An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread

Eur J Clin Microbiol Infect Dis. 2015 Aug;34(8):1647-55. doi: 10.1007/s10096-015-2401-2. Epub 2015 Jun 12.

Abstract

We describe an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-KP) ST258 that occurred in two institutions (a hospital and a nursing home) in the Netherlands between July and December 2013. In total, six patients were found to be positive for KPC-KP. All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and tigecycline. In all settings, extensive environmental contamination was found. Whole genome sequencing revealed the presence of bla KPC-2 and bla SHV-12 genes, as well as the close relatedness of patient and environmental isolates. In the hospital setting, one transmission was detected, despite contact precautions. After upgrading to strict isolation, no further spread was found. After the transfer of the index patient to a nursing home in the same region, four further transmissions occurred. The outbreak in the nursing home was controlled by transferring all KPC-KP-positive residents to a separate location outside the nursing home, where a dedicated nursing team cared for patients. This outbreak illustrates that the spread of pan-resistant Enterobacteriaceae can be controlled, but may be difficult, particularly in long-term care facilities. It, therefore, poses a major threat to patient safety. Clear guidelines to control reservoirs in and outside the hospitals are urgently needed.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Bacterial Proteins / genetics*
  • Colistin / pharmacology*
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross Infection / transmission
  • Disease Outbreaks*
  • Drug Resistance, Bacterial*
  • Environmental Microbiology
  • Female
  • Genome, Bacterial
  • Humans
  • Infection Control / methods
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / microbiology
  • Klebsiella Infections / transmission
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / enzymology
  • Klebsiella pneumoniae / isolation & purification
  • Male
  • Middle Aged
  • Molecular Epidemiology
  • Netherlands / epidemiology
  • Patient Safety
  • Practice Guidelines as Topic
  • Prospective Studies
  • Sequence Analysis, DNA
  • Sequence Homology
  • beta-Lactamases / genetics*

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • beta-Lactamases
  • carbapenemase
  • Colistin