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Roux J, Nekkab N, Colomb-Cotinat M, Astagneau P, Crépey P. Time-series modelling for the quantification of seasonality and forecasting antibiotic-resistant episodes: application to carbapenemase-producing Enterobacteriaceae episodes in France over 2010-20. J Antimicrob Chemother 2021; 76:226-232. [PMID: 32929455 DOI: 10.1093/jac/dkaa388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/17/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacteriaceae (CPE) cause resistant healthcare-associated infections that jeopardize healthcare systems and patient safety worldwide. The number of CPE episodes has been increasing in France since 2009, but the dynamics are still poorly understood. OBJECTIVES To use time-series modelling to describe the dynamics of CPE episodes from August 2010 to December 2016 and to forecast the evolution of CPE episodes for the 2017-20 period. METHODS We used time series to analyse CPE episodes from August 2010 to November 2016 reported to the French national surveillance system. The impact of seasonality was quantified using seasonal-to-irregular ratios. Seven time-series models and three ensemble stacking models (average, convex and linear stacking) were assessed and compared with forecast CPE episodes during 2017-20. RESULTS During 2010-16, 3559 CPE episodes were observed in France. Compared with the average yearly trend, we observed a 30% increase in the number of CPE episodes in the autumn. We noticed a 1 month lagged seasonality of non-imported episodes compared with imported episodes. Average stacking gave the best forecasts and predicted an increase during 2017-20 with a peak up to 345 CPE episodes (95% prediction interval = 124-1158, 80% prediction interval = 171-742) in September 2020. CONCLUSIONS The observed seasonality of CPE episodes sheds light on potential factors associated with the increased frequency of episodes, which need further investigation. Our model predicts that the number of CPE episodes will continue to rise in the coming years in France, mainly due to local dissemination, associated with bacterial carriage by patients in the community, which is becoming an immediate challenge with regard to outbreak control.
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Affiliation(s)
- Jonathan Roux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research) - EA 7449, Rennes, France
| | - Narimane Nekkab
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers, Paris, France.,Institut Pasteur, Cnam, Unité PACRI, Paris, France
| | | | - Pascal Astagneau
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Centre de prévention des infections associées aux soins, Paris, France
| | - Pascal Crépey
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research) - EA 7449, Rennes, France
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2
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Tian H, Sun J, Guo S, Zhu X, Feng H, Zhuang Y, Wang X. The Effectiveness of Drying on Residual Droplets, Microorganisms, and Biofilms in Gastrointestinal Endoscope Reprocessing: A Systematic Review. Gastroenterol Res Pract 2021; 2021:6615357. [PMID: 33927758 PMCID: PMC8049816 DOI: 10.1155/2021/6615357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite endoscope reprocessing, residual droplets remain in gastrointestinal endoscope working channels. Inadequate drying of gastrointestinal endoscope working channels may promote microbial reproduction and biofilm formation, increasing the risk of infection in patients. This review was designed to provide the current status of gastrointestinal endoscope drying, emphasize the importance of gastrointestinal endoscope drying, and evaluate the effectiveness of different drying methods of gastrointestinal endoscope in reducing residual droplets and microbial growth risk. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting checklist. The PubMed, Web of Science, Medline, EMBASE, EBSCO, CNKI, CQVIP, and Wanfang Data databases were searched from 2010 to 2020 to identify eligible articles focused on methods of gastrointestinal endoscope drying and the status of endoscope drying. The following key points were analyzed: type of intervention, amount of residual droplets, major microbial types, and effectiveness of biofilm intervention. JBI quality assessment tool was used to determine bias risk for inclusion in the article. RESULTS This review included twelve articles. Two of the articles reported lack of drying of gastrointestinal endoscopes while the other ten reported residual droplets, microbial growth, and biofilm formation after different methods of drying. Four articles reported 0 to 4.55 residual droplets; four articles reported that the main microbial types were cocci and bacilli, most commonly Staphylococcus, Escherichia coli, Bacillus maltophilia, and Pseudomonas aeruginosa; and two reported that drying could effectively reduce biofilm regeneration. The type of intervention is as follows: automatic endoscopy reprocessor (AER), manual compressed air drying, and the Dri-Scope Aid for automatic drying and drying cabinet. CONCLUSIONS While endoscope reprocessing may not always be effective, an automatic endoscope reprocessor plus the Dri-Scope Aid with automatic drying over 10 min or storage in a drying cabinet for 72 h may be preferred.
