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Intensive Care Unit Outbreak of Extended-Spectrum β-Lactamase–Producing Klebsiella Pneumoniae Controlled by Cohorting Patients and Reinforcing Infection Control Measures

Published online by Cambridge University Press:  02 January 2015

C. Laurent ,
H. Rodriguez-Villalobos ,
F. Rost ,
H. Strale ,
J.-L. Vincent ,
A. Deplano ,
M. J. Struelens  and
B. Byl
C. Laurent
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
H. Rodriguez-Villalobos
Affiliation:
Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
F. Rost
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
H. Strale
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
J.-L. Vincent
Affiliation:
Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
A. Deplano
Affiliation:
Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
M. J. Struelens
Affiliation:
Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
B. Byl*
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
*
Department of Infection Control and Hospital Epidemiology, Hôpital Erasme 808, route de Lennick, Brussels, Belgium (baudouin.byl@erasme.ulb.ac.be)
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Abstract

Objective.

To describe an outbreak of extended-spectrum β-lactamase (ESBL)–producing Klebsiella pneumoniae in the intensive care units (ICUs) of a hospital and the impact of routine and reinforced infection control measures on interrupting nosocomial transmission.

Design.

Outbreak report.

Setting.

A 31-bed intensive care department (composed of 4 ICUs) in a university hospital in Belgium.

Intervention.

After routine infection control measures (based on biweekly surveillance cultures and contact precautions) failed to interrupt a 2-month outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures were implemented. The frequency of surveillance cultures was increased to daily sampling. Colonized patients were moved to a dedicated 6-bed ICU, where they received cohorted care with the support of additional nurses. Two beds were closed to new admissions in the intensive care department. Meetings between the ICU and infection control teams were held every day. Postdischarge disinfection of rooms was enforced. Broad-spectrum antibiotic use was discouraged.

Results.

Compared with a baseline rate of 0.44 cases per 1,000 patient-days for nosocomial transmission, the incidence peaked at 11.57 cases per 1,000 patient-days (October and November 2005; rate ratio for peak vs baseline, 25.46). The outbreak involved 30 patients, of whom 9 developed an infection. Bacterial genotyping disclosed that the outbreak was polyclonal, with 1 predominant genotype. Reinforced infection control measures lasted for 50 days. After the implementation of these measures, the incidence fell to 0.08 cases per 1,000 patient-days (rate ratio for after the outbreak vs during the outbreak, 0.11).

Conclusion.

These data indicate that, in an intensive care department in which routine screening and contact precautions failed to prevent and interrupt an outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures controlled the outbreak without major disruption of medical care.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 517 - 524
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Knothe, H, Shah, P, Krcmery, V, Antal, M, Mitsuhashi, S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315–317.Google Scholar
2.Paterson, DL, Bonomo, RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657–686.CrossRefGoogle ScholarPubMed
3.Macrae, MB, Shannon, KP, Rayner, DM, Kaiser, AM, Hoffman, PN, French, GL. A simultaneous outbreak on a neonatal unit of two strains of multiply antibiotic resistant Klebsiella pneumoniae controllable only by ward closure. J Hosp Infect 2001;49:183–192.Google Scholar
4.Kang, CI, Kim, SH, Kim, DM, et al. Risk factors for and clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase–producing Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2004;25:860–867.Google Scholar
5.Peña, C, Pujol, M, Ardanuy, C, et al. An outbreak of hospital-acquired Klebsiella pneumoniae bacteraemia, including strains producing extended-spectrum beta-lactamase. J Hosp Infect 2001;47:53–59.Google Scholar
6.Tumbarello, M, Spanu, T, Sanguinetti, M, et al. Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 2006;50:498–504.CrossRefGoogle ScholarPubMed
7.Lin, MF, Huang, ML, Lai, SH. Risk factors in the acquisition of extended-spectrum beta-lactamase Klebsiella pneumoniae: a case-control study in a district teaching hospital in Taiwan. J Hosp Infect 2003;53:39–45.CrossRefGoogle Scholar
8.Boo, NY, Ng, SF, Lim, VK. A case-control study of risk factors associated with rectal colonization of extended-spectrum beta-lactamase producing Klebsiella sp. in newborn infants. J Hosp Infect 2005;61:68–74.Google Scholar
9.Richards, C, Alonso-Echanove, J, Caicedo, Y, Jarvis, WR. Klebsiella pneumoniae bloodstream infections among neonates in a high-risk nursery in Cali, Colombia. Infect Control Hosp Epidemiol 2004;25:221–225.Google Scholar
10.Paterson, DL, Ko, WC, Von Gottberg, A, et al. International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections. Ann Intern Med 2004;140:26–32.Google Scholar
11.Kim, BN, Woo, JH, Kim, MN, Ryu, J, Kim, YS. Clinical implications of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae bacteraemia. J Hosp Infect 2002;52:99–106.Google Scholar
12.Gupta, A, Della-Latta, P, Todd, B, et al. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 2004;25:210–215.CrossRefGoogle Scholar
13.Ayan, M, Kuzucu, C, Durmaz, R, Aktas, E, Cizmeci, Z. Analysis of three outbreaks due to Klebsiella species in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:495–500.Google Scholar
14.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Last accessed 8 May 2008.Google Scholar
15.Holländer, R, Ebke, M, Barck, H, von Pritzbuer, E. Asymptomatic carriage of Klebsiella pneumoniae producing extended-spectrum beta-lactamase by patients in a neurological early rehabilitation unit: management of an outbreak. J Hosp Infect 2001;48:207–213.CrossRefGoogle Scholar
16.Harris, AD, Perencevich, EN, Johnson, JK, et al. Patient-to-patient transmission is important in extended-spectrum β–lactamase-producing Klebsiella pneumoniae acquisition. Clin Infect Dis 2007;45:1347–1350.Google Scholar
17.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
18.Bradford, PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933–951.CrossRefGoogle ScholarPubMed
19.Piagnerelli, M, Carlier, E, Deplano, A, Lejeune, P, Govaerts, D. Risk factors for infection and molecular typing in patients in the intensive care unit colonized with nosocomial Enterobacter aerogenes. Infect Control Hosp Epidemiol 2002;23:452–456.Google Scholar
20.Garner, JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53–80.Google Scholar
21.Hugonnet, S, Chevrolet, JC, Pittet, D. The effect of workload on infection risk in critically ill patients. Crit Care Med 2007;35:76–81.Google Scholar
22.Noritomi, DT, Chierego, M, Byl, B, et al. Is compliance with hand disinfection in the intensive care unit related to work experience? Infect Control Hosp Epidemiol 2007;28:362–364.Google Scholar
23.Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 1997;16:1045–1048.Google Scholar
24.Casolari, C, Pecorari, M, Fabio, G, et al. A simultaneous outbreak of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit. J Hosp Infect 2005;61:312–320.Google Scholar
25.Lee, SO, Lee, ES, Park, SY, Kim, SY, Seo, YH, Cho, YK. Reduced use of third-generation cephalosporins decreases the acquisition of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2004;25:832–837.Google Scholar
26.Peña, C, Pujol, M, Ardanuy, C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1998;42:53–58.Google Scholar