Successful control of the first carbapenem-resistant Klebsiella pneumoniae outbreak in a Chinese hospital 2017–2019

Abstract

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is considered as a serious global threat. CRKPs occurred only sporadically in the Second Hospital of Shanxi Medical University. Our study aimed to investigate and control the first outbreak of CRKP in our hospital occurred between October 2017 and August 2019. Methods: The antimicrobial stewardship (AMS) workers have been implemented control measures properly. Clinical and epidemiological data were retrospectively collected from medical records. Carbapenemase genes were detected by modified carbapenem inactivation method (mCIM) test and the EDTA-modified carbapenem inactivation method (eCIM) test. Resistance genes were identified by polymerase chain reaction (PCR) and sequencing. Genetic relatedness was studied by multilocus sequence typing (MLST). Results: During the outbreak, 31 patients were infected with CRKP isolates. 20 (64.5%) patients were infected with KPC-2 and/or NDM-1 producing K. pneumoniae. Mostly MLST-sequence types belonged to ST11 (21/31). The outbreak was two major K. pneumoniae clusters present in epidemiologically linked patients. Conclusions: Setting up AMS workers is potentially a highly efficient strategy for the successful control of the outbreak. A multimodal and multidisciplinary infection control strategy proved to be crucial. The emergence of CRKP in our hospital emphasizes the importance of continuous monitoring of these isolates, which helps to limit the spread of CRKPs and improve the level of management.

Outbreak of Multidrug-Resistant OXA-232-Producing ST15 Klebsiella pneumoniae in a Teaching Hospital in Wenzhou, China

“…The horizontal transmission of mobile elements such as plasmids, phages, integrations, conjugate elements, and insertion elements is a key factor in the outbreak of K. pneumoniae . 27 Potron A. and colleagues found that the plasmid-mediated carbapenem-resistance gene bla OXA-232 was located on a small plasmid pOXA-232 of 6,41 bp and carried a ColE-type backbone. 4 The plasmid pOXA-232 was a non-conjugative plasmid because it could not be transferred through conjugation experiments.…”

Three Novel Sequence Types Carbapenem-Resistant Klebsiella pneumoniae Strains ST5365, ST5587, ST5647 Isolated from Two Tertiary Teaching General Hospitals in Shanxi Province, in North China: Molecular Characteristics, Resistance and Virulence Factors

“…In Zhu et al study, in a Chinese hospital from 2017 to 2019, the first CRKP outbreak which presumably put down to cross-transmitted among patients was successfully controlled via the multimodal and multidisciplinary infection control and effective surveillance. 38 Thus, only strict prevention and effective control can be taken to commendably interdict the occurrence and rapid spread of nosocomial cross-infections.…”

A case–control study of infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase-1: Predictors and outcomes

“…In our case, a significant risk factor for acquiring KP-NDM-1 infection was the use of previous antibiotics, including meropenem, which was analogous to device-related infections; the use of antibiotics has also been reported as a risk factor in the medical literature ( Tian et al., 2018 ; Snyder et al., 2019 ; Kollef et al., 2021 ; Seo et al., 2021 ). Carbapenem-resistant K. pneumoniae and KP-NDM-1 can cause outbreaks ( Zhu et al., 2020 ). A report from Singapore analyzing an outbreak of NDM-1-producing Enterobacter cloacae among adults admitted to an acute hospital’s general ward showed that comorbidities and recent antibiotic use were significant risk factors ( Ho et al., 2016 ).…”