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Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)–producing Enterobacteriaceae outbreak

  • Allison E. Reeme (a1), Sarah L. Bowler (a2), Blake W. Buchan (a3), Mary Beth Graham (a4), Elizabeth Behrens (a5), Siddhartha Singh (a6), Johnny C. Hong (a7), Jennifer Arvan (a1), Joshua W. Hyke (a1), Louis Palen (a1), Sabrina Savage (a1), Heather Seliger (a1), Susan Huerta (a5), Nathan A. Ledeboer (a3), Shireen Kotay (a8), Amy J. Mathers (a8), Vaughn S. Cooper (a9), Mustapha Munir Mustapha (a2), Roberta T. Mettus (a2), Yohei Doi (a2) and L. Silvia Munoz-Price (a4)...

Abstract

Objective:

Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.

Design:

Observational study.

Setting:

A 566-room academic teaching facility in Milwaukee, Wisconsin.

Patients:

Solid-organ transplant recipients.

Methods:

Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.

Results:

A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.

Conclusions:

A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.

Copyright

Corresponding author

Author for correspondence: L. Silvia Munoz-Price, Email: smunozprice@mcw.edu

References

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Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)–producing Enterobacteriaceae outbreak

  • Allison E. Reeme (a1), Sarah L. Bowler (a2), Blake W. Buchan (a3), Mary Beth Graham (a4), Elizabeth Behrens (a5), Siddhartha Singh (a6), Johnny C. Hong (a7), Jennifer Arvan (a1), Joshua W. Hyke (a1), Louis Palen (a1), Sabrina Savage (a1), Heather Seliger (a1), Susan Huerta (a5), Nathan A. Ledeboer (a3), Shireen Kotay (a8), Amy J. Mathers (a8), Vaughn S. Cooper (a9), Mustapha Munir Mustapha (a2), Roberta T. Mettus (a2), Yohei Doi (a2) and L. Silvia Munoz-Price (a4)...

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