title: Extended measures for controlling an outbreak of VIM-1 producing imipenem-resistant Klebsiella pneumoniae in a liver transplant centre in France, 2003-2004.
abstract: We report the successful control of an outbreak caused by imipenem-resistant VIM-1-producing Klebsiella pneumoniae (IR-Kp) in France. This outbreak occurred in a care centre for abdominal surgery that includes a 15-bed liver intensive care unit and performs more than 130 liver transplantations per year. The index case was a patient with acute liver failure transferred from a hospital in Greece for urgent liver transplantation who was carrying IR-Kp at admission as revealed by routine culture of a rectal swab. Infection control measures were undertaken and included contact isolation and promotion of hand hygiene with alcohol-based hand rub solution. Nevertheless, secondary IR-Kp cases were identified during the six following months from 3 December 2003 to 2 June 2004. From 2 June to 21 October, extended infection control measures were set up, such as cohorting IR-Kp carriers, contact patients and new patients in distinct sections with dedicated staff, limiting ward admission, and strict control of patient transfer. They led to a rapid control of the outbreak. The global attack rate of the IR-Kp outbreak was 2.5%, 13% in liver transplant patients and 0.4% in the other patients in the care centre (p<0.005). Systematic screening for IR-Kp of all patients admitted to the care centre is still maintained to date and no secondary IR-Kp case has been detected since 2 June 2004.
authors.affiliation: Assistance Publique-Hopitaux de Paris, hospital Paul Brousse, Infection Control Unit, Villejuif, France. najiby.kassis-chikhani@pbr.aphp.fr
authors.forename: N
authors.initials: N
authors.lastname: Kassis-Chikhani
authors.forename: F
authors.initials: F
authors.lastname: Saliba
authors.forename: A
authors.initials: A
authors.lastname: Carbonne
authors.forename: S
authors.initials: S
authors.lastname: Neuville
authors.forename: D
authors.initials: D
authors.lastname: Decre
authors.forename: C
authors.initials: C
authors.lastname: Sengelin
authors.forename: C
authors.initials: C
authors.lastname: Guerin
authors.forename: N
authors.initials: N
authors.lastname: Gastiaburu
authors.forename: A
authors.initials: A
authors.lastname: Lavigne-Kriaa
authors.forename: C
authors.initials: C
authors.lastname: Boutelier
authors.forename: G
authors.initials: G
authors.lastname: Arlet
authors.forename: D
authors.initials: D
authors.lastname: Samuel
authors.forename: D
authors.initials: D
authors.lastname: Castaing
authors.forename: E
authors.initials: E
authors.lastname: Dussaix
authors.forename: V
authors.initials: V
authors.lastname: Jarlier
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005260:Female; D005602:France / Q000453:epidemiology; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D015378:Imipenem / Q000494:pharmacology / Q000627:therapeutic use; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology / Q000302:isolation & purification*; D016031:Liver Transplantation; D008297:Male; D008826:Microbial Sensitivity Tests; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem; C417264:VIM-1 metallo-beta-lactamase; D001618:beta-Lactamases