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Outbreak of Klebsiella pneumoniae Carbapenemase–Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida

  • Adriana Jiménez (a1) (a2), José G. Castro (a3), L. Silvia Munoz-Price (a4), Dennise de Pascale (a1), Luis Shimose (a5), Mustapha M. Mustapha (a6), Caressa N. Spychala (a6), Roberta T. Mettus (a6), Vaughn S. Cooper (a6) and Yohei Doi (a6)...



To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida.


An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted.


An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions.


Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.

Infect Control Hosp Epidemiol 2017;38:320–326


Corresponding author

Address correspondence to Adriana Jiménez, MPH, BSMT, Department of Infection Prevention and Control, Jackson Memorial Hospital, 1611 NW 12th Ave PPW 301, Miami, FL 33136 (


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