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Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Puerto Rico Associated with a Novel Carbapenemase Variant

Published online by Cambridge University Press:  02 January 2015

Christopher J. Gregory ,
Eloisa Llata ,
Nicholas Stine ,
Carolyn Gould ,
Luis Manuel Santiago ,
Guillermo J. Vazquez ,
Iraida E. Robledo ,
Arjun Srinivasan ,
Richard V. Goering  and
Kay M. Tomashek
Christopher J. Gregory*
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Centers for Disease Control and Prevention Dengue Branch, San Juan, Puerto Rico
Eloisa Llata
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Health Care Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Nicholas Stine
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Carolyn Gould
Affiliation:
Division of Health Care Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Luis Manuel Santiago
Affiliation:
Centers for Disease Control and Prevention Dengue Branch, San Juan, Puerto Rico
Guillermo J. Vazquez
Affiliation:
University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
Iraida E. Robledo
Affiliation:
University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
Arjun Srinivasan
Affiliation:
Division of Health Care Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Richard V. Goering
Affiliation:
Creighton University School of Medicine, Omaha, Nebraska
Kay M. Tomashek
Affiliation:
Centers for Disease Control and Prevention Dengue Branch, San Juan, Puerto Rico
*
Centers for Disease Control and Prevention Dengue Branch, 1324 Calle Cañada, San Juan, PR 00920, (hgk4@cdc.gov)
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Abstract

Background.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality.

Objective.

To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak.

Design.

Two case-control studies.

Setting.

A 328-bed tertiary care teaching hospital.

Patients.

Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period.

Methods.

We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the blaKPC gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis.

Results.

In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak.

Conclusions.

Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 5 , May 2010 , pp. 476 - 484
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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