title: Control of an outbreak due to orthopedic infections caused by Enterobacteriaceae producing IMP-4 or IMP-8 carbapenemases.
abstract: OBJECTIVE
  To investigate control of an outbreak due to orthopedic infections caused by Enterobacteriaceae producing IMP carbapenemases.
  
  
  METHODS
  The sporadic orthopedic infections with Enterobacteriaceae producing carbapenemase (CPE) were retrospectively analyzed in a Chinese tertiary care hospital from November 2010 to September 2012.
  
  
  RESULTS
  The CPE were isolated from four distinct orthopedic patients, three patients infected with Enterobacter cloacae while the other with Klebsiella oxytoca. All strains were resistant to almost all the conventional antimicrobial. The strains produced IMP-4 type detected in the two early patients, while other strains could produce IMP-8 type. All of the four patients had ever undergoing invasive surgical procedure, and three of them were given fluoroquinolones for anti-infection treatment while the other patients was treated with meropenem. Ultimately, all patients were cured and discharged, without outbreak of nosocomial infection caused by CPE.
  
  
  CONCLUSIONS
  Our study shows that strict infection control plays an important role in limiting dissemination of Enterobacteriaceae producing IMP carbapenemase. In addition, reasonable supporting treatment and disinfection protection seems to be more effective for the infection of strains.
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, n(o) 67 Dongchang Road, Liaocheng, Shandong 252000, China.
authors.forename: F
authors.initials: F
authors.lastname: Pang
authors.affiliation: Department of Clinical Pharmacy, Liaocheng People's Hospital, n(o) 67 Dongchang Road, Liaocheng, Shandong 252000, China. Electronic address: jiaxiuqin11@hotmail.com.
authors.forename: X-Q
authors.initials: XQ
authors.lastname: Jia
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, n(o) 67 Dongchang Road, Liaocheng, Shandong 252000, China.
authors.forename: B
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, n(o) 67 Dongchang Road, Liaocheng, Shandong 252000, China.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Li
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, n(o) 67 Dongchang Road, Liaocheng, Shandong 252000, China.
authors.forename: Q-G
authors.initials: QG
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000382:microbiology*; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D016972:Enterobacter cloacae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D005593:Fracture Fixation, Internal; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D041121:Klebsiella oxytoca / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D010000:Osteitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D010356:Patient Isolation; D011481:Protective Clothing; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology; D013845:Thienamycins / Q000627:therapeutic use; D016635:Universal Precautions; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology*; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D013845:Thienamycins; D064704:Levofloxacin; C436760:IMP-8 enzyme; C000595276:IMP-4 beta-lactamase, Enterobacter cloacae; C000595277:IMP-4 beta-lactamase, Klebsiella oxytoca; D001618:beta-Lactamases; D000077731:Meropenem; C053091:lomefloxacin
keywords: Carbapénèmase IMP; Enterobacteriaceae; IMP carbapenemase; Infection; Orthopedic; Orthopédique