1
|
Bedenić B, Luxner J, Car H, Sardelić S, Bogdan M, Varda-Brkić D, Šuto S, Grisold A, Beader N, Zarfel G. Emergence and Spread of Enterobacterales with Multiple Carbapenemases after COVID-19 Pandemic. Pathogens 2023; 12:pathogens12050677. [PMID: 37242347 DOI: 10.3390/pathogens12050677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Resistance to carbapenems in Enterobacterales has become a matter of the highest concern in the last decade. Recently, Enterobacterales harboring multiple carbapenemases were detected in three hospital centers in Croatia and in the outpatient setting, posing a serious therapeutic challenge for clinicians. In this study, we analyzed eight Klebsiella pneumoniae and two Enterobacter cloacae complex isolates with multiple carbapenemases, with regard to antibiotic susceptibility, β-lactamase production and plasmid content. The isolates demonstrated uniform resistance to amoxicillin/clavulanate, piperacillin/tazobactam, cefuroxime, ceftazidime, cefotaxime, ceftriaxone and ertapenem. Among novel β-lactam/inhibitor combinations, ceftazidime/avibactam exhibited moderate activity, with 50% of isolates susceptible. All isolates demonstrated resistance to imipenem/cilastatin/relebactam, and all but one to ceftolozane/tazobactam. Four isolates exhibited a multidrug-resistant phenotype (MDR), whereas six were allocated to an extensively drug-resistant phenotype (XDR). OKNV detected three combinations of carbapenemases: OXA-48+NDM (five isolates), OXA-48+VIM (three isolates) and OXA-48+KPC (two isolates). Inter-array testing identified a wide variety of resistance genes for β-lactam antibiotics: blaCTX-M-15, blaTEM, blaSHV, blaOXA-1, blaOXA-2, blaOXA-9, aminoglycosides: aac6, aad, rmt, arm and aph, fluoroquinolones: qnrA, qnrB and qnrS, sulphonamides: sul1 and sul2 and trimethoprim: dfrA5, dfrA7, dfrA14, dfrA17 and dfrA19. mcr genes were reported for the first time in Croatia. This study demonstrated the ability of K. pneumoniae and E. cloacae to acquire various resistance determinants under the selection pressure of antibiotics widely used during the COVID-19 pandemic. The novel inter-array method showed good correlation with OKNV and PCR, although some discrepancies were found.
Collapse
Affiliation(s)
- Branka Bedenić
- Department of Microbiology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
- Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Josefa Luxner
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University Graz, 8010 Graz, Austria
| | - Haris Car
- Zagreb Health School, 10000 Zagreb, Croatia
| | - Sanda Sardelić
- Department of Microbiology, University Hospital Centre Split, 21000 Split, Croatia
| | - Maja Bogdan
- Department of Microbiology, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Dijana Varda-Brkić
- Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Sandra Šuto
- Department of Microbiology, Andrija Štampar Public Health Institute, 10000 Zagreb, Croatia
| | - Andrea Grisold
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University Graz, 8010 Graz, Austria
| | - Nataša Beader
- Department of Microbiology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
- Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Gernot Zarfel
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University Graz, 8010 Graz, Austria
| |
Collapse
|
2
|
Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures. Porto Biomed J 2022; 7:e186. [PMID: 37152080 PMCID: PMC10158887 DOI: 10.1097/j.pbj.0000000000000186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background KPC-producing K pneumoniae (KPC-Kp) is a public health problem with important clinical and epidemiological implications. We describe an outbreak of KPC-Kp at vascular surgery and neurosurgery wards in a central hospital in Porto, Portugal. Methods A case of KPC-Kp was considered to be a patient positive for KPC-Kp with strong epidemiological plausibility of having acquired this microorganism in the affected wards and/or with genetic relationship ≥92% between KPC-Kp isolates. Active surveillance cultures (ASCs) and real-time polymerase chain reaction were used for the detection of carbapenemase genes through rectal swab in a selected population. Molecular analysis was performed using pulsed-field gel electrophoresis at the National Reference Laboratory. Patient risk factors were collected from the electronic medical record system. Information regarding outbreak containment strategy was collected from the Infection Control Unit records. Results Of the 16 cases, 11 (69%) were identified through active screening, representing 1.4% of the total 766 ASCs collected. The most frequent risk factors identified were previous admission (63%), antibiotic exposure in the past 6 months (50%), and immunodepression (44%). The length of stay until KPC-Kp detection was high (0-121 days, mean 35.6), as was the total length of stay (5-173 days, mean 56.6). Three patients (19%) were infected by KPC-Kp, 2 of whom died. One previously colonized patient died later because of KPC-Kp infection. Conclusions Multifactorial strategy based on contact precautions (with patient and healthcare professional cohorts) and ASC, as well as Antibiotic Stewardship Program reinforcement, allowed to contain this KPC-Kp outbreak.
Collapse
|
3
|
Efficacy of tigecycline alone or in combination for experimental infections by KPC carbapenemase-producing Klebsiella pneumoniae. Int J Antimicrob Agents 2021; 58:106384. [PMID: 34161789 DOI: 10.1016/j.ijantimicag.2021.106384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/09/2021] [Accepted: 06/05/2021] [Indexed: 11/21/2022]
Abstract
Although in vitro data suggest that tigecycline is active against Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp), experimental and clinical data are limited. We studied the effect of tigecycline alone or in combination for experimental infections by KPC-Kp. A total of 540 male C57BL/6 mice were infected with three genetically diverse KPC-Kp isolates susceptible to tigecycline with meropenem minimum inhibitory concentrations (MICs) of 4, 16 and 256 μg/mL, respectively. Mice were randomly treated with water for injection, tigecycline, meropenem and colistin alone, and double or triple combinations of tigecycline, colistin and meropenem. Mouse survival was recorded for 14 days. In separate experiments, mice were sacrificed 6 h and 24 h after bacterial challenge for quantitative culture of tissues and serological analysis. Time-kill curves were performed. Tigecycline, colistin and meropenem concentrations were measured in tissues and serum by high-performance liquid chromatography (HPLC). Survival was significantly prolonged when mice were treated with tigecycline alone and tigecycline-containing regimens compared with control mice and mice treated with tigecycline-sparing regimens. Tigecycline-sparing regimens were active only against the isolate with a meropenem MIC of 4 μg/mL. Mortality was associated with progression to multiple organ failure. Tigecycline and tigecycline-containing regimens achieved a rapid decrease of bacterial loads both in tissues and in vitro. Tigecycline concentrations in tissues were negatively correlated with tissue bacterial load. Tigecycline alone or in combination with meropenem and/or colistin achieves effective treatment of experimental KPC-Kp infections irrespective of the meropenem MIC.
Collapse
|
4
|
Teimour pour M, Gheysarzadeh A, Pakzad I, Valadbeigi H, Maleki A, Sadeghifard N. Antimicrobial resistance and genetic analysis of multi-drug resistant Klebsiella pneumoniae isolates by pulsed-field gel electrophoresis. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
5
|
Köhler AT, Rodloff AC, Labahn M, Reinhardt M, Truyen U, Speck S. Evaluation of disinfectant efficacy against multidrug-resistant bacteria: A comprehensive analysis of different methods. Am J Infect Control 2019; 47:1181-1187. [PMID: 31060869 DOI: 10.1016/j.ajic.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multidrug-resistant gram-negative bacteria (MDR-GNB) constitute a threat to health care worldwide. Disinfectants are used to prevent and control the spread of MDR-GNB in a hospital setting but their efficacy might be impaired by bacterial mechanisms that may act on both antimicrobials and disinfectants. Determination of minimum inhibitory concentrations is mainly used to determine bacterial susceptibility against disinfectants, but practical tests on surfaces might be more suitable to predict in-use conditions. Our objective was to compare and evaluate 4 different methods widely used to assess surface disinfectant efficacy. METHODS The efficacy of benzalkonium chloride (BAC), peracetic acid (PAA), and ethanol (ETH) against multidrug-resistant Acinetobacter, Pseudomonas, and Klebsiella strains was assessed by minimum inhibitory concentration determinations, quantitative suspension tests, qualitative suspension tests, and carrier tests. Test results were compared to ascertain the most appropriate method. RESULTS ETH, PAA, and BAC were highly effective against MDR-GNB, but we observed marked differences in efficacious concentrations (up to 100-fold) as a function of the test method applied. Minimum inhibitory concentration determination was not reliable for evaluating susceptibility or resistance to BAC. CONCLUSIONS Surface tests should be used to determine bacterial susceptibility against disinfectants. Moreover, suitable guidelines are needed that allow for the standardization and comparison of bactericidal values obtained by different investigators.
Collapse
|
6
|
[Multidrug-resistant gram-negative rods in the intensive care unit : Epidemiology, prevention and treatment options]. Med Klin Intensivmed Notfmed 2019; 114:263-275. [PMID: 30824943 DOI: 10.1007/s00063-019-0547-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/03/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
In Germany, multidrug-resistant gram-negative rods (MRGN) are classified in two groups, namely those with resistance against three (3MRGN) and those with resistance against four (4MRGN) of the following antibiotic groups: acylureidopenicillins, third or fourth generation cephalosporins, fluoroquinolones and carbapenemes. The rate of 3MRGN enterobacteria and 4MRGN Pseudomonas aeruginosa has significantly increased in German intensive care units from 2008-2014. In contrast, 4MRGN enterobacteria are still rare. The 3MRGN and 4MRGN phenotypes can be associated with different antimicrobial resistance mechanisms such as the production of extended-spectrum β‑lactamases (ESBL) or carbapenemases. The strategy for the prevention and control of MRGN in intensive care units includes basic hygiene measures as well as special measures such as contact isolation of patients. The treatment of MRGN infections should be carried out according to the antimicrobial susceptibility test results.