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Affiliation(s)
- Hefeng Tian
- 1The First Hospital of Jilin University, Changchun, China
| | - Jiao Sun
- 2School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province 130021, China
| | - Shaoning Guo
- 1The First Hospital of Jilin University, Changchun, China
| | - Xuanrui Zhu
- 1The First Hospital of Jilin University, Changchun, China
| | - Han Feng
- 1The First Hospital of Jilin University, Changchun, China
| | - Yijin Zhuang
- 1The First Hospital of Jilin University, Changchun, China
| | - Xiu Wang
- 1The First Hospital of Jilin University, Changchun, China
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3
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Nekkab N, Crépey P, Astagneau P, Opatowski L, Temime L. Assessing the role of inter-facility patient transfer in the spread of carbapenemase-producing Enterobacteriaceae: the case of France between 2012 and 2015. Sci Rep 2020; 10:14910. [PMID: 32913244 PMCID: PMC7483561 DOI: 10.1038/s41598-020-71212-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/31/2020] [Indexed: 11/09/2022] Open
Abstract
The spread of carbapenemase-producing Enterobacteriaceae (CPE) in healthcare settings is a major public health threat that has been associated with cross-border and local patient transfers between healthcare facilities. Since the impact of transfers on spread may vary, our study aimed to assess the contribution of a patient transfer network on CPE incidence and spread at a countrywide level, with a case study of France from 2012 to 2015. Our results suggest a transition in 2013 from a CPE epidemic sustained by internationally imported episodes to an epidemic sustained by local transmission events through patient transfers. Incident episodes tend to occur within close spatial distance of their potential infector. We also observe an increasing frequency of multiple spreading events, originating from a limited number of regional hubs. Consequently, coordinated prevention and infection control strategies should focus on transfers of carriers of CPE to reduce regional and inter-regional transmission.
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Affiliation(s)
- Narimane Nekkab
- Laboratoire MESuRS, Conservatoire National Des Arts Et Métiers, Paris, France. .,Unité PACRI, Institut Pasteur, Conservatoire National Des Arts Et Métiers, Paris, France. .,EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, University Rennes, Rennes, France.
| | - Pascal Crépey
- EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, University Rennes, Rennes, France
| | - Pascal Astagneau
- Centre régional de prévention Des Infections associées Aux Soins (CPias), Paris, France.,INSERM, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, Sorbonne Université, 75013, Paris, France
| | - Lulla Opatowski
- UMR 1181, «Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases» (B2PHI), University Versailles Saint Quentin en Yvelines, Saint Quentin en Yvelines, France.,Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, Paris, France.,Inserm UMR 1181 (B2PHI), Paris, France
| | - Laura Temime
- Laboratoire MESuRS, Conservatoire National Des Arts Et Métiers, Paris, France.,Unité PACRI, Institut Pasteur, Conservatoire National Des Arts Et Métiers, Paris, France
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4
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Epidemiology of carbapenemase-producing Klebsiella pneumoniae in northern Portugal: Predominance of KPC-2 and OXA-48. J Glob Antimicrob Resist 2020; 22:349-353. [DOI: 10.1016/j.jgar.2020.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
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5
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Contamination of chicken meat with extended-spectrum beta-lactamase producing- Klebsiella pneumoniae and Escherichia coli during scalding and defeathering of broiler carcasses. Food Microbiol 2019; 77:185-191. [DOI: 10.1016/j.fm.2018.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 01/04/2023]
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6
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Nekkab N, Astagneau P, Temime L, Crépey P. Spread of hospital-acquired infections: A comparison of healthcare networks. PLoS Comput Biol 2017; 13:e1005666. [PMID: 28837555 PMCID: PMC5570216 DOI: 10.1371/journal.pcbi.1005666] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022] Open
Abstract
