Skip to main content
×
Home
    • Aa
    • Aa

Nosocomial Transmission of New Delhi Metallo-β-Lactamase-1-Producing Klebsiella pneumoniae in Toronto, Canada

  • Christopher F. Lowe (a1), Julianne V. Kus (a1), Natasha Salt (a2), Sandra Callery (a2), Lisa Louie (a2), Mohammed A. Khan (a1), Mary Vearncombe (a1) (a2) and Andrew E. Simor (a1) (a2)...
Abstract
Design.

An analysis of a cluster of New Delhi metallo-β-lactamase-l-producing Klebsiella pneumoniae (NDMl-Kp) and a retrospective case-cohort analysis of risk factors for acquisition in contacts of NDM1-Kp-positive patients.

Setting.

A 1,100-bed Canadian academic tertiary care center.

Patients.

Two index patients positive for NDMl-Kp as well as 45 contacts (roommates, ward mates, or environmental contacts) were investigated.

Methods.

Retrospective chart reviews of all patients colonized or infected with NDM1-Kp as well as contacts of these patients were performed in order to describe the epidemiology and impact of infection prevention and control measures. A case-cohort analysis was conducted investigating 45 contacts of NDM1-Kp-positive patients to determine risk factors for acquisition of NDM1-Kp. Rectal swabs were screened for NDMl-Kp using chromogenic agar. Presence of blaNDM-1 was confirmed by multiplex polymerase chain reaction. Clonality was assessed with pulsed-field gel electrophoresis (PFGE) using restriction enzyme XbaI.

Results.

Two index cases carrying NDM1-Kp with different PFGE patterns were identified. Nosocomial transmission to 7 patients (4 roommates, 2 ward mates, and 1 environmental contact) was subsequenüy identified. Risk factors for acquisition of NDM1-Kp were a history of prior receipt of certain antibiotics (fluoroquinolones [odds ratio (OR), 16.8 (95% confidence interval [CI], 1.30-58.8); P = .005], trimethoprim-sulfamethoxazole [OR, 11.3 (95% CI, 1.84-70.0); P = .01], and carbapenems [OR, 16.8 (95% CI, 1.79-157.3); P = .04]) and duration of exposure to NDM1-Kp-positive roommates (26.5 vs 6.7 days; P< .001).

Conclusion.

Two distinct clones of NDM1-Kp were transmitted to 7 inpatient contacts over several months. Implementation of contact precautions, screening of contacts for NDM1-Kp carriage, and attention to environmental disinfection contributed to the interruption of subsequent spread of the organism. The appropriate duration and frequency of screening contacts of NDMl-Kp-positive patients require further study.

Copyright
Corresponding author
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room Bl 21, Toronto, Ontario M4N 3M5, Canada (andrew.simor@sunnybrook.ca)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. AM Queenan , K Bush . Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev 2007;20:440458.

2. L Poirel , RA Bonnin , P Nordmann . Analysis of the resistome of a multidrug-resistant NDM-1-producing Escherichia coli strain by high-throughput genome sequencing. Antimicrob Agents Chemother 2011;55:42244229.

3. D Yong , MA Toleman , CG Giske , et al. Characterization of a new metallo-β-lactamase gene, blaNDM-1, a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:50465054.

4. P Nordmann , T Naas , L Poirel . Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17: 17911798.

6. MR Mulvey , JM Grant , K Plewes , D Roscoe , DA Boyd . New Delhi metallo-β-lactamase in Klebsiella pneumoniae and Escherichia co? Canada. Emerg Infect Dis 2011;17:103106.

7. G Peirano , J Ahmed-Bentley , N Woodford , JD Pitout . New Delhi metallo-β-lactamase from traveler returning to Canada. Emerg Infect Dis 2011;17:242244.

8. N Tijet , DC Alexander , D Richardson , et al. New Delhi metallo-β-lactamase, Ontario, Canada. Emerg Infect Dis 2011;17:306307.

10. LF Mataseje , E Bryce , D Roscoe , et al. Carbapenem-resistant gram-negative bacilli in Canada 2009-10: results from the Canadian Nosocomial Infection Surveillance Program (CNISP). J Antimicrob Chemother 2012;67:13591367.

11. C Lowe , K Katz , A McGeer , Muller MP ; Toronto ESBL Working Group. Disparity in infection control practices for multidrug-resistant Enterobacteriaceae. Am J Infect Control 2012;40: 836839.

13. PA Bradford , S Bratu , C Urban , et al. Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 β-lactamases in New York City. Clin Infect Dis 2004;39:5560.

16. EM Ribot , MA Fair , R Gautom , et al. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Food-borne Pathog Dis 2006;3:5967.

17. P Nordmann , JP Couard , D Sansot , L Poirel . Emergence of an autochthonous and community-acquired NDM-1-producing Klebsiella pneumoniae in Europe. Clin Infect Dis 2012;54: 150151.

20. P Nordmann , L Poirel , TR Walsh , DM Livermore . The emerging NDM carbapenemases. Trends Microbiol 2011;19:588595.

21. M Gazin , F Paasch , H Goossens , S Malhotra-Kumar ; MOSAR WP2 and SATURN WP1 Study Teams. Current trends in culture-based and molecular detection of extended-spectrum-β-lactamase-harboring and carbapenem-resistant Enterobacteriaceae. J Clin Microbiol 2012;50:11401146.

23. LH Su , HS Leu , Chiu YP , et al. Molecular investigation of two clusters of hospital-acquired bacteraemia caused by multi-resistant Klebsiella pneumoniae using pulsed-field gel electrophoresis and in frequent restriction site PCR. J Hosp Infect 2000; 46:110117.

27. C Denis , L Poirel , A Carricajo , et al. Nosocomial transmission of NDM-1-producing Escherichia coli within a non-endemic area in France. Clin Microbiol Infect 2012;18:E128E130.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 28 *
Loading metrics...

Abstract views

Total abstract views: 276 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st August 2017. This data will be updated every 24 hours.