Collapse
|
7
|
Efficacy of sodium hypochlorite against multidrug-resistant Gram-negative bacteria. J Hosp Infect 2018; 100:e40-e46. [PMID: 30026008 DOI: 10.1016/j.jhin.2018.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/10/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increased antimicrobial resistance has been observed among many bacteria leading to treatment failures in human and veterinary medicine. Disinfection is a prerequisite for infection control and prevention in healthcare settings. Chlorine compounds are cost-effective and accessible worldwide. AIM To determine the efficacy of sodium hypochlorite (NaOCl) against multidrug-resistant Gram-negative bacteria (MDR-GNB). METHODS Minimum inhibitory concentrations (MICs) were determined using broth macro-dilution. Bactericidal efficacy was measured by qualitative and quantitative suspension tests followed by practical tests without mechanical action on stainless steel carriers. The guidelines of the German Association for Applied Hygiene were followed. FINDINGS Results varied remarkably depending on the method. MICs were 0.1% or 0.2% NaOCl. Qualitative suspension tests revealed up to 500-fold lower bactericidal concentrations. Pseudomonas aeruginosa (P = 0.0025) was significantly less susceptible in these tests whereas quantitative suspension tests revealed no significant differences between strains (P > 0.05). Practical tests determined bactericidal concentrations of 0.8-0.32% NaOCl at 1 min of contact and even lower concentrations for longer contact times. At 1 min, five Klebsiella were significantly less susceptible (P = 0.0124), whereas the lower susceptibility of P. aeruginosa was not confirmed. Organic load inhibited bactericidal activity significantly, whereas contact time had a marginal effect. Differing test results underline that MIC determination and qualitative suspension tests may be insufficient approaches to evaluate bacterial susceptibility or resistance. CONCLUSION NaOCl efficiently reduced Pseudomonas aeruginosa, Acinetobacter spp., and Klebsiella spp., most notably in the absence of organic matter. Strain- and species-specific differences in susceptibility were noticed, but in general MDR-GNB revealed no higher tolerance to NaOCl.
Collapse
|
8
|
Koppe U, von Laer A, Kroll LE, Noll I, Feig M, Schneider M, Claus H, Eckmanns T, Abu Sin M. Carbapenem non-susceptibility of Klebsiella pneumoniae isolates in hospitals from 2011 to 2016, data from the German Antimicrobial Resistance Surveillance (ARS). Antimicrob Resist Infect Control 2018; 7:71. [PMID: 29992016 PMCID: PMC5987571 DOI: 10.1186/s13756-018-0362-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/22/2018] [Indexed: 01/08/2023] Open
Abstract
Background Carbapenem resistance in Klebsiella pneumoniae is of significant public health concern and recently spread across several countries. We investigated the extent of carbapenem non-susceptibility in K. pneumoniae isolates in Germany. Methods We analysed 2011-2016 data from the German Antimicrobial Resistance Surveillance (ARS) System, which contains routine data of antimicrobial susceptibility testing from voluntarily participating German laboratories. Klebsiella pneumoniae isolates tested resistant or intermediate against an antibiotic were classified as non-susceptible. Results We included 154,734 isolates from 655 hospitals in the analysis. Carbapenem non-susceptibility in K. pneumoniae isolates was low in Germany 0.63% (95% CI 0.51-0.76%). However, in continuously participating hospitals the number of K. pneumoniae isolates almost doubled and we found evidence for a slowly increasing trend for non-susceptibility (OR = 1.20 per year, 95% CI 1.09-1.33, p < 0.001). Carbapenem non-susceptibility was highest among isolates from patients aged 20-39 in men but not in women. Moreover, carbapenem non-susceptibility was more frequently reported for isolates from tertiary care, specialist care, and prevention and rehabilitation care hospitals as well as from intensive care units. Co-resistance of carbapenem non-susceptible isolates against antibiotics such as tigecycline, gentamicin, and co-trimoxazole was common. Co-resistance against colistin was 13.3% (95% CI 9.8-17.9%) in carbapenem non-susceptible isolates. Conclusion Carbapenem non-susceptibility in K. pneumoniae isolates in Germany is still low. However, it is slowly increasing and in the light of the strong increase of K. pneumoniae isolates over the last year this poses a significant challenge to public health. Continued surveillance to closely monitor trends as well as infection control and antibiotic stewardship activities are necessary to preserve treatment options.
Collapse
Affiliation(s)
- Uwe Koppe
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Anja von Laer
- Postgraduate Training for Applied Epidemiology, Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Lars E. Kroll
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, 12101 Berlin, Germany
| | - Ines Noll
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Marcel Feig
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Marc Schneider
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Hermann Claus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Tim Eckmanns
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Muna Abu Sin
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| |
Collapse
|
9
|
Becker L, Kaase M, Pfeifer Y, Fuchs S, Reuss A, von Laer A, Sin MA, Korte-Berwanger M, Gatermann S, Werner G. Genome-based analysis of Carbapenemase-producing Klebsiella pneumoniae isolates from German hospital patients, 2008-2014. Antimicrob Resist Infect Control 2018; 7:62. [PMID: 29744043 PMCID: PMC5930415 DOI: 10.1186/s13756-018-0352-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background By using whole genome sequence data we aimed at describing a population snapshot of carbapenemase-producing K. pneumoniae isolated from hospitalized patients in Germany between 2008 and 2014. Methods We selected a representative subset of 107 carbapenemase-producing K. pneumoniae clinical isolates possessing the four most prevalent carbapenemase types in Germany (KPC-2, KPC-3, OXA-48, NDM-1). Isolates were processed via illumina NGS. Data were analysed using different SNP-based mapping and de-novo assembly approaches. Relevant information was extracted from NGS data (antibiotic resistance determinants, wzi gene/cps type, virulence genes). NGS data from the present study were also compared with 238 genome data from two previous international studies on K. pneumoniae. Results NGS-based analyses revealed a preferred prevalence of KPC-2-producing ST258 and KPC-3-producing ST512 isolates. OXA-48, being the most prevalent carbapenemase type in Germany, was associated with various K. pneumoniae strain types; most of them possessing IncL/M plasmid replicons suggesting a preferred dissemination of blaOXA-48 via this well-known plasmid type. Clusters ST15, ST147, ST258, and ST512 demonstrated an intermingled subset structure consisting of German and other European K. pneumoniae isolates. ST23 being the most frequent MLST type in Asia was found only once in Germany. This latter isolate contained an almost complete set of virulence genes and a K1 capsule suggesting occurrence of a hypervirulent ST23 strain producing OXA-48 in Germany. Conclusions Our study results suggest prevalence of "classical" K. pneumonaie strain types associated with widely distributed carbapenemase genes such as ST258/KPC-2 or ST512/KPC-3 also in Germany. The finding of a supposed hypervirulent and OXA-48-producing ST23 K. pneumoniae isolates outside Asia is highly worrisome and requires intense molecular surveillance.
Collapse
Affiliation(s)
| | - Martin Kaase
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
- Present address: Department of Infection Control and Infectious Diseases, University Medical Centre Goettingen, Goettingen, Germany
| | | | | | | | | | | | - Miriam Korte-Berwanger
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
- Fachgruppe Infektiologie und Hygiene, Landeszentrum Gesundheit North-Rhine Westphalia, Gesundheitscampus 10, Bochum, Germany
| | - Sören Gatermann
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | | |
Collapse
|
10
|
Starzyk-Łuszcz K, Zielonka TM, Jakubik J, Życińska K. Mortality Due to Nosocomial Infection with Klebsiella pneumoniae ESBL<sup/>. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1022:19-26. [PMID: 28456930 DOI: 10.1007/5584_2017_38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Klebsiella pneumoniae is one of the most important hospital pathogens, particularly concerning the multidrug-resistant strain ESBL+. The aim of this study was to evaluate nosocomial infections with K. pneumoniae ESBL+ in the context of infection location, risk factors, and prognosis. This hospital study was conducted retrospectively and covered a 3 months' period. The infection with K. pneumoniae ESBL+ was diagnosed in 36 patients (19 women and 17 men) of the mean age of 74.2 ± 14.8 years. The number of infected patients amounted to 2.2% of all patients admitted to Czerniakowski Hospital in Warsaw, Poland, over the study time. Twenty of these patients died (13 women and 7 men), representing 14% of all hospital deaths at the time. The infection with K. pneumoniae ESBL+ occurred most frequently in the department of internal diseases, and rarely in neurology or intensive care wards. Bacteria was most often isolated from the urine, with the most distinct association between the use of urinary catheters and death (p = 0.019). We conclude that infections with K. pneumoniae ESBL+ were associated with over 55% mortality and usually occurred in the setting of internal diseases. Deaths due to K. pneumoniae ESBL+ infection were significantly related to the use of urinary bladder catheters.
Collapse
Affiliation(s)
| | - Tadeusz M Zielonka
- Department of Family Medicine, Warsaw Medical University, 1A Banacha Street, 02-097, Warsaw, Poland.
| | - Joanna Jakubik
- Committee of Infection Control, Czerniakowski Hospital, Warsaw, Poland
| | - Katarzyna Życińska
- Department of Family Medicine, Warsaw Medical University, 1A Banacha Street, 02-097, Warsaw, Poland
| |
Collapse
|
11
|
Protonotariou E, Poulou A, Politi L, Sgouropoulos I, Metallidis S, Kachrimanidou M, Pournaras S, Tsakris A, Skoura L. Hospital outbreak due to a Klebsiella pneumoniae ST147 clonal strain co-producing KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital in Northern Greece. Int J Antimicrob Agents 2018; 52:331-337. [PMID: 29654892 DOI: 10.1016/j.ijantimicag.2018.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 01/27/2023]
Abstract
Here we present the characteristics of a large outbreak caused by a clonal Klebsiella pneumoniae strain producing both KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital. Between January 2013 and January 2015, 45 carbapenem-resistant K. pneumoniae isolates that gave a positive modified Hodge test and were phenotypically suspected of metallo-β-lactamase (MBL) and K. pneumoniae carbapenemase (KPC) co-production were recovered from 25 patients hospitalised in AHEPA University Hospital (Thessaloniki, Greece). All of the patients were hospitalised in the three intensive care units of the hospital and 17 (68%) of them developed bloodstream infections; the overall mortality of the patients involved in the outbreak was 48% (12/25). Molecular testing verified that all 45 K. pneumoniae isolates co-harboured blaKPC-2 and blaVIM-1 genes and were associated with OmpK35 deficiency and OmpK36 porin loss. The blaTEM-1 gene was also present in 18 isolates. Pulsed-field gel electrophoresis (PFGE) clustered all of the isolates into a single clonal type, and multilocus sequence typing (MLST) assigned them to the emerging high-risk ST147 clonal lineage. Following recognition of the outbreak, infection control measures were implemented in the affected areas. The outbreak continued for ca. 2 years and since then only sporadic cases of K. pneumoniae harbouring both carbapenemases have been detected.