Hospital-acquired infections (HAIs), including emerging multi-drug resistant organisms, threaten healthcare systems worldwide. Efficient containment measures of HAIs must mobilize the entire healthcare network. Thus, to best understand how to reduce the potential scale of HAI epidemic spread, we explore patient transfer patterns in the French healthcare system. Using an exhaustive database of all hospital discharge summaries in France in 2014, we construct and analyze three patient networks based on the following: transfers of patients with HAI (HAI-specific network); patients with suspected HAI (suspected-HAI network); and all patients (general network). All three networks have heterogeneous patient flow and demonstrate small-world and scale-free characteristics. Patient populations that comprise these networks are also heterogeneous in their movement patterns. Ranking of hospitals by centrality measures and comparing community clustering using community detection algorithms shows that despite the differences in patient population, the HAI-specific and suspected-HAI networks rely on the same underlying structure as that of the general network. As a result, the general network may be more reliable in studying potential spread of HAIs. Finally, we identify transfer patterns at both the French regional and departmental (county) levels that are important in the identification of key hospital centers, patient flow trajectories, and regional clusters that may serve as a basis for novel wide-scale infection control strategies. Hospital-acquired infections (HAIs), including emerging multi-drug resistant organisms, threaten healthcare systems worldwide. Efficient containment measures of HAIs must mobilize the entire healthcare network. Thus, to best understand how to reduce the scale of potential HAI epidemic spread, we explore patient transfer patterns in the French healthcare system. We construct and compare the characteristics of three different patient transfer networks based on data on transfers of patients with diagnosed HAIs, suspected HAIs, or of all patients. Our analyses show that these healthcare networks, the patient populations that comprise them and the patient movement patterns are heterogeneous and centralized. Despite the differences in patient populations, the HAI-specific and suspected-HAI healthcare networks have the same underlying structure as that of the general healthcare network. We identify key hospital centers, patient flow trajectories, at both the regional and department (county) level that may serve as a basis for proposing novel wide-scale infection control strategies.
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Affiliation(s)
- Narimane Nekkab
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers, 292 Rue Saint-Martin, Paris, France
- Institut Pasteur, Cnam, Unité PACRI, 25–28, rue du Docteur Roux, Paris, France
- Ecole des Hautes Etudes en Santé Publique, Département d'Epidémiologie et de Biostatistiques, 15 Avenue du Professeur-Léon-Bernard, Rennes, France
- * E-mail:
| | - Pascal Astagneau
- Ecole des Hautes Etudes en Santé Publique, Département d'Epidémiologie et de Biostatistiques, 15 Avenue du Professeur-Léon-Bernard, Rennes, France
- Centre de prévention des infections associées aux soins (C-CLIN), APHP, Paris, France
- Faculté de médecine Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - Laura Temime
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers, 292 Rue Saint-Martin, Paris, France
- Institut Pasteur, Cnam, Unité PACRI, 25–28, rue du Docteur Roux, Paris, France
| | - Pascal Crépey
- Ecole des Hautes Etudes en Santé Publique, Département d'Epidémiologie et de Biostatistiques, 15 Avenue du Professeur-Léon-Bernard, Rennes, France
- UMR190, Emergence des Pathologies Virales, Marseille, France
- UPRES EA 7449 Reperes, Rennes, France
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7
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Abstract
Inadequate drying of endoscope channels is a possible cause of replication and survival of remaining pathogens during storage. The presence during storage of potentially contaminated water in endoscope channels may promote bacterial proliferation and biofilm formation. An incomplete drying procedure or lack of drying and not storing in a vertical position are the most usual problems identified during drying and endoscope storage. Inadequate drying and storage procedures, together with inadequate cleaning and disinfection, are the most important sources of endoscope contamination and post-endoscopic infection. Flexible endoscopes may be dried in automated endoscope reprocessors (AERs), manually, or in drying/storage cabinets. Flushing of the endoscope channels with 70-90% ethyl or isopropyl alcohol followed by forced air drying is recommended by several guidelines. Current guidelines recommend that flexible endoscopes are stored in a vertical position in a closed, ventilated cupboard. Drying and storage cabinets have a drying system that circulates and forces the dry filtered air through the endoscope channels. Endoscope reprocessing guidelines are inconsistent with one another or give no exact recommendations about drying and storage of flexible endoscopes. There is no conclusive evidence on the length of time endoscopes can be safely stored before requiring re-disinfection and before they pose a contamination risk. To minimize the risk of disease transmission and nosocomial infection, modification and revision of guidelines are recommended as required to be consistent with one another.
