Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-17T15:01:15.021Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Transmission of New Delhi Metallo-β-Lactamase-1-Producing Klebsiella pneumoniae in Toronto, Canada

Published online by Cambridge University Press:  02 January 2015

Christopher F. Lowe ,
Julianne V. Kus ,
Natasha Salt ,
Sandra Callery ,
Lisa Louie ,
Mohammed A. Khan ,
Mary Vearncombe  and
Andrew E. Simor
Christopher F. Lowe
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Julianne V. Kus
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Natasha Salt
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Sandra Callery
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Lisa Louie
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Mohammed A. Khan
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Mary Vearncombe
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Andrew E. Simor*
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
*
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room Bl 21, Toronto, Ontario M4N 3M5, Canada ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Design.

An analysis of a cluster of New Delhi metallo-β-lactamase-l-producing Klebsiella pneumoniae (NDMl-Kp) and a retrospective case-cohort analysis of risk factors for acquisition in contacts of NDM1-Kp-positive patients.

Setting.

A 1,100-bed Canadian academic tertiary care center.

Patients.

Two index patients positive for NDMl-Kp as well as 45 contacts (roommates, ward mates, or environmental contacts) were investigated.

Methods.

Retrospective chart reviews of all patients colonized or infected with NDM1-Kp as well as contacts of these patients were performed in order to describe the epidemiology and impact of infection prevention and control measures. A case-cohort analysis was conducted investigating 45 contacts of NDM1-Kp-positive patients to determine risk factors for acquisition of NDM1-Kp. Rectal swabs were screened for NDMl-Kp using chromogenic agar. Presence of blaNDM-1 was confirmed by multiplex polymerase chain reaction. Clonality was assessed with pulsed-field gel electrophoresis (PFGE) using restriction enzyme XbaI.

Results.

Two index cases carrying NDM1-Kp with different PFGE patterns were identified. Nosocomial transmission to 7 patients (4 roommates, 2 ward mates, and 1 environmental contact) was subsequenüy identified. Risk factors for acquisition of NDM1-Kp were a history of prior receipt of certain antibiotics (fluoroquinolones [odds ratio (OR), 16.8 (95% confidence interval [CI], 1.30-58.8); P = .005], trimethoprim-sulfamethoxazole [OR, 11.3 (95% CI, 1.84-70.0); P = .01], and carbapenems [OR, 16.8 (95% CI, 1.79-157.3); P = .04]) and duration of exposure to NDM1-Kp-positive roommates (26.5 vs 6.7 days; P< .001).

Conclusion.

Two distinct clones of NDM1-Kp were transmitted to 7 inpatient contacts over several months. Implementation of contact precautions, screening of contacts for NDM1-Kp carriage, and attention to environmental disinfection contributed to the interruption of subsequent spread of the organism. The appropriate duration and frequency of screening contacts of NDMl-Kp-positive patients require further study.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 49 - 55
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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