Collapse
Affiliation(s)
- Efthymia Protonotariou
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece.
| | - Aggeliki Poulou
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece
| | - Lida Politi
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Ioannis Sgouropoulos
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Melania Kachrimanidou
- First Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Pournaras
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Lemonia Skoura
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece
| |
Collapse
|
12
|
van Loon K, Voor In 't Holt AF, Vos MC. A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother 2018; 62:e01730-17. [PMID: 29038269 PMCID: PMC5740327 DOI: 10.1128/aac.01730-17] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (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.
Collapse
Affiliation(s)
- Karlijn van Loon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
13
|
Kaiser T, Finstermeier K, Häntzsch M, Faucheux S, Kaase M, Eckmanns T, Bercker S, Kaisers UX, Lippmann N, Rodloff AC, Thiery J, Lübbert C. Stalking a lethal superbug by whole-genome sequencing and phylogenetics: Influence on unraveling a major hospital outbreak of carbapenem-resistant Klebsiella pneumoniae. Am J Infect Control 2018; 46:54-59. [PMID: 28935481 DOI: 10.1016/j.ajic.2017.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND From July 2010-April 2013, Leipzig University Hospital experienced the largest outbreak of a Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing Klebsiella pneumoniae (KPC-2-Kp) strain observed in Germany to date. After termination of the outbreak, we aimed to reconstruct transmission pathways by phylogenetics based on whole-genome sequencing (WGS). METHODS One hundred seventeen KPC-2-Kp isolates from 89 outbreak patients, 5 environmental KPC-2-Kp isolates, and 24 K pneumoniae strains not linked to the outbreak underwent WGS. Phylogenetic analysis was performed blinded to clinical data and based on the genomic reads. RESULTS A patient from Greece was confirmed as the source of the outbreak. Transmission pathways for 11 out of 89 patients (12.4%) were plausibly explained by descriptive epidemiology, applying strict definitions. Five of these and an additional 15 (ie, 20 out of 89 patients [22.5%]) were confirmed by phylogenetics. The rate of phylogenetically confirmed transmissions increased significantly from 8 out of 66 (12.1% for the time period before) to 12 out of 23 patients (52.2% for the time period after; P <.001) after implementation of systematic screening for KPC-2-Kp (33,623 screening investigations within 11 months). Using descriptive epidemiology, systematic screening showed no significant effect (7 out of 66 [10.6%] vs 4 out of 23 [17.4%] patients; P = .465). The phylogenetic analysis supported the assumption that a contaminated positioning pillow served as a reservoir for the persistence of KPC-2-Kp. CONCLUSIONS Effective phylogenetic identification of transmissions requires systematic microbiologic screening. Extensive screening and phylogenetic analysis based on WGS should be started as soon as possible in a bacterial outbreak situation.
Collapse
|
14
|
Ye Y, Xu L, Han Y, Chen Z, Liu C, Ming L. Mechanism for carbapenem resistance of clinical Enterobacteriaceae isolates. Exp Ther Med 2017; 15:1143-1149. [PMID: 29399114 DOI: 10.3892/etm.2017.5485] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/19/2017] [Indexed: 11/06/2022] Open
Abstract
Carbapenemase-producing 'super bacteria', particularly NDM-1 and its variants, have become a major public health concern worldwide. The present study aimed to explore the molecular mechanism for carbapenem resistance of clinical Enterobacteriaceae isolates. Seventy-eight non-repeated Enterobacteriaceae strains resistant to any carbapenem were screened at the First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) between December 2011 and December 2015. Outer membrane porin (OMP) proteins were detected using SDS-PAGE. Carbapenemases, extended-spectrum β-lactamases (ESBLs) and plasmid AmpC enzyme genes were detected using polymerase chain reaction (PCR). PCR and SDS-PAGE demonstrated that 60.3% (47/78) of the strains produced carbapenemases, of which 33.3% (26/78) produced KPC-2 carbapenemase, suggesting that the strains resisted carbapenems primarily through carbapenemases. SDS-PAGE showed that the OMP proteins in the majority of carbapenem-resistant Enterobacteriaceae (CRE) strains were deleted or decreased compared with those in the sensitive strains. Of the 44 Klebsiella strains, 59.1% (26/44) did not express or expressed less OmpK35 or OmpK36. Among the 34 strains of other enterobacteria, 97.1% (33/34) did not express or expressed less OmpC or OmpF. Of all CRE strains, 35.9% (28/78) lost at least one OMP protein, indicating that the strains resisted carbapenems also by producing ESBLs and/or plasmid AmpC enzyme, as well as by losing OMP proteins. The resistance of clinically isolated CRE strains may primarily be attributed to the production of carbapenemases, and may also involve the deletion of OMP proteins or mutation of OMP genes.
Collapse
Affiliation(s)
- Yafei Ye
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Lijuan Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Yanping Han
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Zhe Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Cailin Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Liang Ming
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| |
Collapse
|
15
|
Barwa R, Shaaban M. Molecular Characterization of Klebsiella pneumoniae Clinical Isolates with Elevated Resistance to Carbapenems. Open Microbiol J 2017; 11:152-159. [PMID: 28932329 PMCID: PMC5585459 DOI: 10.2174/1874285801711010152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/23/2017] [Accepted: 04/25/2017] [Indexed: 02/06/2023] Open
Abstract
Background: Emergence of carbapenems-resistant K. pneumoniae represents a serious challenge for antimicrobial therapy. Objective: The aim of this research is to determine different mechanisms mediating the emergence of K. pneumoniae isolates with high-level carbapenem resistance. Method: A total of 80 K. pneumoniae isolates were purified from sputum and urine specimens. The minimum inhibitory concentrations (MICs) of imipenem and meropenem were determined by broth microdilution method. Carbapenemases were detected by Modified Hodge test and PCR. Additionally, the copy numbers of the identified genes (blaVIM-1, blaNDM-1 and blaOXA-48) were quantified by RT-PCR. The outer membrane proteins OmpK35 and OmpK36 of the resistant isolates were analyzed. Results: Eight isolates were resistant to carbapenems; six of these isolates possessed elevated MICs to imipenem and meropenem (≥16 µg/ml). Carbapenem resistant isolates harbored blaNDM-1 (n=5), blaVIM-1 (n=4) and blaOXA-48 (n=1) with some isolates had multiple carbapenemases genes. Six isolates with high MICs to imipenem contained multi-copies of the carbapenemases genes along with the lack of OmpK35. Isolates with intermediate resistance to carbapenems (MIC; 4-8 µg/ml) did not exhibit multiple carbapenemases but lacked the OmpK35. Random amplified polymorphic DNA exhibited three different patterns and indicated that five isolates encoded the same pattern P1. Conclusion: This study elucidated that multiple carbapenemases genes, high copy number of carbapenemases and loss of the porin OmpK35 could collectively contribute to the emergence of K. pneumoniae isolates with high resistance to carbapenems. Hence, more restrictions should be applied on the use of carbapenems to reduce the emergence of the resistant clones.
Collapse
Affiliation(s)
- Rasha Barwa
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, 35516, Mansoura, Egypt
| | - Mona Shaaban
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, 35516, Mansoura, Egypt
| |
Collapse
|
16
|
Clarivet B, Grau D, Jumas-Bilak E, Jean-Pierre H, Pantel A, Parer S, Lotthé A. Persisting transmission of carbapenemase-producing Klebsiella pneumoniae due to an environmental reservoir in a university hospital, France, 2012 to 2014. ACTA ACUST UNITED AC 2017; 21:30213. [PMID: 27168586 DOI: 10.2807/1560-7917.es.2016.21.17.30213] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
Abstract
In France, the proportion of episodes of carbapenemase-producing Enterobacteriaceae (CPE) with no recent stay or hospitalisation abroad is increasing. In this study, we investigate epidemiological links between apparently unrelated cases of OXA-48-producing Klebsiella pneumoniae (Kp OXA-48) colonisation or infection. We genotyped detected organisms by repetitive sequence-based PCR, and used a dynamic registry of cases and contacts to cross-reference patients' hospital stays. Between 1 November 2012 and 28 February 2014, 23 Kp OXA-48 cases were detected in a university hospital in Montpellier, of which 15 were involved in three outbreaks: outbreaks I and II occurred in November 2012 and outbreak III in October 2013. Molecular comparison of bacterial strains revealed clonal identity between cases involved in outbreaks II and III and four single cases. Cross-referencing of hospital stays revealed that these single cases and the index case of outbreak III had occupied the same room. Active case search among former occupants of that room found an additional Kp OXA-48 carrier. A clonal strain was isolated from the sink of that room. The epidemiological link between the contaminated room and outbreak II remained undetected. This study is a reminder that environmental reservoirs should be considered as a source of CPE transmission.
