Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system

被引:122
作者
Endimiani, Andrea [1 ,2 ]
DePasquale, John M. [3 ,4 ]
Forero, Sandra [3 ]
Perez, Federico [1 ,2 ]
Hujer, Andrea M. [1 ]
Roberts-Pollack, Daneshia [3 ]
Fiorella, Paul D. [3 ]
Pickens, Nancy [3 ]
Kitchel, Brandon
Casiano-Colon, Aida E. [6 ]
Tenover, Fred C. [5 ]
Bonomo, Robert A. [1 ,2 ,7 ,8 ]
机构
[1] Louis Stokes Cleveland Dept Vet Affairs Med Ctr, Res Serv, Cleveland, OH 44106 USA
[2] Case Western Reserve Sch Med, Dept Med, Cleveland, OH 44106 USA
[3] Florida Dept Hlth, Tallahassee, FL 32399 USA
[4] Ctr Dis Control & Prevent, Off Workforce & Career Dev, Atlanta, GA 30333 USA
[5] Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Atlanta, GA 30333 USA
[6] Integrated Reg Labs, Ft Lauderdale, FL 33309 USA
[7] Case Western Reserve Sch Med, Dept Pharmacol, Cleveland, OH 44106 USA
[8] Case Western Reserve Sch Med, Dept Mol Biol & Microbiol, Cleveland, OH 44106 USA
关键词
LTCF; porins; carbapenemases; Enterobacteriaceae; outbreak; CARBAPENEM-RESISTANT KLEBSIELLA; SPECTRUM BETA-LACTAMASES; IN-VITRO ACTIVITY; ESCHERICHIA-COLI; MOLECULAR EPIDEMIOLOGY; KPC CARBAPENEMASE; INFECTION; ENTEROBACTERIACEAE; OUTBREAK; FACILITY;
D O I
10.1093/jac/dkp327
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: To characterize isolates of Klebsiella pneumoniae producing KPC carbapenemase (KPC-Kp) associated with an outbreak in a long-term acute care hospital (LTACH) in South Florida. Methods: During 21 March to 20 April 2008, 241 K. pneumoniae isolates detected at Integrated Regional Laboratories (Ft. Lauderdale, FL) for which the ertapenem MICs were >= 4 mg/L were studied. PCR, cloning and sequence analysis were used to detect bla(KPC) and to characterize the P-lactamase and outer membrane proteins (Omps). The expression level of KPC enzymes was studied by immunoblotting. Genetic relatedness of isolates was investigated with rep-PCR and PFGE. Clinical records of patients were investigated. Results: Seven KPC-Kp strains were isolated from different patients located at a single LTACH, with a further three isolates being recovered from patients at different hospitals. All KPC-Kp isolates in patients from the LTACH and from one hospital patient were genetically related and shared PFGE patterns that clustered with known sequence type (ST) 258 strains. These strains were highly resistant to carbapenems (MICs >= 32 mg/L) due to an increased level of KPC expression and loss of Omps. Rectal colonization was documented in all LTACH patients with KPC-Kp isolates. Treatment failures were common (crude mortality rate of 69%). Active surveillance and enhanced infection control practices terminated the KPC-Kp outbreak. Conclusions: The detection of KPC-Kp in an LTACH represents a serious infection control and therapeutic challenge in a new clinical setting. The speed at which the epidemic of KPC-Kp is spreading in our healthcare system mandates urgent action.
引用
收藏
页码:1102 / 1110
页数:9
相关论文
共 45 条
  • [1] [Anonymous], 2009, M100S19 CLIN LAB STA
  • [2] Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY:: molecular epidemiology and in vitro activity of polymyxin B and other agents
    Bratu, S
    Tolaney, P
    Karumudi, U
    Quale, J
    Mooty, M
    Nichani, S
    Landman, D
    [J]. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2005, 56 (01) : 128 - 132
  • [3] A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION
    CHARLSON, ME
    POMPEI, P
    ALES, KL
    MACKENZIE, CR
    [J]. JOURNAL OF CHRONIC DISEASES, 1987, 40 (05): : 373 - 383
  • [4] Molecular mechanisms disrupting porin expression in ertapenem-resistant Klebsiella and Enterobacter spp. clinical isolates from the UK
    Doumith, Michel
    Ellington, Matthew J.
    Livermore, David M.
    Woodford, Neil
    [J]. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2009, 63 (04) : 659 - 667
  • [5] Bacteremia due to Klebsiella pneumoniae isolates producing the TEM-52 extended-spectrum β-lactamase:: Treatment outcome of patients receiving imipenem or ciprofloxacin
    Endimiani, A
    Luzzaro, F
    Perilli, M
    Lombardi, G
    Colí, A
    Tamborini, A
    Amicosante, G
    Toniolo, A
    [J]. CLINICAL INFECTIOUS DISEASES, 2004, 38 (02) : 243 - 251
  • [6] Characterization of blaKPC-containing Klebsiella pneumoniae isolates detected in different institutions in the Eastern USA
    Endimiani, Andrea
    Hujer, Andrea M.
    Perez, Federico
    Bethel, Christopher R.
    Hujer, Kristine M.
    Kroeger, Jennifer
    Oethinger, Margret
    Paterson, David L.
    Adams, Mark D.
    Jacobs, Michael R.
    Diekema, Daniel J.
    Hall, Gerri S.
    Jenkins, Stephen G.
    Rice, Louis B.
    Tenover, Fred C.
    Bonomo, Robert A.
    [J]. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2009, 63 (03) : 427 - 437
  • [7] In Vitro Activity of NXL104 in Combination with β-Lactams against Klebsiella pneumoniae Isolates Producing KPC Carbapenemases
    Endimiani, Andrea
    Choudhary, Yuvraj
    Bonomo, Robert A.
    [J]. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2009, 53 (08) : 3599 - 3601
  • [8] Long-term acute care: A review of the literature
    Eskildsen, Manuel A.
    [J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2007, 55 (05) : 775 - 779
  • [9] The Emerging Threat of Multidrug-Resistant Gram-Negative Organisms in Long-Term Care Facilities
    Fallon, Erin O'
    Pop-Vicas, Aurora
    Agata, Erika D'
    [J]. JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2009, 64 (01): : 138 - 141
  • [10] Detection of Plasmid-Mediated KPC-Producing Klebsiella pneumoniae in Ottawa, Canada: Evidence of Intrahospital Transmission
    Goldfarb, David
    Harvey, Sarah-Beth
    Jessamine, Kelsi
    Jessamine, Peter
    Toye, Baldwin
    Desjardins, Marc
    [J]. JOURNAL OF CLINICAL MICROBIOLOGY, 2009, 47 (06) : 1920 - 1922