1. Queenan, AM, Bush, K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev 2007;20:440–458.10.1128/CMR.00001-07Google Scholar
2. Poirel, L, Bonnin, RA, Nordmann, P. Analysis of the resistome of a multidrug-resistant NDM-1-producing Escherichia coli strain by high-throughput genome sequencing. Antimicrob Agents Chemother 2011;55:4224–4229.10.1128/AAC.00165-11Google Scholar
3. Yong, D, Toleman, MA, Giske, CG, et al. Characterization of a new metallo-β-lactamase gene, bla NDM-1, a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046–5054.10.1128/AAC.00774-09Google Scholar
4. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae . Emerg Infect Dis 2011;17: 1791–1798.10.3201/eid1710.110655Google Scholar
5. Kus, JV, Tadros, M, Simor, A, et al. New Delhi metallo-β-lactamase-1: local acquisition in Ontario, Canada, and challenges in detection. CMAJ 2011;183:1257–1261.10.1503/cmaj.110477Google Scholar
6. Mulvey, MR, Grant, JM, Plewes, K, Roscoe, D, Boyd, DA. New Delhi metallo-β-lactamase in Klebsiella pneumoniae and Escherichia co? Canada. Emerg Infect Dis 2011;17:103–106.10.3201/eid1701.101358Google Scholar
7. Peirano, G, Ahmed-Bentley, J, Woodford, N, Pitout, JD. New Delhi metallo-β-lactamase from traveler returning to Canada. Emerg Infect Dis 2011;17:242–244.10.3201/eid1702.101313Google Scholar
8. Tijet, N, Alexander, DC, Richardson, D, et al. New Delhi metallo-β-lactamase, Ontario, Canada. Emerg Infect Dis 2011;17:306–307.10.3201/eid1702.101561Google Scholar
9. Public Health Agency of Canada. Guidance: Infection Prevention and Control Measures for Healthcare Workers in All Healthcare Settings: Carbapenem-Resistant Gram-Negative Bacilli. Ottawa, Ontario: Public Health Agency of Canada, 2011. http://www.phac-aspc.gc.ca/nois-sinp/guide/ipcm-mpci/pdf/guide-eng.pdf. Accessed January 9, 2012.Google Scholar
10. Mataseje, LF, Bryce, E, Roscoe, D, et al. Carbapenem-resistant gram-negative bacilli in Canada 2009-10: results from the Canadian Nosocomial Infection Surveillance Program (CNISP). J Antimicrob Chemother 2012;67:1359–1367.Google Scholar
11. Lowe, C, Katz, K, McGeer, A, MP, Muller; Toronto ESBL Working Group. Disparity in infection control practices for multidrug-resistant Enterobacteriaceae . Am J Infect Control 2012;40: 836–839.10.1016/j.ajic.2011.11.008Google Scholar
12. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: Twenty-First Informational Supplement. Wayne, PA: CLSI, 2011:M100-S21.Google Scholar
13. Bradford, PA, Bratu, S, Urban, C, et al. Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 β-lactamases in New York City. Clin Infect Dis 2004;39:55–60.10.1086/421495Google Scholar
14. European Committee on Antimicrobial Susceptibility Testing. Breakpoint Tables for Interpretation of MICs and Zone Diameters. Växjö, Sweden: European Society of Clinical Microbiology and Infectious Diseases, 2011. http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Disk_test_documents/EUCAST_breakpoints_vl.3_pdf.pdf. Accessed January 12, 2012.Google Scholar
15. Pfizer Canada. Product Monograph: PrTygacil: Tigecycline for Injection. Kirkland, Quebec: Pfizer Canada, 2010.Google Scholar
16. Ribot, EM, Fair, MA, Gautom, R, et al. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Food-borne Pathog Dis 2006;3:59–67.10.1089/fpd.2006.3.59Google Scholar
17. Nordmann, P, Couard, JP, Sansot, D, Poirel, L. Emergence of an autochthonous and community-acquired NDM-1-producing Klebsiella pneumoniae in Europe. Clin Infect Dis 2012;54: 150–151.10.1093/cid/cir720Google Scholar
18. Provincial Infectious Diseases Advisory Committee. Annex A: Screening Testing and Surveillance for Antibiotic-Resistant Organisms (AROs). 3rd ed. Toronto, Ontario: Ontario Agency for Health Protection and Promotion, 2011. http://www.oahpp.ca/resources/documents/pidac/Annex%20A%20-%20PHO%20template%20-%20REVISION%20-%202012Apr25.pdf. Accessed January 12, 2012.Google Scholar
19. Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58:256–260.Google Scholar
20. Nordmann, P, Poirel, L, Walsh, TR, Livermore, DM. The emerging NDM carbapenemases. Trends Microbiol 2011;19:588–595.10.1016/j.tim.2011.09.005Google Scholar
21. Gazin, M, Paasch, F, Goossens, H, Malhotra-Kumar, S; MOSAR WP2 and SATURN WP1 Study Teams. Current trends in culture-based and molecular detection of extended-spectrum-β-lactamase-harboring and carbapenem-resistant Enterobacteriaceae . J Clin Microbiol 2012;50:1140–1146.10.1128/JCM.06852-11Google Scholar
22. Nordmann, P, Girlich, D, Poirel, L. Detection of carbapenemase producers in Enterobacteriaceae using a novel screening medium. J Clin Microbiol 2012;50:2761–2766.10.1128/JCM.06477-11Google Scholar
23. Su, LH, Leu, HS, YP, Chiu, et al. Molecular investigation of two clusters of hospital-acquired bacteraemia caused by multi-resistant Klebsiella pneumoniae using pulsed-field gel electrophoresis and in frequent restriction site PCR. J Hosp Infect 2000; 46:110–117.10.1053/jhin.2000.0815Google Scholar
24. Lowe, CF, Willey, B, O'Shaughnessy, A, et al. Outbreak of extended-spectrum β-lactamase-producing Klebsiella oxytoca associated with contaminated handwashing sinks. Emerg Infect Dis 2012;18:1242–1247.10.3201/eid1808.111268Google Scholar
25. Hota, S, Hirji, Z, Stockton, K, et al. Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect Control Hosp Epidemiol 2009;30:25–33.10.1086/592700Google Scholar
26. Gaibani, P, Ambretti, S, Berlingeri, A, et al. Outbreak of NDM1-producing Enterobacteriaceae in northern Italy, July to August 2011. Euro Surveill 2011;16:20027.Google Scholar
27. Denis, C, Poirel, L, Carricajo, A, et al. Nosocomial transmission of NDM-1-producing Escherichia coli within a non-endemic area in France. Clin Microbiol Infect 2012;18:E128–E130.10.1111/j.1469-0691.2012.03761.xGoogle Scholar
28. Poirel, L, Herve, V, Hombrouck-Alet, C, Nordmann, P. Long-term carriage of NDM-1-producing Escherichia coli . J Antimicrob Chemother 2011;66:2185–2186.10.1093/jac/dkr236Google Scholar