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Affiliation(s)
- J Kovaleva
- Centre for Medical Analysis, Herentals, Belgium.
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8
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Infectious complications in gastrointestinal endoscopy and their prevention. Best Pract Res Clin Gastroenterol 2016; 30:689-704. [PMID: 27931630 DOI: 10.1016/j.bpg.2016.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 01/31/2023]
Abstract
Gastrointestinal endoscopes are medical devices that have been associated with outbreaks of health care-associated infections. Because of the severity and limited treatment options of infections caused by multidrug-resistant Enterobacteriaceae and Pseudomonas aeruginosa, considerable attention has been paid to detection and prevention of these post-endoscopic outbreaks. Endoscope reprocessing involves cleaning, high-level disinfection/sterilization followed by rinsing and drying before storage. Failure of the decontamination process implies the risk of settlement of biofilm producing species in endoscope channels. This review covers the infectious complications in gastrointestinal endoscopy and their prevention and highlights the problem of infection risk associated with different steps of endoscope reprocessing.
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9
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Tavares CP, Pereira PS, Marques EDA, Faria C, de Souza MDPAH, de Almeida R, Alves CDFM, Asensi MD, Carvalho-Assef APD. Molecular epidemiology of KPC-2-producing Enterobacteriaceae (non-Klebsiella pneumoniae) isolated from Brazil. Diagn Microbiol Infect Dis 2015; 82:326-30. [PMID: 25935630 DOI: 10.1016/j.diagmicrobio.2015.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/31/2015] [Accepted: 04/13/2015] [Indexed: 11/18/2022]
Abstract
In Brazil, since 2009, there has been an ever increasing widespread of the bla(KPC-2) gene, mainly in Klebsiella pneumoniae. This study aims to assess the molecular epidemiology and genetic background of this gene in Enterobacteriaceae (non-K. pneumoniae) species from 9 Brazilian states between 2009 and 2011. Three hundred eighty-seven isolates were analyzed exhibiting nonsusceptibility to carbapenems, in which the bla(KPC-2) gene was detected in 21.4%. By disk diffusion and E-test, these isolates exhibited high rates of resistance to most of the antimicrobials tested, including tigecycline (45.6% nonsusceptible) and polymyxin B (16.5%), the most resistant species being Enterobacter aerogenes and Enterobacter cloacae. We found great clonal diversity and a variety of bla(KPC-2)-carrying plasmids, all of them exhibiting a partial Tn4401 structure. Therefore, this study demonstrates the dissemination of KPC-2 in 9 Enterobacteriaceae species, including species that were not previously described such as Pantoea agglomerans and Providencia stuartii.
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Affiliation(s)
| | | | - Elizabeth de Andrade Marques
- Departamento de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, RJ, Brazil
| | - Celio Faria
- Laboratório Central de Saúde Pública do Distrito Federal, DF, Brazil
| | | | | | | | - Marise Dutra Asensi
- Laboratório de Pesquisa em Infecção Hospitalar, Oswaldo Cruz Institute, RJ, Brazil
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10
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Partridge SR, Ginn AN, Wiklendt AM, Ellem J, Wong JSJ, Ingram P, Guy S, Garner S, Iredell JR. Emergence of blaKPC carbapenemase genes in Australia. Int J Antimicrob Agents 2014; 45:130-6. [PMID: 25465526 DOI: 10.1016/j.ijantimicag.2014.10.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 10/02/2014] [Accepted: 10/06/2014] [Indexed: 01/03/2023]
Abstract
blaKPC genes encoding resistance to carbapenems are increasingly widely reported and are now endemic in parts of several countries, but only one Klebsiella pneumoniae isolate carrying blaKPC-2 had previously been reported in Australia, in 2010. Here we characterised this isolate, six additional K. pneumoniae and one Escherichia coli carrying blaKPC and another K. pneumoniae lacking blaKPC, all isolated in Australia in 2012. Seven K. pneumoniae belonged to clonal complex (CC) 292, associated with blaKPC in several countries. Five with blaKPC-2 plus the isolate lacking a blaKPC gene were sequence type 258 (ST258) and the seventh was the closely related ST512 with blaKPC-3. The eighth K. pneumoniae isolate, novel ST1048, and the E. coli (ST131) also carried blaKPC-2. blaKPC genes were associated with the most common Tn4401a variant, which gives the highest levels of expression, in all isolates. The ST258 isolates appeared to share a similar set of plasmids, with IncFIIK, IncX3 and ColE-type plasmids identified in most isolates. All K. pneumoniae isolates had a characteristic insertion in the ompK35 gene resulting in a frameshift and early termination, but only the ST512 isolate had a GlyAsp insertion in loop 3 of OmpK36 that may contribute to increased resistance. The clinical epidemiology of blaKPC emergence in Australia thus appears to reflect the global dominance of K. pneumoniae CC292 (and perhaps E. coli ST131). Some, but not all, patients carrying these isolates had previously been hospitalised outside Australia, suggesting multiple discrete importation events of closely related strains, as well as undetected nosocomial spread.
