Skip to main content Accessibility help
×
Home
Hostname: page-component-59b7f5684b-b2xwp Total loading time: 0.298 Render date: 2022-10-02T20:51:24.751Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

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

Published online by Cambridge University Press:  14 May 2019

Allison E. Reeme
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Sarah L. Bowler
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Blake W. Buchan
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Mary Beth Graham
Affiliation:
Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Elizabeth Behrens
Affiliation:
Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Siddhartha Singh
Affiliation:
Division of General Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Johnny C. Hong
Affiliation:
Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
Jennifer Arvan
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Joshua W. Hyke
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Louis Palen
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Sabrina Savage
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Heather Seliger
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Susan Huerta
Affiliation:
Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Nathan A. Ledeboer
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Shireen Kotay
Affiliation:
Division of Infectious Diseases, University of Virginia, Charlottesville, Virginia
Amy J. Mathers
Affiliation:
Division of Infectious Diseases, University of Virginia, Charlottesville, Virginia
Vaughn S. Cooper
Affiliation:
Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
Mustapha Munir Mustapha
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Roberta T. Mettus
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Yohei Doi
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
L. Silvia Munoz-Price*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
*
Author for correspondence: L. Silvia Munoz-Price, Email: smunozprice@mcw.edu

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.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Antibiotic resistance. World Health Organization website. http://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. Published 2016. Accessed July 18, 2018.Google Scholar
Nordmann, P, Cuzon, G, Naas, T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9:228236.CrossRefGoogle ScholarPubMed
Tracking CRE. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/organisms/cre/trackingcre.html. Published 2017. Accessed July 18, 2018.Google Scholar
Logan, LK, Weinstein, RA. The epidemiology of carbapenem-resistant Enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis 2017;215:S28S36.CrossRefGoogle ScholarPubMed
CRE control and prevention toolkit. Agency for Healthcare Research and Quality website. https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cretoolkit/index.html. Published 2014. Accessed July 18, 2018.Google Scholar
Multiplex real-time PCR detection of Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-β-lactamase (NDM-1) genes. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/pdfs/labsettings/KPC-NDM-protocol-2011.pdf. Published 2011. Accessed July 18, 2018.Google Scholar
Mathers, AJ, Vegesana, K, German Mesner, I, et al. Intensive care unit wastewater interventions to prevent transmission of multi-species Klebsiella pneumoniae carbapenemase (KPC) producing organisms. Clin Infect Dis 2018;67:171178.CrossRefGoogle Scholar
Kim, YA, Qureshi, ZA, Adams-Haduch, JM, Park, YS, Shutt, KA, Doi, Y. Features of infections due to Klebsiella pneumoniae carbapenemase-producing Escherichia coli: emergence of sequence type 131. Clin Infect Dis 2012;55:224231.CrossRefGoogle ScholarPubMed
Bueno, MFC, Francisco, GR, O’Hara, JA, De Oliveira Garcia, D, Doi, Y. Coproduction of 16S rRNA methyltransferase RmtD or RmtG with KPC-2 and CTX-M group extended-spectrum β-lactamases in Klebsiella pneumoniae. Antimicrob Agents Chemother 2013;57:23972400.CrossRefGoogle ScholarPubMed
Munoz-Price, LS, Hayden, MK, Lolans, K, et al. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;4:341347.CrossRefGoogle Scholar
Munoz-Price, LS, De La Cuesta, C, Adams, S, et al. Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida. Infect Control Hosp Epidemiol 2010;10:10741077.CrossRefGoogle Scholar
Gohil, SK, Singh, R, Chang, J, et al. Emergence of carbapenem-resistant Enterobacteriaceae in Orange County, California, and support for early regional strategies to limit spread. Am J Infect Control 2017;45:11771182.CrossRefGoogle ScholarPubMed
Khan, AS, Dancer, SJ, Humphreys, H. Priorities in the prevention and control of multidrug-resistant Enterobacteriaceae in hospitals J Hosp Infect 2012;82:8593.CrossRefGoogle ScholarPubMed
Palmore, TN, Henderson, DK. Managing transmission of carbapenem-resistant enterobacteriaceae in healthcare settings: a view from the trenches. Clin Infect Dis 2013;57:15931599.CrossRefGoogle ScholarPubMed
Munoz-Price, LS, Quinn, JP. Deconstructing the infection control bundles for the containment of carbapenem-resistant Enterobacteriaceae. Curr Opin Infect Dis 2013;26:378387.CrossRefGoogle ScholarPubMed
Kotay, S, Chai, W, Guilford, W, Barry, K, Mathers, AJ. Spread from the sink to the patient: In situ study using green fluorescent protein (GFP)-expressing Escherichia coli to model bacterial dispersion from hand-washing sink-trap reservoirs. Appl Environ Microbiol 2017;83:e0332716.CrossRefGoogle ScholarPubMed
Kizny Gordon, AE, Mathers, AJ, Cheong, EYL, et al. The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections—a systematic review of the literature. Clin Infect Dis 2017;64:14351444.CrossRefGoogle ScholarPubMed
Naas, T, Bonnin, RA, Cuzon, G, Villegas, MV, Nordmann, P. Complete sequence of two KPC-harbouring plasmids from Pseudomonas aeruginosa. J Antimicrob Chemother 2013;68:17571762.CrossRefGoogle ScholarPubMed
Yao, Y, Lazaro-Perona, F, Falgenhauer, L, et al. Insights into a novel blaKPC-2-Encoding IncP-6 plasmid reveal carbapenem-resistance circulation in several Enterobacteriaceae species from wastewater and a hospital source in Spain. Front Microbiol 2017;8:1143.CrossRefGoogle Scholar
Kukla, R, Chudejova, K, Papagiannitsis, CC, et al. Characterization of KPC-encoding plasmids from enterobacteriaceae isolated in a Czech hospital. Antimicrob Agents Chemother 2018;62:e0215217.Google Scholar
Supplementary material: Image

Reeme et al. supplementary material

Reeme et al. supplementary material 1

Download Reeme et al. supplementary material(Image)
Image 152 KB
5
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

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

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

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

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *