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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)
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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

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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