Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-25T07:51:52.279Z Has data issue: false hasContentIssue false
  • English
  • Français

An outbreak of ST307 extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae in a rehabilitation center: An unusual source and route of transmission

Published online by Cambridge University Press:  05 November 2019

Marrit B. Boonstra ,
Dorien C. M. Spijkerman ,
Anne F. Voor in ‘t holt ,
Rob J. van der Laan ,
Lonneke G. M. Bode ,
Wim van Vianen ,
Corné H. W. Klaassen ,
Margreet C. Vos  and
Juliëtte A. Severin
Marrit B. Boonstra
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Dorien C. M. Spijkerman
Affiliation:
Rijndam Rehabilitation Center, Rotterdam, The Netherlands
Anne F. Voor in ‘t holt
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Rob J. van der Laan
Affiliation:
Rijndam Rehabilitation Center, Rotterdam, The Netherlands
Lonneke G. M. Bode
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Wim van Vianen
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Corné H. W. Klaassen
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Margreet C. Vos
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Juliëtte A. Severin*
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
*
Author for correspondence: J. A. Severin, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Nosocomial outbreaks due to multidrug-resistant microorganisms in rehabilitation centers have rarely been reported. We report an outbreak of extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae (ESBL-K. pneumoniae) on a single ward in a rehabilitation center in Rotterdam, The Netherlands.

Design:

Outbreak description.

Setting:

A 40-bed ward of a rehabilitation center in the Netherlands.

Methods:

In October 2016, 2 patients were found to be colonized by genetically indistinguishable ESBL-K. pneumoniae isolates. Therefore, an outbreak management team was installed, by whom a contact tracing plan was made. In addition to general outbreak measures, specific measures were formulated to allow continuation of the rehabilitation process. Also, environmental cultures were taken. Multiple-locus variable-number tandem-repeat analysis and amplification fragment-length polymorphism were used to determine strain relatedness. Selected isolates were subjected to whole-genome multilocus sequence typing.

Results:

The outbreak lasted 8 weeks. In total, 14 patients were colonized with an ESBL-K. pneumoniae, of whom 11 patients had an isolate belonging to sequence type 307. Overall, 163 environmental cultures were taken. Several sites of a household washing machine were repeatedly found to be contaminated with the outbreak strain. This machine was used to wash lifting slings and patient clothing contaminated with feces. The outbreak was contained after taking the machine temporarily out of service and implementing a reinforced and adapted protocol on the use of this machine.

Conclusion:

We conclude that in this outbreak, the route of transmission of the outbreak strain via the household washing machine played a major role.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 1 , January 2020 , pp. 31 - 36
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Reuland, EA, Al Naiemi, N, Kaiser, AM, et al. Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam. J Antimicrob Chemother 2016;71:1076–1082.CrossRefGoogle ScholarPubMed
Willemsen, I, Oome, S, Verhulst, C, Pettersson, A, Verduin, K, Kluytmans, J. Trends in extended spectrum beta-lactamase (ESBL)–producing Enterobacteriaceae and ESBL genes in a Dutch teaching hospital, measured in 5 yearly point prevalence surveys (2010–2014). PLoS One 2015;10:e0141765.CrossRefGoogle Scholar
Huizinga, P, van den Bergh, MK, van Rijen, M, Willemsen, I, van ‘t Veer, N, Kluytmans, J. Proton pump inhibitor use is associated with extended-spectrum beta-lactamase–producing Enterobacteriaceae rectal carriage at hospital admission: a cross-sectional study. Clin Infect Dis 2017;64:361–363.CrossRefGoogle ScholarPubMed
Kluytmans-van den Bergh, MFQ, van Mens, SP, Haverkate, MR, et al. Quantifying hospital-acquired carriage of extended-spectrum beta-lactamase–producing Enterobacteriaceae among patients in Dutch hospitals. Infect Control Hosp Epidemiol 2018;39:32–39.CrossRefGoogle ScholarPubMed
Platteel, TN, Leverstein-van Hall, MA, Cohen Stuart, JW, et al. Predicting carriage with extended-spectrum beta-lactamase–producing bacteria at hospital admission: a cross-sectional study. Clin Microbiol Infect 2015;21:141–146.CrossRefGoogle ScholarPubMed
Schwaber, MJ, Navon-Venezia, S, Kaye, KS, Ben-Ami, R, Schwartz, D, Carmeli, Y. Clinical and economic impact of bacteremia with extended-spectrum beta-lactamase–producing Enterobacteriaceae . Antimicrob Agents Chemother 2006;50:1257–1262.CrossRefGoogle ScholarPubMed
Stone, PW, Gupta, A, Loughrey, M, et al. Attributable costs and length of stay of an extended-spectrum beta-lactamase–producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:601–606.CrossRefGoogle Scholar
Maslikowska, JA, Walker, SA, Elligsen, M, et al. Impact of infection with extended-spectrum beta-lactamase–producing Escherichia coli or Klebsiella species on outcome and hospitalization costs. J Hosp Infect 2016;92:33–41.CrossRefGoogle ScholarPubMed
Paterson, DL, Bonomo, RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657–686.CrossRefGoogle ScholarPubMed
Kluytmans-Vandenbergh, MF, Kluytmans, JA, Voss, A. Dutch guideline for preventing nosocomial transmission of highly resistant microorganisms (HRMO). Infection 2005;33:309–313.CrossRefGoogle Scholar
WHO guidelines on hand hygiene in health care. World Health Organization website. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. Published 2009. Accessed October 20, 2018.Google Scholar
Brink, AA, von Wintersdorff, CJ, van der Donk, CF, et al. Development and validation of a single-tube multiple-locus variable number tandem repeat analysis for Klebsiella pneumoniae . PLoS One 2014;9:e91209.CrossRefGoogle ScholarPubMed
van Burgh, S, Maghdid, DM, Ganjo, AR, et al. PME and other ESBL-positive multiresistant Pseudomonas aeruginosa isolated from hospitalized patients in the region of Kurdistan, Iraq. Microb Drug Resist 2019;25:32–38.CrossRefGoogle ScholarPubMed
Carattoli, A, Zankari, E, Garcia-Fernandez, A, et al. In silico detection and typing of plasmids using PlasmidFinder and plasmid multilocus sequence typing. Antimicrob Agents Chemother 2014;58:3895–3903.CrossRefGoogle ScholarPubMed
Jia, B, Raphenya, AR, Alcock, B, et al. CARD 2017: expansion and model-centric curation of the comprehensive antibiotic resistance database. Nucleic Acids Res 2017;45:D566–D573.CrossRefGoogle ScholarPubMed
Robicsek, A, Jacoby, GA, Hooper, DC. The worldwide emergence of plasmid-mediated quinolone resistance. Lancet Infect Dis 2006;6:629–640.CrossRefGoogle ScholarPubMed
Jana, S, Deb, JK. Molecular understanding of aminoglycoside action and resistance. Appl Microbiol Biotechnol 2006;70:140–150.CrossRefGoogle ScholarPubMed
