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Outbreak of Klebsiella pneumoniae Carbapenemase–Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida

Published online by Cambridge University Press:  07 December 2016

Adriana Jiménez ,
José G. Castro ,
L. Silvia Munoz-Price ,
Dennise de Pascale ,
Luis Shimose ,
Mustapha M. Mustapha ,
Caressa N. Spychala ,
Roberta T. Mettus ,
Vaughn S. Cooper  and
Yohei Doi
Adriana Jiménez*
Affiliation:
Jackson Memorial Hospital, Miami, Florida Florida International University, Miami, Florida
José G. Castro
Affiliation:
University of Miami Miller School of Medicine, Miami, Florida
L. Silvia Munoz-Price
Affiliation:
Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, Wisconsin
Dennise de Pascale
Affiliation:
Jackson Memorial Hospital, Miami, Florida
Luis Shimose
Affiliation:
Cleveland Clinic, Cleveland, Ohio
Mustapha M. Mustapha
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Caressa N. Spychala
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Roberta T. Mettus
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Vaughn S. Cooper
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Yohei Doi
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Address correspondence to Adriana Jiménez, MPH, BSMT, Department of Infection Prevention and Control, Jackson Memorial Hospital, 1611 NW 12th Ave PPW 301, Miami, FL 33136 ([email protected])
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Abstract

OBJECTIVE

To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida.

METHODS

An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted.

RESULTS

An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions.

CONCLUSIONS

Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.

Infect Control Hosp Epidemiol 2017;38:320–326

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 320 - 326
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Munoz-Price, LS, Poirel, L, Bonomo, RA, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 2013;13:785–796.CrossRefGoogle ScholarPubMed
2. Nordmann, P, Poirel, L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect 2014;20:821–830.CrossRefGoogle ScholarPubMed
3. Mathers, AJ, Cox, HL, Kitchel, B, et al. Molecular dissection of an outbreak of carbapenem-resistant Enterobacteriaceae reveals intergenus KPC carbapenemase transmission through a promiscuous plasmid. MBio 2011;2:e00204–e00211.CrossRefGoogle ScholarPubMed
4. Ahn, C, Syed, A, Hu, F, O’Hara, JA, Rivera, JI, Doi, Y. Microbiological features of KPC-producing Enterobacter isolates identified in a U.S. hospital system. Diagn Microbiol Infect Dis 2014;80:154–158.CrossRefGoogle Scholar
5. O’Hara, JA, Hu, F, Ahn, C, et al. Molecular epidemiology of KPC-producing Escherichia coli: occurrence of ST131-fimH30 subclone harboring pKpQIL-like IncFIIk plasmid. Antimicrob Agents Chemother 2014;58:4234–4237.CrossRefGoogle ScholarPubMed
6. Zarb, P, Coignard, B, Griskeviciene, J, et al.; National Contact Points for the ECDC pilot point prevalence survey; Hospital Contact Points for the ECDC pilot point prevalence survey. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill 2012;17.Google ScholarPubMed
7. Adler, A, Khabra, E, Paikin, S, Carmeli, Y. Dissemination of the bla KPC gene by clonal spread and horizontal gene transfer: comparative study of incidence and molecular mechanisms. J Antimicrob Chemother 2016;71:2143–2146.CrossRefGoogle Scholar
8. Tijet, N, Muller, MP, Matukas, LM, Khan, A, Patel, SN, Melano, RG. Lateral dissemination and inter-patient transmission of bla KPC-3: role of a conjugative plasmid in spreading carbapenem resistance. J Antimicrob Chemother 2016;71:344–347.CrossRefGoogle Scholar
9. Munoz-Price, LS, De La Cuesta, C, Adams, S, et al. Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida. Infect Control Hosp Epidemiol 2010;31:1074–1077.CrossRefGoogle Scholar
10. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; 25th informational supplement. Wayne, PA: CLSI; 2015.Google Scholar
11. Nordmann, P, Poirel, L, Dortet, L. Rapid detection of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2012;18:1503–1507.CrossRefGoogle ScholarPubMed
12. Alrowais, H, McElheny, CL, Spychala, CN, et al. Fosfomycin resistance in Escherichia coli, Pennsylvania, USA. Emerg Infect Dis 2015;21:2045–2047.CrossRefGoogle ScholarPubMed
13. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
14. Page, AJ, Cummins, CA, Hunt, M, et al. Roary: rapid large-scale prokaryote pan genome analysis. Bioinformatics 2015;31:3691–3693.CrossRefGoogle ScholarPubMed
15. Stamatakis, A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics 2014;30:1312–1313.CrossRefGoogle ScholarPubMed
16. Deshpande, LM, Rhomberg, PR, Sader, HS, Jones, RN. Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobacteriaceae isolated in the United States Medical Centers: report from the MYSTIC Program (1999-2005). Diagn Microbiol Infect Dis 2006;56:367–372.CrossRefGoogle ScholarPubMed