Outbreak of Imipenemase-1-Producing Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. Methods: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. Results: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. Conclusions: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
Abstract
Background: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. Methods: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. Results: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. Conclusions: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
참고문헌 (30)
- Podschun R, "Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors", Clin Microbiol Rev, 11, pp.589~603 (1998)
- Nikaido H., "Prevention of drug access to bacterial targets : permeability barriers and active efflux", Science, 264, pp.382~388 (1994)
- Piddock LJ., "Clinically relevant chromosomally encoded multidrug resistance efflux pumps in bacteria", Clin Microbiol Rev, 19, pp.382~402 (2006)
- Jacoby GA, "The new β-lactamases", N Eng J Med, 352, pp.380~391 (2005)
- Walther-Rasmussen J, "OXA-type carbapenemases", J Antimicrob Chemother, 57, pp.373~383 (2006)
- Watanabe M, "Transferable imipenem resistance in Pseudomonas aeruginosa", Antimicrob Agents Chemother, 35, pp.147~151 (1991)
- Nordmann P, "Emerging carbapenemases in Gram-negative aerobes", Clin Microbiol Infect, 8, pp.321~331 (2002)
- Walsh TR, "Metallo-beta-lactamases: the quiet before the storm?", Clin Microbiol Rev, 18, pp.306~325 (2005)
- Lincopan N, "First isolation of metallo-beta-lactamase-producing multiresistant Klebsiella pneumoniae from a patient in Brazil", J Clin Microbiol, 43, pp.516~519 (2005)
- Koh TH, "Carbapenem-hydrolysing IMP-1 beta-lactamase in Klebsiella pneumoniae from Singapore", Lancet, 353, pp.2162~ (1999)
- Shibata N, "PCR typing of genetic determinants for metallo-beta-lactamases and integrases carried by gram-negative bacteria isolated in Japan, with focus on the class 3 integron", J Clin Microbiol, 41, pp.5407~5413 (2003)
- Yan JJ, "Outbreak of infection with multidrug-resistant Klebsiella pneumoniae carrying blaIMP-8 in a university medical center in Taiwan", J Clin Microbiol, 39, pp.4433~4439 (2001)
- "Monitoring of antimicrobial resistance on general hospitals in Korea" (2010)[URL]
- "Emergence and charcteristics of Carbapenemase-Producing Enterobacteriaceae(CPE) in Korea, 2011" (2012)[URL]
- "Status of Carbapenemase producing Enterobacteriaceae in Korea, 2014" (2015)[URL]
- 정석훈, "Outbreaks of Imipenem-Resistant Acinetobacter baumannii Producing Carbapenemases in Korea", The Journal of Microbiology, 44(4), pp.423~431 (2006), 한국미생물학회
- Clinical and Laboratory Standards Institute., "Performance standards for antimicrobial susceptibility testing:Twentieth Informational Supplement M100-S20", Clinical and Laboratory Standards Institute, ~ (2010)
- Hussein K, "Carbapenem resistance among Klebsiella pneumoniae isolates risk factors, molecular characteristics, and susceptibility patterns", Infect Control Hosp Epidemiol, 30, pp.666~671 (2009)
- Patel G, "Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies", Infect Control Hosp Epidemiol, 29, pp.1099~1106 (2008)
- Schwaber MJ, "Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality", Antimicrob Agents Chemother, 52, pp.1028~1033 (2008)
- Gould CV, "Guideline for prevention of catheter-associated urinary tract infections 2009", Infect Control Hosp Epidemiol, 31, pp.319~326 (2010)
- Chu YW, "Skin carriage of acinetobacters in Hong Kong", J Clin Microbiol, 37, pp.2962~2967 (1999)
- Tankovic J, "Characterization of a hospital outbreak of imipenem-resistant Acinetobacter baumannii by phenotypic and genotypic typing methods", J Clin Microbiol, 32, pp.2677~2681 (1994)
- Go ES, "Clinical and molecular epidemiology of acinetobacter infections sensitive only to polymyxin B and sulbactam", Lancet, 344, pp.1329~1332 (1994)
- Catalano M, "Survival of Acinetobacter baumannii on bed rails during an outbreak and during sporadic cases", J Hosp Infect, 42, pp.27~35 (1999)
- Wendt C, "Survival of Acinetobacter baumannii on dry surfaces", J Clin Microbiol, 35, pp.1394~1397 (1997)
- Wilson AP, "The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens : a randomized crossover study in critical care units in two hospitals", Crit Care Med, 39, pp.651~658 (2011)
- Bratu S, "Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City : a new threat to our antibiotic armamentarium", Arch Intern Med, 165, pp.1430~1435 (2005)
- Bilavsky E, "How to stem the tide of carbapenemase-producing enterobacteriaceae? : proactive versus reactive strategies", Curr Opin Infect Dis, 23, pp.327~331 (2010)
- Centers for Disease Control and Prevention (CDC)., "Guidance for control of infections with carbapenemresistant or carbapenemase-producing Enterobacteriaceae in acute care facilities", MMWR Morb Mortal Wkly Rep, 58, pp.256~260 (2009)