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Affiliation(s)
- Sally R Partridge
- Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Westmead Millennium Institute, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Andrew N Ginn
- Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Westmead Millennium Institute, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Agnieszka M Wiklendt
- Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW, Australia
| | - Justin Ellem
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW, Australia
| | - Jenny S J Wong
- Dorevitch Pathology, Department of Microbiology, Footscray, Vic., Australia
| | - Paul Ingram
- Department of Microbiology, Royal Perth Hospital, Perth, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | - Stephen Guy
- Department of Infectious Diseases, Western Health, Footscray, Vic., Australia
| | - Sarah Garner
- Dorevitch Pathology, Department of Microbiology, Heidelberg, Vic., Australia
| | - Jonathan R Iredell
- Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Westmead Millennium Institute, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia.
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11
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Gastmeier P, Vonberg RP. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection 2013; 42:15-21. [PMID: 24166131 DOI: 10.1007/s15010-013-0544-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Two endoscopy-associated nosocomial outbreaks caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) were recently observed in two German hospitals. In this study, we performed a systematic search of the medical literature in order to elucidate the epidemiology of Klebsiella spp. in endoscopy-associated outbreaks. METHODS Medline, the Outbreak Database ( http://www.outbreak-database.com ) and reference lists of articles extracted from these databases were screened for descriptions of endoscopy-associated nosocomial outbreaks. The data extracted and analysed were: (1) the type of medical department affected; (2) characterisation of pathogen to species and conspicuous resistance patterns (if applicable); (3) type of endoscope and the grade of its contamination; (4) number and the types of infections; (5) actual cause of the outbreak. RESULTS A total of seven nosocomial outbreaks were identified, of which six were outbreaks of endoscopic retrograde cholangiopancreatography-related infections and caused by contaminated duodenoscopes. Including our own outbreaks in the analysis, we identified one extended-spectrum beta-lactamase-producing K. pneumoniae strain and six CPKP strains. Insufficient reprocessing after the use of the endoscope was the main reason for subsequent pathogen transmission. CONCLUSIONS There were only two reports of nosocomial outbreaks due to Klebsiella spp. in the first three decades of endoscopic procedures, but seven additional outbreaks of this kind have been reported within the last 4 years. It is very likely that many of such outbreaks have been missed in the past because this pathogen belongs to the physiological gut flora. However, with the emergence of highly resistant (carbapenemase-producing) strains, strict adherence to infection control guidelines is more important than ever.
