RESUMEN
OBJECTIVE: Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms and the novel use of a cohorting unit for its control. DESIGN: Observational study. SETTING: A 566-room academic teaching facility in Milwaukee, Wisconsin. PATIENTS: Solid-organ transplant recipients. METHODS: Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing. RESULTS: A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones. CONCLUSIONS: A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
Asunto(s)
Infección Hospitalaria/prevención & control , Brotes de Enfermedades/prevención & control , Control de Infecciones/métodos , Infecciones por Klebsiella/prevención & control , Anciano , Proteínas Bacterianas/genética , Infección Hospitalaria/epidemiología , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Femenino , Humanos , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/genética , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Paquetes de Atención al Paciente , Wisconsin/epidemiología , beta-Lactamasas/genéticaRESUMEN
In 2018, the Clostridium difficile LabID event methodology changed so that hospitals doing 2-step tests, nucleic acid amplification test (NAAT) plus enzyme immunofluorescence assay (EIA), had their adjustment modified to EIA-based tests, and only positive final tests (eg, EIA) were counted in the numerator. We report the immediate impact of this methodological change at 3 Milwaukee hospitals.