Ramirez, MS, Traglia, GM, Lin, DL, Tran, T, Tolmasky, ME. Plasmid-mediated antibiotic resistance and virulence in gram-negatives: the Klebsiella pneumoniae paradigm. Microbiol Spectr 2014;2:1–15.CrossRefGoogle ScholarPubMed
Arild, AH, Brusdal, R, Halvorsen Gunnarsen, JT, Terpstra, PMJ, Kessel van, IAC. An investigation of domestic laundry in Europe—habits, hygiene and technical performance. 2003.Google Scholar
Callewaert, C, Van Nevel, S, Kerckhof, FM, Granitsiotis, MS, Boon, N. Bacterial exchange in household washing machines. Front Microbiol 2015;6:1381.CrossRefGoogle ScholarPubMed
Honisch, M, Stamminger, R, Bockmuhl, DP. Impact of wash cycle time, temperature and detergent formulation on the hygiene effectiveness of domestic laundering. J Appl Microbiol 2014;117:1787–1797.CrossRefGoogle ScholarPubMed
Gattlen, J, Amberg, C, Zinn, M, Mauclaire, L. Biofilms isolated from washing machines from three continents and their tolerance to a standard detergent. Biofouling 2010;26:873–882.CrossRefGoogle ScholarPubMed
Scott, E, Bloomfield, SF. The survival and transfer of microbial contamination via cloths, hands and utensils. J Appl Bacteriol 1990;68:271–278.CrossRefGoogle ScholarPubMed
Scott, E, Bloomfield, SF. Investigations of the effectiveness of detergent washing, drying and chemical disinfection on contamination of cleaning cloths. J Appl Bacteriol 1990;68:279–283.CrossRefGoogle ScholarPubMed
Cheng, VCC, Chen, JHK, Leung, SSM, et al. Seasonal outbreak of Bacillus bacteremia associated with contaminated linen in Hong Kong. Clin Infect Dis 2017;64:S91–S97.CrossRefGoogle ScholarPubMed
Balm, MN, Jureen, R, Teo, C, et al. Hot and steamy: outbreak of Bacillus cereus in Singapore associated with construction work and laundry practices. J Hosp Infect 2012;81:224–230.CrossRefGoogle ScholarPubMed
Hosein, IK, Hoffman, PN, Ellam, S, et al. Summertime Bacillus cereus colonization of hospital newborns traced to contaminated, laundered linen. J Hosp Infect 2013;85:149–154.CrossRefGoogle ScholarPubMed
Schmithausen, RM, Sib, E, Exner, M, et al. The washing machine as a reservoir for transmission of extended spectrum beta-lactamase (CTX-M-15)-producing Klebsiella oxytoca ST201 in newborns. Appl Environ Microbiol. doi: 10.1128/AEM.01435-19.CrossRefGoogle Scholar
Bockmuhl, DP. Laundry hygiene-how to get more than clean. J Appl Microbiol 2017;122:1124–1133.CrossRefGoogle ScholarPubMed
Lakdawala, N, Pham, J, Shah, M, Holton, J. Effectiveness of low-temperature domestic laundry on the decontamination of healthcare workers’ uniforms. Infect Control Hosp Epidemiol 2011;32:1103–1108.CrossRefGoogle ScholarPubMed
Rehberg, L, Frontzek, A, Melhus, A, Bockmuhl, DP. Prevalence of beta-lactamase genes in domestic washing machines and dishwashers and the impact of laundering processes on antibiotic-resistant bacteria. J Appl Microbiol 2017;123:1396–1406.CrossRefGoogle ScholarPubMed
Walter, WG, Schillinger, JE. Bacterial survival in laundered fabrics. Appl Microbiol 1975;29:368–373.Google ScholarPubMed
Blaser, MJ, Smith, PF, Cody, HJ, Wang, WL, LaForce FM. Killing of fabric-associated bacteria in hospital laundry by low-temperature washing. J Infect Dis 1984;149:48–57.CrossRefGoogle ScholarPubMed
Smith, JA, Neil, KR, Davidson, CG, Davidson, RW. Effect of water temperature on bacterial killing in laundry. Infect Control 1987;8:204–209.CrossRefGoogle ScholarPubMed
National Working Group for Infection Prevention Guideline Linnengoed. [In Dutch] https://www.rivm.nl/documenten/wip-richtlijn-linnengoed. Published 2014. Accessed October 20, 2018.Google Scholar
NEN-EN. 14065:2002 Textiles—Laundry processed textiles—Biocontamination control. 2008.Google Scholar
NEN-EN-ISO. 9001:2008/C1:2009. Kwaliteitsmanagementsystemen—Eisen. 2008.Google Scholar
Villa, L, Feudi, C, Fortini, D, et al. Diversity, virulence, and antimicrobial resistance of the KPC-producing Klebsiella pneumoniae ST307 clone. Microb Genom 2017;3:e000110.Google ScholarPubMed
Livermore, DM, Winstanley, TG, Shannon, KP. Interpretative reading: recognizing the unusual and inferring resistance mechanisms from resistance phenotypes. J Antimicrob Chemother 2001;48 suppl 1:87–102.CrossRefGoogle Scholar