Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-22T06:04:38.221Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Larissa M. Pisney ,
Joyanna M. Wendt ,
Duncan R. MacCannell ,
Sarah J. Janelle ,
Brandon Kitchel ,
J. Kamile Rasheed ,
Brandi M. Limbago ,
Carolyn V. Gould  and
Alexander J. Kallen
...Show all authors
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
*
Epidemic Intelligence Service Officer, Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver CO 80246 (erin.epson@state.co.us)
Get access Rights & Permissions [Opens in a new window]

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 blaNDM. 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
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 390 - 397
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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

1. Johnson, AP, Woodford, N. Global spread of antibiotic resistance: the example of New Delhi metallo-beta-lactamase (NDM)-mediated carbapenem resistance. J Med Microbiol 2013;62:499–513.CrossRefGoogle ScholarPubMed
2. Yong, D, Toleman, MA, Giske, CG, et al. Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046–5054.CrossRefGoogle Scholar
3. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17:1791–1798.CrossRefGoogle ScholarPubMed
4. Wilson, ME, Chen, LH. NDM-1 and the role of travel in its dissemination. Curr Infect Dis Rep 2012;14:213–226.CrossRefGoogle ScholarPubMed
5. Centers for Disease Control and Prevention. Detection of Enterobacteriaceae isolates carrying metallo-beta-lactamase: United States, 2010. MMWR Morb Mortal Wkly Rep 2010;59:750.Google Scholar
6. Nordmann, P, Poirel, L, Walsh, TR, Livermore, DM. The emerging NDM carbapenemases. Trends Microbiol 2011;19:588–595.CrossRefGoogle ScholarPubMed
7. Centers for Disease Control and Prevention (CDC). Multiplex Real-Time PCR Detection of Klebsiella pneumoniae Carbapenemase (KPC) and New Delhi metallo-beta-lactamase (NDM-1). Atlanta, Georgia: CDC, 2011. http://www.cdc.gov/HAI/pdfs/labSettings/KPC-NDM-protocol-2011.pdf. Accessed August 6, 2013.Google Scholar
8. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. Wayne, PA: CLSI, 2012. CLSI document M100-S22.Google Scholar
9. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Nineteenth Informational Supplement. Wayne, PA: CLSI, 2009. CLSI document M100-S19.Google Scholar
10. Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically: Approved Standard. 9th ed. Wayne, PA: CLSI, 2012. CLSI document M07–M09.Google Scholar
11. Centers for Disease Control and Prevention (CDC). Laboratory Protocol for Detection of Carbapenem-Resistant or Carbapenemase-Producing Klebsiella spp. and E. coli from Rectal Swabs. Atlanta, Georgia: CDC, 2011. http://www.cdc.gov/hai/pdfs/labsettings/klebsiella_or_ecoli.pdf. Accessed August 6, 2013.Google Scholar
12. Kitchel, B, Rasheed, JK, Patel, JB, et al. Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258. Antimicrob Agents Chemother 2009;53:3365–3370.CrossRefGoogle ScholarPubMed
13. kSNP 2.0 ed. Livermore, California: Lawrence Livermore National Lab, 2013.Google Scholar
14. Gardner, SN, Hall, BG. When whole-genome alignments just won't work: kSNP v2 software for alignment-free SNP discovery and phylogenetics of hundreds of microbial genomes. PLOS ONE 2013;8(12):e81760.CrossRefGoogle ScholarPubMed
15. Li, H, Durbin, R. Fast and accurate short read alignment with Burrows-Wheeler transform. Bioinformatics 2009;25:1754–1760.CrossRefGoogle ScholarPubMed
16. Li, H, Handsaker, B, Wysoker, A, et al. The sequence alignment/map (SAM) format and SAMtools. Bioinformatics 2009;25:2078–2079.CrossRefGoogle ScholarPubMed
17. Koboldt, D, Zhang, Q, Larson, D, et al. VarScan 2: somatic mutation and copy number alteration discovery in cancer by exome sequencing. Genome Res 2012;22(3):568–576.CrossRefGoogle ScholarPubMed
18. Garrison, E, Marth, G. Haplotype-based variant detection from short-read sequencing, eprint arXiv: 12073907. 2012.Google Scholar
19. Tamura, K, Peterson, D, Peterson, N, Stecher, G, Nei, M, Kumar, S. MEGA5: Molecular evolutionary genetics analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol 2011;28:2731–2739.CrossRefGoogle ScholarPubMed
20. Centers for Disease Control and Prevention (CDC). New Carbapenem-Resistant Enterobacteriaceae Warrant Additional Action by Healthcare Providers. Atlanta, Georgia: CDC, 2013. http://www.bt.cdc.gov/HAN/han00341.asp. Accessed August 6, 2013.Google Scholar
21. Borgia, S, Lastovetska, O, Richardson, D, et al. Outbreak of carbapenem-resistant Enterobacteriaceae containing blaNDM-1, Ontario, Canada. Clin Infect Dis 2012;55:e109–e117.CrossRefGoogle ScholarPubMed
22. Lowe, CF, Kus, JV, Salt, N, et al. Nosocomial transmission of New Delhi metallo-beta-lactamase-1-producing Klebsiella pneumoniae in Toronto, Canada. Infect Control Hosp Epidemiol 2013;34:49–55.CrossRefGoogle Scholar
23. Escobar Perez, JA, Olarte Escobar, NM, Castro-Cardozo, B, et al. Outbreak of NDM-1-producing Klebsiella pneumoniae in a neo-natal unit in Colombia. Antimicrob Agents Chemother 2013;57:1957–1960.CrossRefGoogle Scholar
24. Centers for Disease Control and Prevention (CDC). 2012 CRE Toolkit: Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE). Atlanta, Georgia: CDC, 2012. http://www.cdc.gov/hai/organisms/cre/cre-toolkit/f-level-prevention.html. Accessed August 6, 2013.Google Scholar
25. Snitkin, ES, Zelazny, AM, Thomas, PJ, et al. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med 2012;4:148ra16.CrossRefGoogle ScholarPubMed
26. Koser, CU, Holden, MT, Ellington, MJ, et al. Rapid whole-genome sequencing for investigation of a neonatal MRSA outbreak. New Engl J Med 2012;366:2267–2275.CrossRefGoogle ScholarPubMed
27. Lewis, T, Loman, NJ, Bingle, L, et al. High-throughput whole-genome sequencing to dissect the epidemiology of Acinetobacter baumannii isolates from a hospital outbreak. J Hosp Infect 2010;75:37–41.CrossRefGoogle ScholarPubMed
28. Thurlow, CJ, Prabaker, K, Lin, MY, et al. Anatomic sites of patient colonization and environmental contamination with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae at long-term acute care hospitals. Infect Control Hosp Epidemiol 2013;34:56–61.CrossRefGoogle ScholarPubMed
29. Munoz-Price, LS, Quinn, JP. Deconstructing the infection control bundles for the containment of carbapenem-resistant Enterobacteriaceae. Curr Opin Infect Dis 2013;26:378–387.CrossRefGoogle ScholarPubMed
30. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed