE) are major health care-associated pathogens and responsible for hospital outbreaks worldwide. To prevent a further increase in CRE infections and to improve infection prevention strategies, it is important to summarize the current knowledge about CRE infection prevention in hospital settings. This systematic review aimed to identify risk factors for CRE acquisition among hospitalized patients. In addition, we summarized the environmental sources/reservoirs and the most successful infection prevention strategies related to CRE. A total of 3,983 potentially relevant articles were identified and screened. Finally, we included 162 studies in the systematic review, of which 69 studies regarding risk factors for CRE acquisition were included in the random-effects meta-analysis studies. The meta-analyses regarding risk factors for CRE acquisition showed that the use of medical devices generated the highest pooled estimate (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 3.38 to 7.67), followed by carbapenem use (OR = 4.71; 95% CI = 3.54 to 6.26). To control hospital outbreaks, bundled interventions, including the use of barrier/contact precautions for patients colonized or infected with CRE, are needed. In addition, it is necessary to optimize the therapeutic approach, which is an important message to infectious disease specialists, who need to be actively involved in a timely manner in the treatment of patients with known CRE infections or suspected carriers of CRE.

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Rapid containment of coincident outbreaks with 2 carbapenem-resistant Klebsiella pneumoniae strains in an intensive care unit

Cited by 3 publications

References 8 publications

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

Surface Chemistry of Bacteriophage and Laser Ablated Nanoparticle Complexes for Pathogen Detection

A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae

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