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Affiliation(s)
- P Gastmeier
- Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin, Germany
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12
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Sho T, Muratani T, Hamasuna R, Yakushiji H, Fujimoto N, Matsumoto T. The mechanism of high-level carbapenem resistance in Klebsiella pneumoniae: underlying Ompk36-deficient strains represent a threat of emerging high-level carbapenem-resistant K. pneumoniae with IMP-1 β-lactamase production in Japan. Microb Drug Resist 2013; 19:274-81. [PMID: 23514607 DOI: 10.1089/mdr.2012.0248] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The mechanisms of high-level carbapenem resistance in Klebsiella pneumoniae isolated in Japan were investigated. High-level carbapenem-resistant K. pneumoniae Mkp4437 and a less carbapenem-sensitive K. pneumoniae strain, Mkp4365, were recovered from the same patient. These two strains were found to be homologous by pulsed-field gel electrophoresis, and both strains contained blaIMP-1, blaDHA-1, blaCTXM-14, blaTEM-1, and blaSHV-1. Based on the sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, the lack of Ompk36 was observed in Mkp4437. Direct sequencing of the ompK36 gene demonstrated that a new insertional sequence in the open reading frame of the ompK36 gene was found in Mkp4437. Three clinical isolates (minimum inhibitory concentration [MIC] 2-4 mg/L to imipenem) were identified upon screening the strains of K. pneumoniae isolated in the University hospital with MICs of ≥ 1 mg/L to imipenem. Interestingly, these three isolates all lacked OmpK36. Conjugation of the plasmid harboring IMP-1 to these three OmpK36-deficient strains led to the isolation of high-level carbapenem-resistant transconjugants. In conclusion, the mechanisms of high-level carbapenem resistance in K. pneumoniae entail not only the production of IMP-1 β-lactamase but also the lack of OmpK36. It is vital to monitor for the presence of less carbapenem-sensitive K. pneumoniae strains, which lack OmpK36, because blaIMP-1 transmission to these strains may result in isolates with a high-level carbapenem-resistant phenotype.
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Affiliation(s)
- Takehiko Sho
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
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13
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Complete nucleotide sequence of the first KPC-2- and SHV-12-encoding IncX plasmid, pKpS90, from Klebsiella pneumoniae. Antimicrob Agents Chemother 2012; 57:618-20. [PMID: 23089759 DOI: 10.1128/aac.01712-12] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the complete nucleotide sequence of the pKpS90 plasmid, carrying the bla(KPC-2) and bla(SHV-12) genes. This plasmid was isolated from a sequence type 258 (ST258) Klebsiella pneumoniae strain responsible for an outbreak in a French university hospital in 2009. pKpS90 is a 53,286-bp plasmid that belongs to the IncX incompatibility group. pKpS90 consists of a backbone from IncX plasmids, in which the KPC-2-encoding Tn4401 transposon and a bla(SHV-12)-encoding region have been inserted.
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14
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Direct detection and genotyping of Klebsiella pneumoniae carbapenemases from urine by use of a new DNA microarray test. J Clin Microbiol 2012; 50:3990-8. [PMID: 23035190 DOI: 10.1128/jcm.00990-12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Klebsiella pneumoniae carbapenemases (KPCs) are considered a serious threat to antibiotic therapy, as they confer resistance to carbapenems, which are used to treat extended-spectrum beta-lactamase (ESBL)-producing bacteria. Here, we describe the development and evaluation of a DNA microarray for the detection and genotyping of KPC genes (bla(KPC)) within a 5-h period. To test the whole assay procedure (DNA extraction plus a DNA microarray assay) directly from clinical specimens, we compared two commercial DNA extraction kits (the QIAprep Spin miniprep kit [Qiagen] and the urine bacterial DNA isolation kit [Norgen]) for the direct DNA extraction from urine samples (dilution series spiked in human urine). Reliable single nucleotide polymorphism (SNP) typing was demonstrated using 1 × 10(5) CFU/ml urine for Escherichia coli (Qiagen and Norgen) and 80 CFU/ml urine, on average, for K. pneumoniae (Norgen). This study presents, for the first time, the combination of a new KPC microarray with commercial sample preparation for detecting and genotyping microbial pathogens directly from clinical specimens; this paves the way toward tests providing epidemiological and diagnostic data, enabling better antimicrobial stewardship.
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Chen LF, Anderson DJ, Paterson DL. Overview of the epidemiology and the threat of Klebsiella pneumoniae carbapenemases (KPC) resistance. Infect Drug Resist 2012; 5:133-41. [PMID: 23055754 PMCID: PMC3460674 DOI: 10.2147/idr.s26613] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Klebsiella pneumoniae carbapenemases (KPCs) confer resistance to nearly all β-lactams. This broad-spectrum drug resistance mechanism has rapidly spread in the United States and is reportedly increasing elsewhere in the world. Thus, the emergence of KPC resistance is a major threat to global health. This article reviews the epidemiology and provides an overview of the dissemination of KPC-producing organisms.
