title: Outbreak of infection with a multiresistant Klebsiella pneumoniae strain associated with contaminated roll boards in operating rooms.
abstract: An outbreak with a multiresistant Klebsiella pneumoniae (MRKP) strain among seven patients admitted to the adult intensive care unit (ICU) of a regional teaching hospital in The Netherlands was investigated. Epidemiologic investigations revealed a short delay between an operation and the acquisition of the MRKP strain. A case-control study comprising 7 cases and 14 controls was conducted to identify the risk factors associated with the acquisition of the MRKP strain. An operation at each of two operation rooms was strongly associated with the acquisition of the MRKP strain: odds ratio of 36 (95% confidence interval, 2.7 to 481.2; P=0.003, Fisher exact two-tailed test). Cultures of environmental specimens of the operation rooms revealed contamination of the roll boards used to transport patients from the bed to the operation table with the MRKP strains. Molecular genotyping of the isolates revealed clonal similarity between the isolates of the seven cases, isolates from environmental specimen cultures, and in addition, an MRKP isolate from a re-patriated ICU patient from earlier that year. The outbreak ended after cleaning and replacement of the roll boards in the operation rooms and implementation of additional barrier precautions for colonized or infected patients. It was concluded that two operation rooms played a significant role in the transmission of an MRKP strain between ICU patients during the presented outbreak.
authors.affiliation: Department of Clinical Microbiology, St. Elisabeth Hospital, P.O. Box 747, 5000 AS Tilburg, The Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: van 't Veen
authors.forename: Anneke
authors.initials: A
authors.lastname: van der Zee
authors.forename: Jolande
authors.initials: J
authors.lastname: Nelson
authors.forename: Ben
authors.initials: B
authors.lastname: Speelberg
authors.forename: Jan A J W
authors.initials: JA
authors.lastname: Kluytmans
authors.forename: Anton G M
authors.initials: AG
authors.lastname: Buiting
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D004866:Equipment Contamination; D005260:Female; D005838:Genotype; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009873:Operating Rooms; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology; D012150:Polymorphism, Restriction Fragment Length; D012307:Risk Factors; D014187:Transportation of Patients / Q000379:methods