title: Successful control of a hospital-wide outbreak of OXA-48 producing Enterobacteriaceae in the Netherlands, 2009 to 2011.
abstract: On 31 May 2011, after notification of Klebsiella pneumoniae (KP)(OXA-48;CTX-M-15) in two patients, nosocomial transmission was suspected in a Dutch hospital. Hospital-wide infection control measures and an outbreak investigation were initiated. A total of 72,147 patients were categorised into groups based on risk of OXA-48 colonisation or infection, and 7,527 were screened for Enterobacteriaceae(OXA-48) by polymerase chain reaction (PCR). Stored KP isolates (n=408) were retrospectively tested for OXA-48 and CTX-M-1 group extended-spectrum beta-lactamases (ESBL). 285 KP isolates from retrospective and prospective patient screening were genotyped by amplified fragment length polymorphism (AFLP). 41 isolates harbouring different Enterobacteriaceae species were analysed by plasmid multilocus sequence typing (pMLST). No nosocomial transmission of Enterobacteriaceae(OXA-48) was detected after 18 July 2011. Enterobacteriaceae(OXA-48) were found in 118 patients (KP (n=99), Escherichia coli (n=56), ≥1 Enterobacteriaceae(OXA-48) species (n=52)), of whom 21 had clinical infections. 39/41 (95%) of OXA-48 containing plasmids were identical in pMLST. Minimum inhibitory concentrations (MICs) of KP(OXA-48) and E. coli(OXA-48) for imipenem and meropenem ranged from ≤1 to ≥16 mg/L, and 153/157 (97%) had MIC >0.25 mg/L for ertapenem. AFLP identified a cluster of 203 genetically linked isolates (62 KP(OXA-48;CTX-M15); 107 KP(CTX-M-15); 34 KP(OXA-48)). The ‘oldest’ KP(CTX-M-15) and KP(OXA-48) clonal types originated from February 2009 and September 2010, respectively. The last presumed outbreak-related KP(OXA-48) was detected in April 2012. Uncontrolled transmission of KP(CTX-M-15) evolved into a nosocomial outbreak of KP(OXA-48;CTX-M15) with large phenotypical heterogeneity. Although the outbreak was successfully controlled, the contribution of individual containment measures and of the hospital relocating into a new building just before outbreak notification was impossible to quantify.
authors.affiliation: Department of Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Dautzenberg
authors.forename: J M
authors.initials: JM
authors.lastname: Ossewaarde
authors.forename: M E
authors.initials: ME
authors.lastname: de Kraker
authors.forename: A
authors.initials: A
authors.lastname: van der Zee
authors.forename: S
authors.initials: S
authors.lastname: van Burgh
authors.forename: S C
authors.initials: SC
authors.lastname: de Greeff
authors.forename: H A
authors.initials: HA
authors.lastname: Bijlmer
authors.forename: H
authors.initials: H
authors.lastname: Grundmann
authors.forename: J W
authors.initials: JW
authors.lastname: Cohen Stuart
authors.forename: A C
authors.initials: AC
authors.lastname: Fluit
authors.forename: A
authors.initials: A
authors.lastname: Troelstra
authors.forename: M J
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: D000328:Adult; D000368:Aged; D054458:Amplified Fragment Length Polymorphism Analysis; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control; D004926:Escherichia coli / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008969:Molecular Sequence Data; D058885:Multilocus Sequence Typing; D009426:Netherlands / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010957:Plasmids; D011446:Prospective Studies; D012189:Retrospective Studies; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases; C108449:oxacillinase