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

Published online by Cambridge University Press:  02 January 2015

Christopher F. Lowe ,
Julianne V. Kus ,
Natasha Salt ,
Sandra Callery ,
Lisa Louie ,
Mohammed A. Khan ,
Mary Vearncombe  and
Andrew E. Simor
Christopher F. Lowe
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Julianne V. Kus
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Natasha Salt
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Sandra Callery
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Lisa Louie
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Mohammed A. Khan
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Mary Vearncombe
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Andrew E. Simor*
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
*
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room Bl 21, Toronto, Ontario M4N 3M5, Canada (andrew.simor@sunnybrook.ca)
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 49 - 55
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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