Skip to main content
×
Home
    • Aa
    • Aa

Successful Control of an Outbreak of Klebsiella pneumoniae Carbapenemase—Producing K. pneumoniae at a Long-Term Acute Care Hospital

  • L. Silvia Munoz-Price (a1) (a2) (a3), Mary K. Hayden (a4), Karen Lolans (a4), Sarah Won (a4) (a5), Karen Calvert, Michael Lin (a4), Alexander Sterner (a3) and Robert A. Weinstein (a4) (a5)...
Abstract
Objective.

To determine the effect of a bundle of infection control interventions on the horizontal transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae during an outbreak.

Design.

Quasi-experimental study.

Setting.

Long-term acute care hospital.

Intervention.

On July 23,2008, a bundled intervention was implemented: daily 2% Chlorhexidine gluconate baths for patients, enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. Baseline PPS was performed before the intervention was implemented. Any gram-negative rod isolate suspected of KPC production underwent a modified Hodge test and, if results were positive, confirmatory polymerase chain reaction testing. Clinical cases were defined to occur for patients whose samples yielded KPC-positive gram-negative rods in clinical cultures.

Results.

Baseline PPS performed on June 17, 2008, showed a prevalence of colonization with KPC-producing isolates of 21% (8 of 39 patients screened). After implementation of the intervention, monthly PPS was performed 5 times, which showed prevalences of colonization with KPC-producing isolates of 12%, 5%, 3%, 0%, and 0% (P < .001). From January 1, 2008, until the intervention, 8 KPC-positive clinical cases—suspected to be due to horizontal transmission—were detected. From implementation of the intervention through December 31, 2008, only 2 KPC-positive clinical cases, both in August 2008, were detected. From January 1 through December 31, 2008, 8 patients were detected as carriers of KPC-producing isolates at admission to the institution, 4 patients before and 4 patients after the intervention.

Conclusion.

A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.

Copyright
Corresponding author
Jackson Memorial Hospital, Park Plaza West L-302, 1611 Northwest 12th Avenue, Miami, PL 33136-1096 (smunozprice@med.miami.edu)
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. H Yigit , AM Queenan , GJ Anderson , et al.Novel carbapenem-hydro-lyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 2001;45:11511161.

2. MV Villegas , K Lolans , A Correa , JN Kattan , JA Lopez , JP Quinn . First identification of Pseudomonas aeruginosa isolates producing a KPC-type carbapenem-hydrolyzing β-lactamase. Antimicrob Agents Chemother 2007;51:15531555.

3. S Bratu , S Brooks , S Burney , et al.Detection and spread of Escherichia coli possessing the plasmid-borne carbapenemase KPC-2 in Brooklyn, New York. Clin Infect Dis 2007;44:972975.

4. S Bratu , D Landman , M Alam , E Tolentino , J Quale . Detection of KPC carbapenem-hydrolyzing enzymes in Enterobacter spp. from Brooklyn, New York. Antimicrob Agents Chemother 2005;49:776778.

5. V Miriagou , LS Tzouvelekis , S Rossiter , E Tzelepi , FJ Angulo , JM Whichard . Imipenem resistance in a Salmonella clinical strain due to plasmid-mediated class A carbapenemase KPC-2. Antimicrob Agents Chemother 2003;47:12971300.

6. JC Cai , HW Zhou , R Zhang , GX Chen . Emergence of Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli isolates possessing the plas-mid-mediated carbapenem-hydrolyzing β-lactamase KPC-2 in intensive care units of a Chinese hospital. Antimicrob Agents Chemother 2008;52: 20142018.

7. S Bratu , M Mooty , S Nichani , et al.Emergence of KPC-possessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection. Antimicrob Agents Chemother 2005;49:30183020.

8. I Chmelnitsky , S Navon-Venezia , J Strahilevitz , Y Carmeli . Plasmid-me-diated qnrB2 and carbapenemase gene bla(KPC-2) carried on the same plasmid in carbapenem-resistant ciprofloxacin-susceptible Enterobacter cloacae isolates. Antimicrob Agents Chemother 2008;52:29622965.

9. S Bratu , P Tolaney , U Karumudi , et al.Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY: molecular epidemiology and in vitro activity of polymyxin B and other agents. J Antimicrob Chemother 2005;56:128132.

10. ES Moland , ND Hanson , VL Herrera , et al.Plasmid-mediated, carba-penem-hydrolysing β-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother 2003;51:711714.

11. 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.

12. S Bratu , D Landman , R Haag , et al.Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165:14301435.

13. LM Deshpande , PR Rhomberg , HS Sader , RN Jones . Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobac-teriaceae isolated in the United States Medical Centers: report from the MYSTIC Program (1999-2005). Diagn Microbiol Infect Dis 2006;56:367372.

14. C Urban , PA Bradford , M Tuckman , et al.Carbapenem-resistant Escherichia coli harboring Klebsiella pneumoniae carbapenemase β-lactamases associated with long-term care facilities. Clin Infect Dis 2008;46:e127e130.

15. MV Villegas , K Lolans , A Correa , et al.First detection of the plasmid-mediated class A carbapenemase KPC-2 in clinical isolates of Klebsiella pneumoniae from South America. Antimicrob Agents Chemother 2006;50: 28802882.

16. G Cuzon , T Naas , MC Demachy , P Nordmann . Plasmid-mediated carbapenem-hydrolyzing β-lactamase KPC-2 in Klebsiella pneumoniae isolate from Greece. Antimicrob Agents Chemother 2008;52:796797.

17. J Monteiro , AF Santos , MD Asensi , G Peirano , AC Gales . First report of KPC-2-producing Klebsiella pneumoniae strains in Brazil. Antimicrob Agents Chemother 2009;53:333334.

18. T Naas , P Nordmann , G Vedel , C Poyart . Plasmid-mediated carbapenem-hydrolyzing β-lactamase KPC in a Klebsiella pneumoniae isolate from France. Antimicrob Agents Chemother 2005;49:44234424.

20. LS Munoz-Price . Long-term acute care hospitals. Clin Infect Dis 2009;49: 438443.

21. CV Gould , R Rothenberg , JP Steinberg . Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27:920925.

22. KF Anderson , DR Lonsway , JK Rasheed , et al.Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol 2007;45:27232725.

25. LS Munoz-Price , B Hota , A Stermer , RA Weinstein . Prevention of bloodstream infections using daily Chlorhexidine baths at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30:10311035.

26. JD Siegel , E Rhinehart , M Jackson , L Chiarello . 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(10 Suppl 2):S65S164.

28. MO Vernon , MK Hayden , WE Trick , RA Hayes , DW Blom , RA Weinstein . Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306312.

29. EL Larson , JP Cimiotti , J Haas , et al.Gram-negative bacilli associated with catheter-associated and non-catheter-associated bloodstream infections and hand carriage by healthcare workers in neonatal intensive care units. Pediatr Crit Care Med 2005;6:457461.

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: 17 *
Loading metrics...

Abstract views

Total abstract views: 256 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th May 2017. This data will be updated every 24 hours.