title: Inter-hospital outbreak of Klebsiella pneumoniae producing KPC-2 carbapenemase in Ireland.
abstract: OBJECTIVE
  To describe an outbreak of KPC-2-producing Klebsiella pneumoniae with inter-hospital spread and measures taken to control transmission.
  
  
  METHODS
  Between January and March 2011, 13 K. pneumoniae isolates were collected from nine patients at hospital A and two patients at hospital B. Meropenem, imipenem and ertapenem MICs were determined by Etest, carbapenemase production was confirmed by the modified Hodge method and by a disc synergy test, and confirmed carbapenemase producers were tested for the presence of carbapenemase-encoding genes by PCR. PFGE, plasmid analysis, multilocus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST) analysis were performed on all or a subset of isolates.
  
  
  RESULTS
  Meropenem, imipenem and ertapenem MICs were 4 to >32, 8-32 and >16 mg/L, respectively. PCR and sequencing confirmed the presence of bla(KPC-2). PFGE identified four distinguishable (≥88%) pulsed-field profiles (PFPs). Isolates distinguishable by PFGE had identical MLVA profiles, and MLST analysis indicated all isolates belonged to the ST258 clone. Stringent infection prevention and control measures were implemented. Over a period of almost 8 months no further carbapenemase-producing Enterobacteriaceae (CPE) were isolated. However, KPC-2-producing K. pneumoniae was detected in two further patients in hospital A in August (PFP indistinguishable from previous isolates) and October 2011 (PFP similar to but distinguishable from previous isolates).
  
  
  CONCLUSIONS
  Stringent infection prevention and control measures help contain CPE in the healthcare setting; however, in the case of hospital A, where CPE appears to be established in the population served, it may be virtually impossible to achieve eradication or avoid reintroduction into the hospital.
authors: Antimicrobial Resistance and Microbial Ecology (ARME) Group, School of Medicine, National University of Ireland Galway, Galway, Ireland. dearbhaile.morris@nuigalway.ie
authors: Dearbháile
authors: D
authors: Morris
authors: Fiona
authors: F
authors: Boyle
authors: Carol
authors: C
authors: Morris
authors: Iris
authors: I
authors: Condon
authors: Anne-Sophie
authors: AS
authors: Delannoy-Vieillard
authors: Lorraine
authors: L
authors: Power
authors: Aliya
authors: A
authors: Khan
authors: Margaret
authors: M
authors: Morris-Downes
authors: Cathriona
authors: C
authors: Finnegan
authors: James
authors: J
authors: Powell
authors: Regina
authors: R
authors: Monahan
authors: Karen
authors: K
authors: Burns
authors: Nuala
authors: N
authors: O'Connell
authors: Liz
authors: L
authors: Boyle
authors: Alan
authors: A
authors: O'Gorman
authors: Hilary
authors: H
authors: Humphreys
authors: Sylvain
authors: S
authors: Brisse
authors: Jane
authors: J
authors: Turton
authors: Neil
authors: N
authors: Woodford
authors: Martin
authors: M
authors: Cormican
mesh_terms: D004196:Disease Outbreaks; D000077727:Ertapenem; D005798:Genes, Bacterial; D006761:Hospitals; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007494:Ireland / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D013845:Thienamycins / Q000494:pharmacology; D001618:beta-Lactamases / Q000378:metabolism*; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D013845:Thienamycins; D047090:beta-Lactams; D015378:Imipenem; D001618:beta-Lactamases; C547585:beta-lactamase KPC-2, Klebsiella pneumoniae; D000077731:Meropenem; D000077727:Ertapenem