title: An outbreak of carbapenem-resistant OXA-48 - producing Klebsiella pneumonia associated to duodenoscopy.
abstract: BACKGROUND
  Carbapenemase-producing Enterobacteriaceae (CPE) have become a major problem for healthcare systems worldwide. While the first reports from European hospitals described the introduction of CPE from endemic countries, there is now a growing number of reports describing outbreaks of CPE in European hospitals. Here we report an outbreak of Carbapenem-resistant K. pneumoniae in a German University hospital which was in part associated to duodenoscopy.
  
  
  RESULTS
  Between December 6, 2012 and January 10, 2013, carbapenem-resistant K. pneumoniae (CRKP) was cultured from 12 patients staying on 4 different wards. The amplification of carbapenemase genes by multiplex PCR showed presence of the bla OXA-48 gene. Molecular typing confirmed the identity of all 12 isolates. Reviewing the medical records of CRKP cases revealed that there was a spatial relationship between 6 of the cases which were located on the same wards. The remaining 6 cases were all related to endoscopic retrograde cholangiopancreatography (ERCP) which was performed with the same duodenoscope. The outbreak ended after the endoscope was sent to the manufacturer for maintenance.
  
  
  CONCLUSIONS
  Though the outbreak strain was also disseminated to patients who did not undergo ERCP and environmental sources or medical personnel also contributed to the outbreak, the gut of colonized patients is the main source for CPE. Therefore, accurate and stringent reprocessing of endoscopic instruments is extremely important, which is especially true for more complex instruments like the duodenoscope (TJF Q180V series) involved in the outbreak described here.
authors: Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany.
authors: Axel
authors: A
authors: Kola
authors: Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany.
authors: Brar
authors: B
authors: Piening
authors: Medical Department, Division of Hepatology and Gastroenterology, Charité - University Medicine Berlin, Berlin, Germany.
authors: Ulrich-Frank
authors: UF
authors: Pape
authors: Medical Department, Division of Hepatology and Gastroenterology, Charité - University Medicine Berlin, Berlin, Germany.
authors: Wilfried
authors: W
authors: Veltzke-Schlieker
authors: National Reference Laboratory for multidrug-resistant Gram-negative bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany.
authors: Martin
authors: M
authors: Kaase
authors: Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany.
authors: Christine
authors: C
authors: Geffers
authors: Medical Department, Division of Hepatology and Gastroenterology, Charité - University Medicine Berlin, Berlin, Germany.
authors: Bertram
authors: B
authors: Wiedenmann
authors: Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany.
authors: Petra
authors: P
authors: Gastmeier
keywords: Carbapenemases; Endoscopy; K. pneumoniae; OXA-48; Outbreak