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Affiliation(s)
- Luke F Chen
- Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, NC, USA ; Duke Infection Control Outreach Network, Durham, NC, USA ; Duke University Prevention Epicenter Program, Durham, NC, USA ; Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Yu F, Ying Q, Chen C, Li T, Ding B, Liu Y, Lu Y, Qin Z, Parsons C, Salgado C, Qu D, Pan J, Wang L. Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring blaIMP-4 and blaDHA-1 in a neonatal intensive care unit in China. J Med Microbiol 2012; 61:984-989. [PMID: 22466031 DOI: 10.1099/jmm.0.043000-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Outbreaks caused by Klebsiella pneumoniae producing carbapenemases and other β-lactamases have been reported. Four neonates admitted to a neonatal intensive care unit (NICU) in a Chinese hospital developed respiratory infection while receiving intensive care. In all four cases, multidrug-resistant K. pneumoniae was isolated from multiple respiratory specimens, leading to additional characterization of these organisms and investigation of the local environment in the NICU. Multiple β-lactamase genes, including bla(TEM-1), bla(IMP-4), bla(DHA-1) and bla(CTX-M-14), as well as the quinolone resistance gene qnrB4, were harboured by transferable plasmids from all four clinical isolates. Furthermore, PFGE confirmed that three of the four clinical isolates from the patients and three K. pneumoniae isolates collected from the hands of health-care workers and an incubator in the NICU belonged to the same PFGE cluster, indicating that an outbreak due to multidrug-resistant K. pneumoniae carrying bla(IMP-4) and bla(DHA-1) occurred in this NICU. As far as is known, this is the first report of the co-existence of bla(IMP-4) and bla(DHA-1) in the same K. pneumoniae isolate. These data suggest that additional precautions are needed to prevent outbreaks of infection caused by multidrug-resistant K. pneumoniae resulting from environmental exposure in NICUs.
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Affiliation(s)
- Fangyou Yu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
| | - Qunhua Ying
- Department of Laboratory Medicine, Shaoxing Municipal Women and Children Hospital, Shaoxing 312000, PR China
| | - Chun Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
| | - Tingjian Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
| | - Baixing Ding
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
| | - Ying Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
| | - Yuanyuan Lu
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
| | - Zhiqiang Qin
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Chris Parsons
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Cassandra Salgado
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Di Qu
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Institute of Medical Microbiology and Institutes of Biomedical Sciences, Shanghai Medical School of Fudan University, Shanghai 200032, PR China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
| | - Liangxing Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, PR China
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Nosocomial outbreak of Klebsiella pneumoniae carbapenemase-producing Klebsiella oxytoca in Austria. Antimicrob Agents Chemother 2012; 56:2158-61. [PMID: 22290949 DOI: 10.1128/aac.05440-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To date, no outbreak of carbapenemase-producing bacteria has been reported for Austria. While outbreaks of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae have been increasingly reported, no outbreak caused by KPC-producing Klebsiella oxytoca has been described yet, to the best of our knowledge. We report an outbreak of KPC-producing K. oxytoca. In 5 months, 31 KPC-producing Klebsiella oxytoca strains were isolated from five patients. All patients were admitted to the same medical intensive care unit in Austria.
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Molecular characteristics of KPC-producing Enterobacteriaceae at the early stage of their dissemination in Poland, 2008-2009. Antimicrob Agents Chemother 2011; 55:5493-9. [PMID: 21930889 DOI: 10.1128/aac.05118-11] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
After the first report in May 2008, the National Reference Center for Susceptibility Testing confirmed 113 cases of infection or colonization by KPC-producing members of the family Enterobacteriaceae in Poland by the end of 2009. The vast majority of patients were found in 18 hospitals; three patients were diagnosed at outpatient clinics. Most of the institutions were in the Warsaw area, including three hospitals with the highest numbers of cases. When available, the data on previous hospitalizations often indicated that these hospitals were the probable acquisition sites; one patient arrived from New York. The group of 119 unique isolates consisted of Klebsiella pneumoniae (n = 114), followed by Klebsiella oxytoca (n = 3), and Escherichia coli (n = 2). The K. pneumoniae isolates were dominated by the clone sequence type 258 (ST258) (n = 111); others were ST11 and ST23. The ST258 group was heterogeneous, with 28 pulsed-field gel electrophoresis (PFGE) subtypes, ∼25 plasmid profiles, and nine β-lactamase patterns differing by KPC variants (KPC-2 mainly), and SHV-12, CTX-M-3, and TEM-1-like enzymes. Plasmids carrying bla(KPC) genes varied in size (~48 to 250 kb), structure, and conjugation potential. Transferable IncFII(K) plasmids of ~110 to 160 kb, probably pKpQIL or its derivatives, were observed in all K. pneumoniae clones and in K. oxytoca. Also prevalent were nontypeable pETKp50-like plasmids of ~50 kb, found in K. pneumoniae ST258 and E. coli isolates (ST93 and ST224). Two K. pneumoniae-E. coli pairs from single patients might represent the in vivo transfer of such plasmids. The striking diversity of KPC producers at the early stage of dissemination could result from several introductions of these bacteria into the country, their multidirectional evolution during clonal spread, and transfer of the plasmids.
