title: Emergence and outbreak of carbapenemase-producing KPC-3 Klebsiella pneumoniae in Spain, September 2009 to February 2010: control measures.
abstract: This report describes the epidemiological features of the first outbreak caused by KPC3 carbapenemase-producing Klebsiella pneumoniae (KPC-3-KP) in Spain and how it was effectively controlled. From 16 September 2009 to the end of February 2010, seven patients infected or colonised with KPC-3-KP were detected. Stool surveillance cultures were recovered from patients, doctors, nurses, nursing assistants, cleaners and hospital porters working in the affected units. Hand swabs were taken from workers and patients’ relatives for culturing. Environmental samples were also taken. Patients infected or colonised with KPC-3-KP were placed in single rooms under contact precautions and 4% chlorhexidine soap was used for their daily hygiene. Staff attended educational seminars and workshops on hand hygiene and isolation of patients. An alcohol-based disinfectant was used for surface cleaning and disinfecting. The floor was cleaned with a disinfectant containing benzalkonium chloride and didecyldimethylammonium. All samples collected were negative for KPC-3-KP. After implementing the control measures, no further cases were reported in the affected units. All cases had comorbidities, long hospital stay and aggressive/intensive antimicrobial treatment. This study emphasises the importance of early intensification of infection control to interrupt the transmission of KPC-producing organisms.
authors.affiliation: Service of Preventive Medicine, University Hospital Ramón y Cajal, and Health Research Institute, Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Robustillo Rodela
authors.forename: C
authors.initials: C
authors.lastname: Díaz-Agero Pérez
authors.forename: T
authors.initials: T
authors.lastname: Sanchez Sagrado
authors.forename: P
authors.initials: P
authors.lastname: Ruiz-Garbajosa
authors.forename: M J
authors.initials: MJ
authors.lastname: Pita López
authors.forename: V
authors.initials: V
authors.lastname: Monge
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015780:Carbapenems / Q000627:therapeutic use; D004196:Disease Outbreaks / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D017053:Infection Control; D007710:Klebsiella Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010356:Patient Isolation; D016133:Polymerase Chain Reaction; D013030:Spain / Q000453:epidemiology; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C495220:beta-lactamase KPC-3, Klebsiella pneumoniae; C063912:carbapenemase