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Outbreak of Klebsiella pneumoniae Carbapenemase–Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida

Published online by Cambridge University Press:  07 December 2016

Adriana Jiménez ,
José G. Castro ,
L. Silvia Munoz-Price ,
Dennise de Pascale ,
Luis Shimose ,
Mustapha M. Mustapha ,
Caressa N. Spychala ,
Roberta T. Mettus ,
Vaughn S. Cooper  and
Yohei Doi
Adriana Jiménez*
Affiliation:
Jackson Memorial Hospital, Miami, Florida Florida International University, Miami, Florida
José G. Castro
Affiliation:
University of Miami Miller School of Medicine, Miami, Florida
L. Silvia Munoz-Price
Affiliation:
Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, Wisconsin
Dennise de Pascale
Affiliation:
Jackson Memorial Hospital, Miami, Florida
Luis Shimose
Affiliation:
Cleveland Clinic, Cleveland, Ohio
Mustapha M. Mustapha
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Caressa N. Spychala
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Roberta T. Mettus
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Vaughn S. Cooper
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Yohei Doi
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Address correspondence to Adriana Jiménez, MPH, BSMT, Department of Infection Prevention and Control, Jackson Memorial Hospital, 1611 NW 12th Ave PPW 301, Miami, FL 33136 (adriana.jimenez@jhsmiami.org)
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Abstract

OBJECTIVE

To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida.

METHODS

An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted.

RESULTS

An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions.

CONCLUSIONS

Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.

Infect Control Hosp Epidemiol 2017;38:320–326

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 320 - 326
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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