Collapse
Affiliation(s)
- Béatrice Clarivet
- Department of Infection Control and Prevention, University Hospital of Montpellier, France
| | | | | | | | | | | | | |
Collapse
|
17
|
Jin Y, Song X, Liu Y, Wang Y, Zhang B, Fan H, Shao C. Characteristics of carbapenemase-producing Klebsiella pneumoniae as a cause of neonatal infection in Shandong, China. Exp Ther Med 2017; 13:1117-1126. [PMID: 28450951 DOI: 10.3892/etm.2017.4070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/01/2016] [Indexed: 12/12/2022] Open
Abstract
The goal of the present study was to examine the characteristics of carbapenem-resistant Klebsiella pneumoniae as a cause of neonatal infection. A total of 37 carbapenem-resistant Klebsiella pneumoniae-positive newborns hospitalized in Shandong Provincial Hospital, China between April 2011 and October 2013 were examined. Antibiotic susceptibility testing was performed using the agar dilution method and the Etest. Resistance genes were assessed by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used to determine the genotypes and homology of these isolates. Plasmids were analyzed by PFGE and conjugation experiments. The outer membrane proteins were examined by PCR and SDS-PAGE. All of the isolates were revealed to be resistant to the third and fourth generation cephalosporins and piperacillin-tazobactam. Tigecycline, colistin, levofloxacin and amikacin were successful against all of the isolates. The antibiotic resistance rates of aztreonam, gentamicin, trimethoprim-sulfamethoxazole and fosfomycin were 13.51, 48.64, 78.38 and 86.49%, respectively. Of the 37 cases, 25 isolates (67.57%) were blaNDM-1 positive, 13 isolates (35.14%) were blaIMP-4 positive and 1 isolate (2.70%) was blaIMP-8 positive. Two isolates carried both blaNDM-1 and blaIMP-4. The isolate carrying 2-4 plasmids and blaNDM-1 and blaIMP-4 was transferable between strains. SDS-PAGE data indicated that outer membrane proteins remained present. PFGE revealed 7 distinct clusters, and MLST reported the presence of ST20, ST17, ST54, ST705 and ST290 sequences, which indicated that there was clone and plasmid spread between newborns. The main resistance mechanism of carbapenem-resistant Klebsiella pneumoniae was that the isolates expressed the carbapenemase resistance of blaNDM-1 and blaIMP-4 genes. The current study indicates that early detection of these genes may be helpful in infection prevention and control.
Collapse
Affiliation(s)
- Yan Jin
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Xiaofei Song
- Department of Immunology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yigang Liu
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yong Wang
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Bingchang Zhang
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Hui Fan
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Chunhong Shao
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| |
Collapse
|
18
|
Battikh H, Harchay C, Dekhili A, Khazar K, Kechrid F, Zribi M, Masmoudi A, Fendri C. Clonal Spread of Colistin-Resistant Klebsiella pneumoniae Coproducing KPC and VIM Carbapenemases in Neonates at a Tunisian University Hospital. Microb Drug Resist 2016; 23:468-472. [PMID: 27802107 DOI: 10.1089/mdr.2016.0175] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this study, we have attempted to report the first clonal spread of colistin-resistant Klebsiella pneumoniae coproducing KPC and VIM carbapenemases in the neonatal unit of Rabta Teaching Hospital of Tunis (Tunisia). This retrospective study was performed from January 1, 2014 to December 31, 2014 in the Microbiology Laboratory at the Rabta University Hospital of Tunis. Twenty-one nonreplicate colistin-resistant K. pneumoniae were isolated from 19 patients hospitalized in the neonatal unit and 2 patients in the adult intensive care unit (ICU). Most of the strains were isolated from invasive specimens. Pulsed-field gel electrophoresis (PFGE) and PCR analysis and nucleotide sequencing of the blaKPC and blaVIM genes were performed. Mortality was reported in 92% of cases. All the strains were resistant to colistin (minimum inhibitory concentration [MICs] ranged from 8 to 12 mg/L). The MICs for imipenem of K. pneumoniae isolates ranged from 3 to 256 mg/L for 13 strains that were characterized as intermediate or resistant. The MICs for ertapenem were higher than 32 mg/L for the 19 resistant strains. All the isolates were sensitive to tigecycline and chloramphenicol. PFGE analysis revealed two clones (I and II). Twenty of the 21 colistin-resistant, carbapenem-resistant K. pneumoniae isolates belonged to clone I. Only one strain was related to clone II. PCR analysis and nucleotide sequencing revealed that the 20 isolates belonged to clone I, coproduced the blaKPC and blaVIM genes. A single strain (clone II), which was isolated in the ICU, did not produce KPC and VIM carbapenemases. All strains did not produce OXA-48.
Collapse
Affiliation(s)
- Hajer Battikh
- 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia
| | - Chiraz Harchay
- 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia
| | - Amal Dekhili
- 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia
| | - Khaoula Khazar
- 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia
| | - Fehima Kechrid
- 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia
| | - Meriem Zribi
- 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia
| | - Afef Masmoudi
- 2 Neonatal Unit, Rabta Teaching Hospital , Tunis, Tunisia
| | - Chedlia Fendri
- 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia
| |
Collapse
|
19
|
Falco A, Ramos Y, Franco E, Guzmán A, Takiff H. A cluster of KPC-2 and VIM-2-producing Klebsiella pneumoniae ST833 isolates from the pediatric service of a Venezuelan Hospital. BMC Infect Dis 2016; 16:595. [PMID: 27770796 PMCID: PMC5075218 DOI: 10.1186/s12879-016-1927-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/12/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a bacterial pathogen that has developed resistance to multiple antibiotics and is a major cause of nosocomial infections worldwide. Carbapenemase-producing Klebsiella pneumoniae have been isolated in many hospitals in Venezuela, but they have not been well-studied. The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae isolates from the pediatric service of a hospital located in Anzoategui State, in the eastern part of Venezuela. METHODS Nineteen Klebsiella pneumoniae strains isolated in the hospital from April to July 2014 were evaluated phenotypically and molecularly for the presence of carbapenemases blaKPC, blaIMP and blaVIM. Molecular epidemiology was performed with Repetitive Extragenic Palindromic-PCR (REP-PCR) and Multilocus Sequence Typing (MLST). They were also studied for phenotypic and molecular resistance to a quaternary ammonium compound (QAC) disinfectant. RESULTS All 19 isolates contained both bla VIM-2 and bla KPC-2 genes, and the bla KPC-2 gene was associated with Tn4401b. All isolates were phenotypically sensitive to QACs and contained qacΔE and addA2 genes typical of class 1 integrons. Analysis by REP-PCR and MLST showed that all isolates had identical profiles characteristic of sequence type ST833. CONCLUSION All 19 strains are bla VIM-2 and bla KPC-2-producing ST833 K. pneumoniae sensitive to QACs. This analysis may help to understand the routes of dissemination and confirms that QAC disinfectants can be used to help control their spread.
Collapse
Affiliation(s)
- Aura Falco
- Laboratorio de Genética Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
| | - Yusibeska Ramos
- Laboratorio B, Dirección de Energía y Ambiente, Instituto de Estudios Avanzados, Caracas, Venezuela
| | - Esther Franco
- Servicio de Laboratorio Clínico del anexo pediátrico "Dr. Rafael Tobías Guevara" del Complejo Hospitalario Universitario "Dr. Luis Razetti", Barcelona, Venezuela
| | - Alegría Guzmán
- Servicio de Laboratorio Clínico del anexo pediátrico "Dr. Rafael Tobías Guevara" del Complejo Hospitalario Universitario "Dr. Luis Razetti", Barcelona, Venezuela
| | - Howard Takiff
- Laboratorio de Genética Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
| |
Collapse
|
20
|
French CE, Coope C, Conway L, Higgins JPT, McCulloch J, Okoli G, Patel BC, Oliver I. Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review. J Hosp Infect 2016; 95:3-45. [PMID: 27890334 DOI: 10.1016/j.jhin.2016.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND In recent years, infections with carbapenemase-producing Enterobacteriaceae (CPE) have been increasing globally and present a major public health challenge. AIM To review the international literature: (i) to describe CPE outbreaks in acute hospital settings globally; and (ii) to identify the control measures used during these outbreaks and report on their effectiveness. METHODS A systematic search of MEDLINE and EMBASE databases, abstract lists for key conferences and reference lists of key reviews was undertaken, and information on unpublished outbreaks was sought for 2000-2015. Where relevant, risk of bias was assessed using the Newcastle-Ottawa scale. A narrative synthesis of the evidence was conducted. FINDINGS Ninety-eight outbreaks were eligible. These occurred worldwide, with 53 reports from Europe. The number of cases (CPE infection or colonization) involved in outbreaks varied widely, from two to 803. In the vast majority of outbreaks, multi-component infection control measures were used, commonly including: patient screening; contact precautions (e.g. gowns, gloves); handwashing interventions; staff education or monitoring; enhanced environmental cleaning/decontamination; cohorting of patients and/or staff; and patient isolation. Seven studies were identified as providing the best-available evidence on the effectiveness of control measures. These demonstrated that CPE outbreaks can be controlled successfully using a range of appropriate, commonly used, infection control measures. However, risk of bias was considered relatively high for these studies. CONCLUSION The findings indicate that CPE outbreaks can be controlled using combinations of existing measures. However, the quality of the evidence base is weak and further high-quality research is needed, particularly on the effectiveness of individual infection control measures.
Collapse
Affiliation(s)
- C E French
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | - C Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK.
| | - L Conway
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
| | - J P T Higgins
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | | | - G Okoli
- University of Bristol, Bristol, UK
| | | | - I Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
| |
Collapse
|
21
|
Papadimitriou-Olivgeris M, Vamvakopoulou S, Spyropoulou Α, Bartzavali C, Marangos M, Anastassiou ED, Spiliopoulou I, Christofidou M. Performance of four different agar plate methods for rectal swabs, synergy disk tests and metallo-β-lactamase Etest for clinical isolates in detecting carbapenemase-producing Klebsiella pneumoniae. J Med Microbiol 2016; 65:954-961. [PMID: 27452448 DOI: 10.1099/jmm.0.000318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aims of the study were to compare four different agar plate methods in the identification of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) from rectal samples and to assess the role of phenotypic methodologies in the identification of carbapenemase type from clinical K. pneumoniae isolates. Two chromogenic agars (Brilliance CRE and CHROMagar KPC) were compared to MacConkey agar plates with ertapenem (ERT) or imipenem (IMP) disks for the identification of CP-Kp from 912 rectal swabs. CP-Kp was detected in 329 samples by either agar methodology (299 K. pneumoniae carbapenemase positive, 27 Verona integron-encoded metallo-β-lactamase positive and 3 K. pneumoniae carbapenemase and Verona integron-encodedmetallo-β-lactamase positive). Sensitivity of Brilliance CRE, CHROMagar KPC and MacConkey agar plus IMP or ERT disk (inhibition zone <25 mm) was 96.8, 99.2, 67.2 and 81.8 %, while specificity was 90.9, 78.2, 98.1 and 97.9 %, respectively. Synergy meropenem-disk tests with EDTA or phenylboronic acid were used in order to detect the carbapenemase type as compared to PCR results (blaVIM, blaKPC and blaNDM) from 2515 isolates with reduced susceptibility to any of the Etest-examined carbapenems (ERT, IMP or meropenem). Metallo-β-lactamase MP/MPI Etest was applied in 616 isolates. Sensitivity was 98.4, 90.9 and 82.2 % for phenylboronic acid synergy test, EDTA synergy test and metallo-β-lactamase Etest, respectively, while their specificity was high (>97.5 %). Phenotypic methodologies can provide reliable results for the identification of carbapenemase production among K. pneumoniae isolates. Chromogenic agars can be applied in high-risk patients as part of surveillance and infection control programs.
Collapse
Affiliation(s)
| | - Sophia Vamvakopoulou
- Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece
| | - Αikaterini Spyropoulou
- Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece
| | - Christina Bartzavali
- Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece
| | - Markos Marangos
- Division of Infectious Diseases, School of Medicine, University of Patras, 26504 Rion, Patras, Greece
| | - Evangelos D Anastassiou
- Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece
| | - Iris Spiliopoulou
- Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece
| | - Myrto Christofidou
- Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece
| |
Collapse
|
22
|
Thomson GK, Snyder JW, McElheny CL, Thomson KS, Doi Y. Coproduction of KPC-18 and VIM-1 Carbapenemases by Enterobacter cloacae: Implications for Newer β-Lactam-β-Lactamase Inhibitor Combinations. J Clin Microbiol 2016; 54:791-4. [PMID: 26719440 PMCID: PMC4767958 DOI: 10.1128/jcm.02739-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/22/2015] [Indexed: 01/04/2023] Open
Abstract
Enterobacter cloacae strain G6809 with reduced susceptibility to carbapenems was identified from a patient in a long-term acute care hospital in Kentucky. G6809 belonged to sequence type (ST) 88 and carried two carbapenemase genes, bla(KPC-18) and bla(VIM-1). Whole-genome sequencing localized bla(KPC-18) to the chromosome and bla(VIM-1) to a 58-kb plasmid. The strain was highly resistant to ceftazidime-avibactam. Insidious coproduction of metallo-β-lactamase with KPC-type carbapenemase has implications for the use of next-generation β-lactam-β-lactamase inhibitor combinations.
Collapse
Affiliation(s)
- Gina K Thomson
- Department of Microbiology, University of Louisville Hospital, Louisville, Kentucky, USA Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA
| | - James W Snyder
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Christi L McElheny
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kenneth S Thomson
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
23
|
Klebsiella pneumoniae Isolate from a New York City Hospital Belonging to Sequence Type 258 and Carrying blaKPC-2 and blaVIM-4. Antimicrob Agents Chemother 2016; 60:1924-7. [PMID: 26729504 DOI: 10.1128/aac.01844-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/27/2015] [Indexed: 11/20/2022] Open
Abstract
Among 69 of 139 (49.6%) carbapenem-nonsusceptible Enterobacteriaceae carrying blaKPC, 1 Klebsiella pneumoniae was also positive for blaVIM. The isolate belonged to sequence type 258 (ST258) and carried blaKPC-2 on a copy of Tn4401a and blaVIM-4 on a class 1 integron. Genes were located on distinct plasmids belonging to Inc types A/C and FII. Elevated expression of the efflux pump AcrAB-TolC (acrA, 15.3 times) and reduced expression of outer membrane protein genes ompK35 and ompK37 (0.16 and 0.081 times, respectively) associated with various amino acid alterations on OmpK37 were observed. The presence of two carbapenemases in ST258 K. pneumoniae is of great concern due to the ability of this organism to widely disseminate.
Collapse
|
24
|
Multiyear, Multinational Survey of the Incidence and Global Distribution of Metallo-β-Lactamase-Producing Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrob Agents Chemother 2015; 60:1067-78. [PMID: 26643349 DOI: 10.1128/aac.02379-15] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/23/2015] [Indexed: 12/17/2022] Open
Abstract
Metallo-β-lactamases (MBLs) hydrolyze all classes of β-lactams except monobactams and are not inhibited by classic serine β-lactamase inhibitors. Gram-negative pathogens isolated from patient infections were collected from 202 medical centers in 40 countries as part of a global surveillance study from 2012 to 2014. Carbapenem-nonsusceptible Enterobacteriaceae and Pseudomonas aeruginosa were characterized for bla genes encoding VIM, IMP, NDM, SPM, and GIM variants using PCR and sequencing. A total of 471 MBL-positive isolates included the following species (numbers of isolates are in parentheses): P. aeruginosa (308), Klebsiella spp. (85), Enterobacter spp. (39), Proteeae (16), Citrobacter freundii (12), Escherichia coli (6), and Serratia marcescens (5) and were submitted by sites from 34 countries. Of these, 69.6% were collected in 9 countries (numbers of isolates are in parentheses): Russia (72), Greece (61), Philippines (54), Venezuela (29), and Kuwait, Nigeria, Romania, South Africa, and Thailand (20 to 25 isolates each). Thirty-two different MBL variants were detected (14 VIM, 14 IMP, and 4 NDM enzymes). Seven novel MBL variants were encountered in the study, each differing from a previously reported variant by one amino acid substitution: VIM-42 (VIM-1 [V223I]), VIM-43 (VIM-4 [A24V]), VIM-44 (VIM-2 [K257N]), VIM-45 (VIM-2 [T35I]), IMP-48 (IMP-14 [I69T]), IMP-49 (IMP-18 [V49F]), and NDM-16 (NDM-1 [R264H]). The in vitro activities of all tested antibiotics against MBL-positive Enterobacteriaceae were significantly reduced with the exception of that of aztreonam-avibactam (MIC90, 0.5 to 1 μg/ml), whereas colistin was the most effective agent against MBL-positive P. aeruginosa isolates (>97% susceptible). Although the global percentage of isolates encoding MBLs remains relatively low, their detection in 12 species, 34 countries, and all regions participating in this surveillance study is concerning.
Collapse
|
25
|
Kanerva M, Skogberg K, Ryynänen K, Pahkamäki A, Jalava J, Ollgren J, Tarkka E, Lyytikäinen O. Coincidental detection of the first outbreak of carbapenemase-producing Klebsiella pneumoniae colonisation in a primary care hospital, Finland, 2013. ACTA ACUST UNITED AC 2015; 20. [PMID: 26159309 DOI: 10.2807/1560-7917.es2015.20.26.21172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In Finland, occurrence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has previously been sporadic and related to travel. We describe the first outbreak of colonisation with KPC-KP strain ST512; it affected nine patients in a 137-bed primary care hospital. The index case was detected by chance when a non-prescribed urine culture was taken from an asymptomatic patient with suprapubic urinary catheter in June 2013. Thereafter, all patients on the 38-bed ward were screened until two screening rounds were negative and extensive control measures were performed. Eight additional KPC-KP-carriers were found, and the highest prevalence of carriers on the ward was nine of 38. All other patients hospitalised on the outbreak ward between 1 May and 10 June and 101 former roommates of KPC-KP carriers since January had negative screening results. Two screening rounds on the hospital's other wards were negative. No link to travel abroad was detected. Compared with non-carriers, but without statistical significance, KPC-KP carriers were older (83 vs 76 years) and had more often received antimicrobial treatment within the three months before screening (9/9 vs 90/133). No clinical infections occurred during the six-month follow-up. Early detection, prompt control measures and repetitive screening were crucial in controlling the outbreak.
Collapse
Affiliation(s)
- M Kanerva
- Helsinki University Central Hospital, Department of Infectious Diseases, Helsinki, Finland
| | | | | | | | | | | | | | | |
Collapse
|
26
|
An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread. Eur J Clin Microbiol Infect Dis 2015; 34:1647-55. [DOI: 10.1007/s10096-015-2401-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/03/2015] [Indexed: 12/18/2022]
|
27
|
Lepelletier D, Berthelot P, Lucet JC, Fournier S, Jarlier V, Grandbastien B. French recommendations for the prevention of 'emerging extensively drug-resistant bacteria' (eXDR) cross-transmission. J Hosp Infect 2015; 90:186-95. [PMID: 25986165 DOI: 10.1016/j.jhin.2015.04.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/07/2015] [Indexed: 11/15/2022]
Abstract
Controlling the spread of multi- or extensively drug-resistant bacteria (MDR or XDR) includes a dual strategy for reducing antibiotic prescriptions and preventing their spread from patient carriers. Standard precautions are applicable to all health professionals caring for any patients; additional barrier precautions (isolation) are recommended for patients carrying transmissible infectious diseases or MDR bacteria in sporadic or epidemic situations. Moreover, additional precautions may be required for populations at particular risk of infection or colonization by emerging XDR (eXDR), defined in our country as carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci. Our ability to detect and identify eXDR carriers early and ensure their follow-up, through effective communication between all those involved, is a significant challenge for controlling their spread. Thus, the French High Committee for Public Health has updated and standardized all French existing recommendations concerning the prevention of the cross-transmission of these bacteria, and these recommendations are summarized in this review. The recommendations are based on scientific and operational knowledge up to 2013. Different preventive strategies are recommended for patients found to be carrying eXDR and those who are considered to be at risk of having eXDR because of a history of contact. The local context, the experience of the infection control team, the different times at which detection of eXDR takes place (during admission, hospitalization, etc.) and the epidemiological situation (sporadic cases, clusters, outbreaks, widespread epidemic) must be included in risk assessments that in turn inform the control measures that should be applied in each clinical circumstance.
Collapse
Affiliation(s)
- D Lepelletier
- Unité de Gestion du risque Infectieux, Service de Bactériologie-Hygiène Hospitalière, CHU Nantes, Nantes, France; Université de Nantes, EA 3826, UFR Médecine, Nantes, France.
| | - P Berthelot
- Unité d'Hygiène Inter-Hospitalière, Service des Maladies Infectieuses et Laboratoire des Agents Infectieux et Hygiène, CHU St-Etienne, St Etienne, France
| | - J-C Lucet
- Unité Hospitalière de Lutte contre l'Infection Nosocomiale, GH Bichat - Claude Bernard, AP-HP, Paris, France
| | | | - V Jarlier
- Laboratoire de Bactériologie, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France; CLIN central de l'AP-HP, Paris, France
| | - B Grandbastien
- Unité de Lutte contre les Infections Nosocomiales, Service du Risque Infectieux, des Vigilances et d'Infectiologie, CHRU Lille, Lille, France
| |
Collapse
|
28
|
Meletis G, Chatzidimitriou D, Malisiovas N. Double- and multi-carbapenemase-producers: the excessively armored bacilli of the current decade. Eur J Clin Microbiol Infect Dis 2015; 34:1487-93. [PMID: 25894987 DOI: 10.1007/s10096-015-2379-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/30/2015] [Indexed: 11/29/2022]
Abstract
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative nosocomial pathogens commonly carry one carbapenemase gene conferring resistance to carbapenems and other beta-lactam antibiotics. However, increasing reports show that double-carbapenemase-producing (DCP) and even multi-carbapenemase-producing (MCP) bacteria are emerging in some parts of the world, diminishing further, in some cases, the already limited treatment options. In the present review, the up-to-date reports of DCP and MCP isolates are summarized and concerns regarding their emergence are discussed.
Collapse
Affiliation(s)
- G Meletis
- Labnet Laboratories, Agiou Dimitriou str. 161, 53337, Thessaloniki, Greece,
| | | | | |
Collapse
|
29
|
Ludden C, Cormican M, Vellinga A, Johnson JR, Austin B, Morris D. Colonisation with ESBL-producing and carbapenemase-producing Enterobacteriaceae, vancomycin-resistant enterococci, and meticillin-resistant Staphylococcus aureus in a long-term care facility over one year. BMC Infect Dis 2015; 15:168. [PMID: 25887288 PMCID: PMC4399485 DOI: 10.1186/s12879-015-0880-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study examined colonisation with and characteristics of antimicrobial-resistant organisms among residents of a long-term care facility (LTCF) over one year, including strain persistence and molecular diversity among isolates of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Methods Sixty-four residents of a LTCF were recruited (51 at baseline, 13 during the year). Data on dependency levels, hospitalisations, and antimicrobial prescribing were collected. Nasal and rectal swabs and catheter urine specimens were examined quarterly, using chromogenic agars, for ESBL-producing Enterobacteriaceae, carbapenemase-producing Enterobacteriaceae (CPE), vancomycin-resistant enterococci (VRE), and meticillin-resistant S. aureus (MRSA). All ESBL-producing E. coli (ESBL-EC) were characterised by pulsed-field gel electrophoresis (PFGE) and PCR to assess for sequence type (ST) ST131, its resistance-associated H30 and H30-Rx subclones, and blaCTX-M,blaTEM,blaSHV, and blaOXA-1. Results The overall number of residents colonised, by organism, was as follows: ESBL-EC, 35 (55%); MRSA, 17 (27%); ESBL-producing K. pneumoniae (ESBL-KP), 5 (8%); VRE, 2 (3%) and CPE, 0 (0%). All 98 ESBL-EC isolates were H30-Rx ST131, with blaCTX-M-group 1. By PFGE, a group of 91 ESBL-EC (from 33 participants) had ≥ 85% similar profiles and resembled UK epidemic strain A/ international pulsotype PFGE812. Sequential ESBL-EC from individual residents were closely related. Six ESBL-KP isolates, from five participants, had blaCTX-M-group 1 and by PFGE were closely related. Colonisation with ESBL and MRSA was associated with location within the LTCF and previous exposure to antimicrobials. Conclusions Among LTCF residents, colonisation with ESBL-EC and MRSA was common. All ESBL-EC were H30-Rx ST131, consistent with clonal dissemination.
Collapse
Affiliation(s)
- Catherine Ludden
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - Martin Cormican
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland. .,Centre for Health from Environment, Ryan Institute, National University of Ireland Galway, Galway, Ireland.
| | - Akke Vellinga
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | | | - Bernie Austin
- St. Brendan's Home, Community Nursing Unit, Galway, Ireland.
| | - Dearbháile Morris
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| |
Collapse
|
30
|
Jin Y, Shao C, Li J, Fan H, Bai Y, Wang Y. Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province, China. PLoS One 2015; 10:e0119571. [PMID: 25799421 PMCID: PMC4370709 DOI: 10.1371/journal.pone.0119571] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/15/2015] [Indexed: 11/18/2022] Open
Abstract
Despite worldwide dissemination of New Delhi metallo-β-lactamase1 (blaNDM-1), outbreaks remain uncommon in China. In this study, we describe the characteristics of the outbreak-related blaNDM-1-producing K. pneumonia isolates in a neonatal unit in Shandong province, China. We recovered 21 non-repetitive carbapenem-resistant K. pneumoniae isolates with a positively modified Hodge test (MHT) or EDTA synergistic test from patients and environmental samples in Shandong provincial hospital. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) data show K. pneumoniae isolates from 19 patients were clonally related and belong to the clonal groups ST20 and ST17. We note two outbreaks, the first caused by ST20 during August 2012 involving four patients, and the second caused by ST20 and ST17 during January 2012 and September 2013 involving fourteen patients. We found the bed railing of one patient was the source of the outbreak. We verified the presence of the blaNDM-1 gene in 21 K. pneumoniae isolates. The genes blaCTX-M-15, blaCTX-M-14, blaDHA-1, blaTEM-1 and Class I integron were also present in 18 (85.7%), 3 (14.3%), 18 (85.7%), 19 (90.5%) and 19 (90.5%) isolates, respectively. We also found an isolate with both blaNDM-1 and blaIMP-4. All of the isolates exhibited a multidrug-resistance phenotype. The β-lactam resistance of 20 isolates was transferable via conjugation. In addition, we show the resistance of 21 K. pneumoniae isolates to carbapenem is not related to lack of outer-membrane proteins OmpK35 and OmpK36 nor overpression of efflux pumps. This study provides the first report confirming blaNDM-1-producing K. pneumoniae ST20 and ST17 were associated with outbreak. Early detection of resistance genes is an effective strategy in preventing and controlling infection by limiting the dissemination of these organisms.
Collapse
Affiliation(s)
- Yan Jin
- Department of Microbiology, Clinical Laboratory of Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - Chunhong Shao
- Department of Microbiology, Clinical Laboratory of Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - Jian Li
- Jinan Centre for Disease Control and Prevention, Jinan, PR China
| | - Hui Fan
- Department of Microbiology, Clinical Laboratory of Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - Yuanyuan Bai
- Department of Microbiology, Clinical Laboratory of Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - Yong Wang
- Department of Microbiology, Clinical Laboratory of Provincial Hospital affiliated to Shandong University, Jinan, PR China
- * E-mail:
| |
Collapse
|
31
|
Falagas ME, Tansarli GS, Karageorgopoulos DE, Vardakas KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis 2015; 20:1170-5. [PMID: 24959688 PMCID: PMC4073868 DOI: 10.3201/eid2007.121004] [Citation(s) in RCA: 378] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 7 studies, rates ranged from 26% to 44%; in 2 studies, rates were −3% and −4%, respectively. We evaluated the number of deaths attributable to carbapenem-resistant Enterobacteriaceae by using studies from around the world published before April 9, 2012. Attributable death was defined as the difference in all-cause deaths between patients with carbapenem-resistant infections and those with carbapenem-susceptible infections. Online databases were searched, and data were qualitatively synthesized and pooled in a metaanalysis. Nine studies met inclusion criteria: 6 retrospective case–control studies, 2 retrospective cohort studies, and 1 prospective cohort study. Klebsiella pneumoniae was the causative pathogen in 8 studies; bacteremia was the only infection in 5 studies. We calculated that 26%–44% of deaths in 7 studies were attributable to carbapenem resistance, and in 2 studies, which included bacteremia and other infections, −3% and −4% of deaths were attributable to carbapenem resistance. Pooled outcomes showed that the number of deaths was significantly higher in patients with carbapenem-resistant infections and that the number of deaths attributable to carbapenem resistance is considerable.
Collapse
|
32
|
Jean SS, Lee WS, Lam C, Hsu CW, Chen RJ, Hsueh PR. Carbapenemase-producing Gram-negative bacteria: current epidemics, antimicrobial susceptibility and treatment options. Future Microbiol 2015; 10:407-25. [DOI: 10.2217/fmb.14.135] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT Carbapenemases, with versatile hydrolytic capacity against β-lactams, are now an important cause of resistance of Gram-negative bacteria. The genes encoding for the acquired carbapenemases are associated with a high potential for dissemination. In addition, infections due to Gram-negative bacteria with acquired carbapenemase production would lead to high clinical mortality rates. Of the acquired carbapenemases, Klebsiella pneumoniae carbapenemase (Ambler class A), Verona integron-encoded metallo-β-lactamase (Ambler class B), New Delhi metallo-β-lactamase (Ambler class B) and many OXA enzymes (OXA-23-like, OXA-24-like, OXA-48-like, OXA-58-like, class D) are considered to be responsible for the worldwide resistance epidemics. As compared with monotherapy with colistin or tigecycline, combination therapy has been shown to effectively lower case-fatality rates. However, development of new antibiotics is crucial in the present pandrug-resistant era.
Collapse
Affiliation(s)
- Shio-Shin Jean
- Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University; and Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Sen Lee
- Division of infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Carlos Lam
- Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University; and Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency & Critical Medicine, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan
| | - Ray-Jade Chen
- Department of Emergency & Critical Medicine, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine & Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
33
|
Herrmann M, Jungmann S, Halfmann A, Dawson A, Kaase M, Gatermann S, von Müller L, Gärtner BC. A pseudo-outbreak due to Acinetobacter species (GIM-1) contamination of the pneumatic transport system of a Large University Hospital. Infect Control Hosp Epidemiol 2014; 35:1364-72. [PMID: 25333431 DOI: 10.1086/678413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To establish the source and contamination routes resulting in positive clinical and surveillance microbiological cultures with carbapenem-resistant, GIM-1 metallo-β-lactamase-positive Acinetobacter pitii and Acinetobacter radioresistens from 21 patients in 8 departments. DESIGN Retrospective, descriptive study. SETTING A 1,300-bed tertiary care academic medical facility consisting of 90 buildings linked by a pneumatic transport system (PTS). METHODS Microbiological workup of the cluster strains included matrix-assisted laser desorption/ionization time-of-flight species identification, phenotypic carbapenemase tests, polymerase chain reaction-based genotyping of carbapenemase, and pulsed-field gel electrophoresis. Outbreak management procedures were employed according to institutional regulations. RESULTS The rarity of GIM-1 Acinetobacter species in the hospital and region, the lack of epidemiological links between patients, and the fact that in some patients the apparent colonization was clearly nonnosocomial prompted the suspicion of a pseudo-outbreak. Numerous environmental cultures were positive for GIM-1-positive Acinetobacter (including archived sample requisition forms, PTS capsules, cultures from line-diverter and dispenser stations, and sterilized transport capsules following PTS delivery). Moreover, it was observed that condensation fluid from subterranean PTS tubing resulted in water entry in PTS capsules, possibly conferring specimen contamination. After extensive system disinfection, environmental surveys of the PTS were negative, and no further positive patient specimens were encountered. CONCLUSIONS This is the first report of a PTS-associated pseudo-outbreak. The large number of falsely positive patient-related specimens in conjunction with the potential hazard of airborne and contact spread of multidrug-resistant microorganisms (in this case, GIM-1 carbapenem-resistant Acinetobacter species) underscores the need for implementation of infection control-based monitoring and operating procedures in a hospital PTS.
Collapse
Affiliation(s)
- Mathias Herrmann
- Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Sachse S, Bresan S, Erhard M, Edel B, Pfister W, Saupe A, Rödel J. Comparison of multilocus sequence typing, RAPD, and MALDI-TOF mass spectrometry for typing of β-lactam-resistant Klebsiella pneumoniae strains. Diagn Microbiol Infect Dis 2014; 80:267-71. [PMID: 25266674 DOI: 10.1016/j.diagmicrobio.2014.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 06/20/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
Abstract
Extended spectrum of β-lactam (ESBL) resistance of Klebsiella pneumoniae has become an increasing problem in hospital infections. Typing of isolates is important to establish the intrahospital surveillance of resistant clones. In this study, the discriminatory potential of randomly amplified polymorphic DNA and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analyses were compared with multilocus sequence typing (MLST) by using 17 β-lactam-resistant K. pneumoniae isolates of different genotypes. MLST alleles were distributed in 8 sequence types (STs). Among ESBL strains of the same ST, the presence of different β-lactamase genes was common. RAPD band patterns also revealed 8 types that corresponded to MLST-defined genotypes in 15 out of 17 cases. MALDI-TOF analysis could differentiate 5 clusters of strains. The results of this work show that RAPD may be usable as a rapid screening method for the intrahospital surveillance of K. pneumoniae, allowing a discrimination of clonally related strains. MALDI-TOF-based typing was not strongly corresponding to genotyping and warrants further investigation.
Collapse
Affiliation(s)
- Svea Sachse
- Institute of Medical Microbiology, University Hospital of Jena, D-07747 Jena, Germany
| | - Stephanie Bresan
- Institute of Medical Microbiology, University Hospital of Jena, D-07747 Jena, Germany
| | | | - Birgit Edel
- Institute of Medical Microbiology, University Hospital of Jena, D-07747 Jena, Germany
| | - Wolfgang Pfister
- Institute of Medical Microbiology, University Hospital of Jena, D-07747 Jena, Germany
| | - Angela Saupe
- Institute of Medical Microbiology, University Hospital of Jena, D-07747 Jena, Germany
| | - Jürgen Rödel
- Institute of Medical Microbiology, University Hospital of Jena, D-07747 Jena, Germany.
| |
Collapse
|
35
|
Hrabák J, Chudáčková E, Papagiannitsis CC. Detection of carbapenemases in Enterobacteriaceae: a challenge for diagnostic microbiological laboratories. Clin Microbiol Infect 2014; 20:839-53. [PMID: 24813781 DOI: 10.1111/1469-0691.12678] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Carbapenemase-producing bacteria have now spread all over the world. Infections caused by those bacteria are difficult to treat. Therefore, there is an urgent need for accurate and fast detection of carbapenemases in diagnostic laboratories. In this review, we summarize screening methods for suspected isolates, direct assays for confirmation of carbapenemase activity (e.g. the Carba NP test and matrix-assisted laser desorption ionization time-of-flight mass spectrometry carbapenem hydrolysis assay), inhibitor-based methods for carbapenemase classification, and molecular-genetic techniques for precise identification of carbapenemase genes. We also propose a workflow for carbapenemase identification in diagnostic laboratories.
Collapse
Affiliation(s)
- J Hrabák
- Department of Microbiology, Faculty of Medicine and University Hospital in Plzeň, Charles University in Prague, Plzeň, Czech Republic
| | | | | |
Collapse
|
36
|
Fournier S, Monteil C, Lepainteur M, Richard C, Brun-Buisson C, Jarlier V, Ap-Hp Outbreaks Control Group C. Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012. ACTA ACUST UNITED AC 2014; 19. [PMID: 24852956 DOI: 10.2807/1560-7917.es2014.19.19.20802] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 2009, following the occurrence of several outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a programme for controlling the spread of CPE was implemented in the 38 hospitals of the Assistance Publique-Hôpitaux de Paris, a 21,000-bed institution. This programme included recommendations to isolate, and screen for CPE, patients previously hospitalised abroad, and bundled measures to control cross transmission (barrier precautions, dedicated staff and screening of contact patients). From 2004 to 2012, 140 CPE index cases were identified, 17 leading to outbreaks. After application of the programme, in spite of an increase in the number of CPE index cases epidemiologically linked with a recent stay or hospitalisation abroad, the proportion of cases followed by outbreaks, which was 40% (4/10) before 2009, decreased to 10% (13/130) (p=0.02), and the proportion of secondary cases among all CPE cases decreased from 69% (22/32) to 23% (38/168), (p<0.001). The number of secondary cases varied significantly depending on the speed and strength of the measures implemented around the CPE index case: quick (within two days of patient admission at the hospital) setting of nursing staff dedicated to the patient, quick setting of simple barrier precautions, or delayed measures of control (p=0.001). A sustained and coordinated strategy can lead to control CPE at the level of a large regional multi-hospital institution in a country where CPE are at an emerging stage.
Collapse
Affiliation(s)
- S Fournier
- Infection Control Team, Direction de la Politique Medicale, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | | | | | | | | | | |
Collapse
|
37
|
Bedenić B, Zujić-Atalić V, Jajić I, Djuras-Cuculić B, Godič-Torkar K, Vraneš J, Zarfel G, Grisold A. Clonal spread ofKlebsiella pneumoniaeproducing KPC-2 beta-lactamase in Croatian University Hospital. J Chemother 2014; 27:241-5. [DOI: 10.1179/1973947814y.0000000191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
38
|
Lübbert C, Lippmann N, Busch T, Kaisers UX, Ducomble T, Eckmanns T, Rodloff AC. Long-term carriage of Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae after a large single-center outbreak in Germany. Am J Infect Control 2014; 42:376-80. [PMID: 24679563 DOI: 10.1016/j.ajic.2013.12.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The natural progress of intestinal colonization with Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae (KPC-2-KP) is almost unknown. METHODS After a large, single-center outbreak of KPC-2-KP, we analyzed carrier prevalence through retrospective and prospective investigation of intestinal KPC-2-KP carriage 1 month, 3 months, 6 months, 1 year, and 2 years after acquisition, defined as the earliest date of KPC-2-KP detection. Rectal swabs or stool samples were collected at baseline and at each visit and submitted for both culture and KPC-specific polymerase chain reaction. Resolution of intestinal KPC-2-KP carriage was defined as a minimum of 3 consecutive negative polymerase chain reaction test results separated by at least 48 hours. RESULTS In patients available for long-term evaluation 26 out of 84 patients (31%) tested negative for KPC-2-KP after 1 month, 14 out of 34 (41%) after 3 months, 17 out of 26 (65%) after 6 months, 14 out of 19 (74%) after 1 year, and 5 out of 6 (83%) after 2 years. Decolonization of KPC-2-KP was hampered in patients with prolonged or repeated hospitalization (P = .044-.140, depending on the time interval). Two patients retested positive for KPC-2-KP after they had previously shown 3 consecutive negative tests. The longest positive KPC-2-KP carrier status so far was observed after nearly 40 months (1,191 days). CONCLUSIONS The majority of patients experienced spontaneous decolonization within 6 months after acquisition, mainly after discharge from the hospital. However, long-term carriage of >3 years is possible. Appropriate infection control measures must be taken when these patients are readmitted to health care facilities. A series of at least 4 consecutive negative rectal swabs or stool samples separated by sufficient time intervals appears necessary before the declaration of successful KPC-2-KP decolonization is made.
Collapse
Affiliation(s)
- Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany.
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany
| | - Thilo Busch
- Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Udo X Kaisers
- Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Tanja Ducomble
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Arne C Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany
| |
Collapse
|
39
|
Peter S, Wolz C, Kaase M, Marschal M, Schulte B, Vogel W, Autenrieth I, Willmann M. Emergence of Citrobacter freundii carrying IMP-8 metallo-β-lactamase in Germany. New Microbes New Infect 2014; 2:42-5. [PMID: 25356340 PMCID: PMC4184589 DOI: 10.1002/nmi2.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/22/2013] [Accepted: 01/14/2014] [Indexed: 11/08/2022] Open
Abstract
Metallo-β-lactamases (MBLs) in Enterobacteriaceae are an increasing problem worldwide. This report describes the isolation of Citrobacter freundii carrying IMP-8 MBL from three patients during the period from March 2012 until March 2013 in Germany. The blaIMP-8 enzyme is predominantly found in Asia, where IMP-8 has spread to various enterobacterial species causing serious infections. To our best knowledge, this is the first report of blaIMP-8 habouring Enterobacteriaceae in Europe.
