Subject(s)
Catheter-Related Infections , Gram-Negative Bacteria/isolation & purification , Infection Control , Urinary Tract Infections , Asymptomatic Diseases/epidemiology , Catheter-Related Infections/diagnosis , Catheter-Related Infections/epidemiology , Catheter-Related Infections/microbiology , Catheter-Related Infections/prevention & control , Cross Infection/diagnosis , Cross Infection/epidemiology , Cross Infection/microbiology , Cross Infection/prevention & control , Female , Humans , Infection Control/organization & administration , Infection Control/standards , Male , Medicaid/statistics & numerical data , Medicare/statistics & numerical data , Middle Aged , Public Health Surveillance/methods , Retrospective Studies , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , United States/epidemiology , Urinalysis/methods , Urinalysis/statistics & numerical data , Urinary Tract Infections/diagnosis , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Urinary Tract Infections/prevention & controlABSTRACT
OBJECTIVE: To investigate an outbreak of New Delhi metallo-ß-lactamase (NDM)-producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission. DESIGN, SETTING, AND PATIENTS: Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital. METHODS: Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for blaNDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations. RESULTS: Two patients were initially identified with NDM-producing CRE during July-August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission. CONCLUSIONS: A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.
Subject(s)
Carbapenems/therapeutic use , Cross Infection/microbiology , Klebsiella Infections/drug therapy , Klebsiella pneumoniae , beta-Lactamases/biosynthesis , Adult , Aged , Carbapenems/pharmacology , Colorado , Cross Infection/epidemiology , Cross Infection/prevention & control , Disease Outbreaks , Drug Resistance, Bacterial , Female , Hospitals , Humans , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/genetics , Male , Microbial Sensitivity Tests , Middle Aged , Sequence Analysis, DNA , Young AdultABSTRACT
We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-ß-lactamase-producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.
