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Journal of Antimicrobial Chemotherapy
Article . 2012 . Peer-reviewed
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Inter-hospital outbreak of Klebsiella pneumoniae producing KPC-2 carbapenemase in Ireland

Authors: Morris, D.; Boyle, F.; Morris, C.; Condon, I.; Delannoy-Vieillard, A.-S.; Power, L.; Khan, A.; +13 Authors

Inter-hospital outbreak of Klebsiella pneumoniae producing KPC-2 carbapenemase in Ireland

Abstract

To describe an outbreak of KPC-2-producing Klebsiella pneumoniae with inter-hospital spread and measures taken to control transmission. Between January and March 2011, 13 K. pneumoniae isolates were collected from nine patients at hospital A and two patients at hospital B. Meropenem, imipenem and ertapenem MICs were determined by Etest, carbapenemase production was confirmed by the modified Hodge method and by a disc synergy test, and confirmed carbapenemase producers were tested for the presence of carbapenemase-encoding genes by PCR. PFGE, plasmid analysis, multilocus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST) analysis were performed on all or a subset of isolates. Meropenem, imipenem and ertapenem MICs were 4 to 32, 832 and 16 mg/L, respectively. PCR and sequencing confirmed the presence of bla(KPC-2). PFGE identified four distinguishable (epsilon 88) pulsed-field profiles (PFPs). Isolates distinguishable by PFGE had identical MLVA profiles, and MLST analysis indicated all isolates belonged to the ST258 clone. Stringent infection prevention and control measures were implemented. Over a period of almost 8 months no further carbapenemase-producing Enterobacteriaceae (CPE) were isolated. However, KPC-2-producing K. pneumoniae was detected in two further patients in hospital A in August (PFP indistinguishable from previous isolates) and October 2011 (PFP similar to but distinguishable from previous isolates). Stringent infection prevention and control measures help contain CPE in the healthcare setting; however, in the case of hospital A, where CPE appears to be established in the population served, it may be virtually impossible to achieve eradication or avoid reintroduction into the hospital.

Country
Ireland
Keywords

Ertapenem, multiplex pcr, Microbial Sensitivity Tests, beta-Lactams, k, Polymerase Chain Reaction, beta-Lactamases, dissemination, Disease Outbreaks, beta-lactamases, Humans, antimicrobial resistance, pneumoniae, gene, Externally hosted open access publications with University of Galway authors, Molecular Epidemiology, Meropenem, Hospitals, Klebsiella Infections, Molecular Typing, Imipenem, Klebsiella pneumoniae, Genes, Bacterial, Thienamycins, Ireland

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    popularity
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    influence
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Found an issue? Give us feedback
selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
36
Top 10%
Top 10%
Top 10%
bronze