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Carbapenem-Resistant Klebsiella pneumoniae Producing New Delhi Metallo-β-Lactamase at an Acute Care Hospital, Colorado, 2012

Published online by Cambridge University Press:  10 May 2016


Erin E. Epson
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Colorado Department of Public Health and Environment, Denver, Colorado
Larissa M. Pisney
Affiliation:
Division of Infectious Diseases, University of Colorado, Aurora, Colorado
Joyanna M. Wendt
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Duncan R. MacCannell
Affiliation:
Antimicrobial Resistance and Characterization Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah J. Janelle
Affiliation:
Colorado Department of Public Health and Environment, Denver, Colorado
Brandon Kitchel
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
J. Kamile Rasheed
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Brandi M. Limbago
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Carolyn V. Gould
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Alexander J. Kallen
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Michelle A. Barron
Affiliation:
Division of Infectious Diseases, University of Colorado, Aurora, Colorado
Wendy M. Bamberg
Affiliation:
Colorado Department of Public Health and Environment, Denver, Colorado
Corresponding
E-mail address:

Abstract

Objective.

To investigate an outbreak of New Delhi metallo-β-lactamase (NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission.

Design, Setting, and Patients.

Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital.

Methods.

Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for bla NDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations.

Results.

Two patients were initially identified with NDM-producing CRE during July–August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission.

Conclusions.

A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.


Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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