Collapse
Affiliation(s)
- S Peter
- Institute of Medical Microbiology and Hygiene, University of Tübingen Tübingen, Germany ; German Centre for Infection Research (DZIF), partner site Tübingen Tübingen, Germany
| | - C Wolz
- Institute of Medical Microbiology and Hygiene, University of Tübingen Tübingen, Germany ; German Centre for Infection Research (DZIF), partner site Tübingen Tübingen, Germany
| | - M Kaase
- National Reference Laboratory for Multidrug Resistant Gram-negative Bacteria, Department of Medical Microbiology, Ruhr University Bochum Bochum, Germany
| | - M Marschal
- Institute of Medical Microbiology and Hygiene, University of Tübingen Tübingen, Germany ; German Centre for Infection Research (DZIF), partner site Tübingen Tübingen, Germany
| | - B Schulte
- Institute of Medical Microbiology and Hygiene, University of Tübingen Tübingen, Germany ; German Centre for Infection Research (DZIF), partner site Tübingen Tübingen, Germany
| | - W Vogel
- Medical Centre, Department of Haematology, Oncology, Immunology, Rheumatology and Pulmonology, University of Tübingen Tübingen, Germany
| | - I Autenrieth
- Institute of Medical Microbiology and Hygiene, University of Tübingen Tübingen, Germany ; German Centre for Infection Research (DZIF), partner site Tübingen Tübingen, Germany
| | - M Willmann
- Institute of Medical Microbiology and Hygiene, University of Tübingen Tübingen, Germany ; German Centre for Infection Research (DZIF), partner site Tübingen Tübingen, Germany
| |
Collapse
|
40
|
Kaase M. [Carbapenemases in gram-negative bacteria. Current data and trends of resistance resulting from the work of national reference centres]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1401-4. [PMID: 23114438 DOI: 10.1007/s00103-012-1552-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The spread of carbapenemase-producing gram-negative bacteria is one of the major challenges of the present. Since 2009, the National Reference Laboratory for gram-negative nosocomial pathogens has observed the molecular epidemiology of carbapenemases in Germany. In 2011, 1,454 referred bacterial isolates were tested for the presence of carbapenemases. Carbapenemase was found in 34.4% of Enterobacteriaceae isolates, in 19.9% of Pseudomonas aeruginosa isolates and in 96.3% of Acinetobacter baumannii isolates. The most frequent carbapenemases in Enterobacteriaceae were OXA-48, KPC and VIM-1; in P. aeruginosa it was VIM-2 and in A. baumannii OXA-23.
Collapse
Affiliation(s)
- M Kaase
- Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Universitätsstrasse 150, Bochum, Germany.
| |
Collapse
|
41
|
Vergara-López S, Domínguez M, Conejo M, Pascual Á, Rodríguez-Baño J. Wastewater drainage system as an occult reservoir in a protracted clonal outbreak due to metallo-β-lactamase-producing Klebsiella oxytoca. Clin Microbiol Infect 2013; 19:E490-8. [DOI: 10.1111/1469-0691.12288] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/17/2013] [Accepted: 05/27/2013] [Indexed: 11/28/2022]
|
42
|
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.
Collapse
Affiliation(s)
- P Gastmeier
- Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | | |
Collapse
|
43
|
Markovska R, Schneider I, Stoeva T, Bojkova K, Boyanova L, Bauernfeind A, Mitov I. First identification of KPC-2 and VIM-1 producing Klebsiella pneumoniae in Bulgaria. Diagn Microbiol Infect Dis 2013; 77:252-3. [PMID: 24041551 DOI: 10.1016/j.diagmicrobio.2013.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/24/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Rumyana Markovska
- Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria.
| | | | | | | | | | | | | |
Collapse
|
44
|
Daikos GL, Markogiannakis A, Souli M, Tzouvelekis LS. Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae: a clinical perspective. Expert Rev Anti Infect Ther 2013; 10:1393-404. [PMID: 23253318 DOI: 10.1586/eri.12.138] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dissemination of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) has caused a public health crisis that can be paralleled with that caused by the spread of MRSA. CP-Kps, being multidrug-resistant, mainly affect patients with severe underlying conditions in the acute-healthcare setting. CP-Kps are responsible for a variety of life-threatening infections including bacteremia and pneumonia. The shortage of therapeutic options has forced clinicians to use colistin as well as tigecycline, a novel bacteriostatic agent. Although both drugs are generally active in vitro against CP-Kps, therapeutic failures, especially in bacteremias, are quite common. The authors suggest here, after reviewing the literature, that use of the latter drugs should be re-assessed and optimized. The authors have also summarized experimental and clinical data indicating that exploitation of the pharmacokinetic/pharmacodynamic features of carbapenems may provide solutions in bloodstream infections caused by CP-Kps with low-level resistance to the latter drugs. Most importantly, there is evidence that monotherapy must be avoided.
Collapse
Affiliation(s)
- George L Daikos
- First Department of Propaedeutic Medicine, University of Athens, Athens, Greece.
| | | | | | | |
Collapse
|
45
|
Miriagou V, Tzelepi E, Kotsakis SD, Daikos GL, Bou Casals J, Tzouvelekis LS. Combined disc methods for the detection of KPC- and/or VIM-positive Klebsiella pneumoniae: improving reliability for the double carbapenemase producers. Clin Microbiol Infect 2013; 19:E412-5. [PMID: 23627340 DOI: 10.1111/1469-0691.12238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/30/2013] [Accepted: 03/31/2013] [Indexed: 11/29/2022]
Abstract
Klebsiella pneumoniae strains co-producing klebsiella pneumoniae carbapenemase (KPC) and verona integron-encoded metallo-beta-lactamase (VIM) are frequently isolated in Greece and have also occurred in other European countries. Conventional combined disc tests exhibit low sensitivity against these emerging pathogens. We have evaluated modifications of the KPC/Metallo-β-Lactamase Confirmation kit (ROSCO) exhibiting high diagnostic value against KPC, VIM and KPC + VIM producers. The key changes were the inclusion of additional combined tablets containing meropenem plus two inhibitors (dipicolinic acid (1000 μg per tablet) for metallo-β-lactamases and a boronic acid derivative for KPCs) and the replacement of aminophenylboronic acid by phenylboronic acid (400 μg per tablet).
Collapse
Affiliation(s)
- V Miriagou
- Laboratory of Bacteriology, Hellenic Pasteur Institute, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
46
|
Bedenić B, Mazzariol A, Plečko V, Bošnjak Z, Barl P, Vraneš J, Cornaglia G. First report of KPC-producing Klebsiella pneumoniae in Croatia. J Chemother 2013; 24:237-9. [PMID: 23040691 DOI: 10.1179/1973947812y.0000000017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In February 2011, a 78-year-old male patient was admitted to Clinical Hospital Center Zagreb with subdural haematoma. Klebsiella pneumoniae with reduced susceptibility to carbapenems was isolated. PCR revealed the presence of bla(KPC), bla(TEM), and bla(SHV) genes. Sequencing of bla(KPC) gene identified K. pneumoniae carbapenemase (KPC)-2 beta-lactamase. The strain belonged to ST37 clone by multilocus sequence typing. Infection control efforts limited the spread of KPC-producing clone of K. pneumoniae in our hospital so far. To our knowledge, this is the first report of a KPC-producing K. pneumoniae in Croatia.
Collapse
Affiliation(s)
- Branka Bedenić
- School of Medicine, University of Zagreb, Zagreb, Croatia.
| | | | | | | | | | | | | |
Collapse
|
47
|
Perilli M, Bottoni C, Grimaldi A, Segatore B, Celenza G, Mariani M, Bellio P, Frascaria P, Amicosante G. Carbapenem-resistant Klebsiella pneumoniae harbouring blaKPC-3 and blaVIM-2 from central Italy. Diagn Microbiol Infect Dis 2013; 75:218-21. [DOI: 10.1016/j.diagmicrobio.2012.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 09/13/2012] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
|
48
|
Gould IM, Bal AM. New antibiotic agents in the pipeline and how they can help overcome microbial resistance. Virulence 2013; 4:185-91. [PMID: 23302792 PMCID: PMC3654619 DOI: 10.4161/viru.22507] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bacterial resistance is a growing threat and yet few new antibiotics active against multi-resistant bacteria are being explored. A combination of falling profits, regulatory mechanisms and irrational and injudicious use of antibiotics has led to an alarming situation where some infections have no cure. In this article, we summarize the new developments that have been suggested to incentivize the pharmaceutical industries toward the field of infections. We also briefly mention the new compounds on the horizon and some newly approved compounds that might help us tide over this crisis.
Collapse
|
49
|
Landelle C, Pagani L, Harbarth S. Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens? Virulence 2013; 4:163-71. [PMID: 23302791 PMCID: PMC3654617 DOI: 10.4161/viru.22641] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Isolation or cohorting of infected patients is an old concept. Its purpose is to prevent the transmission of microorganisms from infected or colonized patients to other patients, hospital visitors, and health care workers, who may subsequently transmit them to other patients or become infected or colonized themselves. Because the process of isolating patients is expensive, time-consuming, often uncomfortable for patients and may impede care, it should be implemented only when necessary. Conversely, failure to isolate a patient with multidrug-resistant microorganisms may lead to adverse outcomes, and may ultimately be expensive when one considers the direct costs of an outbreak investigation and the indirect costs of lost productivity. In this review, we argue that contact precautions are essential to control the spread of epidemic and endemic multidrug-resistant microorganisms, and discuss limitations of some available data.
Collapse
Affiliation(s)
- Caroline Landelle
- Infection Control Program, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | | | | |
Collapse
|
50
|
Emergence of Klebsiella pneumoniae Coharboring KPC and VIM Carbapenemases in Colombia. Antimicrob Agents Chemother 2012; 57:1101-2. [PMID: 23229478 DOI: 10.1128/aac.01666-12] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|