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Sensitive and specific phenotypic assay for metallo-beta-lactamase detection in Enterobacteria by use of a moxalactam disk supplemented with EDTA. J Clin Microbiol 2011; 49:2667-70. [PMID: 21543570 DOI: 10.1128/jcm.00328-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Moxalactam is highly hydrolyzed by plasmid-mediated metallo-β-lactamases (MBLs), whereas it is poorly inactivated by serine-active carbapenemases. This study demonstrated that moxalactam resistance constituted an effective screen for MBL expression in enterobacteria, which could be confirmed, even in low-MBL-producing isolates, by a disk potentiation test using moxalactam and EDTA.
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Wernli D, Haustein T, Conly J, Carmeli Y, Kickbusch I, Harbarth S. A call for action: the application of The International Health Regulations to the global threat of antimicrobial resistance. PLoS Med 2011; 8:e1001022. [PMID: 21526227 PMCID: PMC3079636 DOI: 10.1371/journal.pmed.1001022] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Stephen Harbarth and colleagues argue that the International Health Regulations (IHR) should be applied to the global health threat of antimicrobial resistance.
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Affiliation(s)
- Didier Wernli
- Division of International and Humanitarian Medicine, University of Geneva
Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Thomas Haustein
- Infection Control Program, University of Geneva Hospitals and Faculty of
Medicine, Geneva, Switzerland
| | - John Conly
- Infection Control Program, University of Geneva Hospitals and Faculty of
Medicine, Geneva, Switzerland
| | - Yehuda Carmeli
- Infection Control Unit, Tel Aviv Sourasky Medical Center, Tel-Aviv,
Israel
| | - Ilona Kickbusch
- Global Health Programme, Graduate Institute of International and
Development Studies, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, University of Geneva Hospitals and Faculty of
Medicine, Geneva, Switzerland
- * E-mail:
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Woodford N, Turton JF, Livermore DM. Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistance. FEMS Microbiol Rev 2011; 35:736-55. [PMID: 21303394 DOI: 10.1111/j.1574-6976.2011.00268.x] [Citation(s) in RCA: 630] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Multilocus sequence typing reveals that many bacterial species have a clonal structure and that some clones are widespread. This underlying phylogeny was not revealed by pulsed-field gel electrophoresis, a method better suited to short-term outbreak investigation. Some global clones are multiresistant and it is easy to assume that these have disseminated from single foci. Such conclusions need caution, however, unless there is a clear epidemiological trail, as with KPC carbapenemase-positive Klebsiella pneumoniae ST258 from Greece to northwest Europe. Elsewhere, established clones may have repeatedly and independently acquired resistance. Thus, the global ST131 Escherichia coli clone most often has CTX-M-15 extended-spectrum β-lactamase (ESBL), but also occurs without ESBLs and as a host of many other ESBL types. We explore this interaction of clone and resistance for E. coli, K. pneumoniae, Acinetobacter baumannii- a species where three global lineages dominate--and Pseudomonas aeruginosa, which shows clonal diversity, but includes the relatively 'tight' serotype O12/Burst Group 4 cluster that has proved adept at acquiring resistances--from PSE-1 to VIM-1 β-lactamases--for over 20 years. In summary, 'high-risk clones' play a major role in the spread of resistance, with the risk lying in their tenacity--deriving from poorly understood survival traits--and a flexible ability to accumulate and switch resistance, rather than to constant resistance batteries.
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Affiliation(s)
- Neil Woodford
- Microbiology Services-Colindale, Health Protection Agency, London, UK
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