title: An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread.
abstract: We describe an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-KP) ST258 that occurred in two institutions (a hospital and a nursing home) in the Netherlands between July and December 2013. In total, six patients were found to be positive for KPC-KP. All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and tigecycline. In all settings, extensive environmental contamination was found. Whole genome sequencing revealed the presence of bla KPC-2 and bla SHV-12 genes, as well as the close relatedness of patient and environmental isolates. In the hospital setting, one transmission was detected, despite contact precautions. After upgrading to strict isolation, no further spread was found. After the transfer of the index patient to a nursing home in the same region, four further transmissions occurred. The outbreak in the nursing home was controlled by transferring all KPC-KP-positive residents to a separate location outside the nursing home, where a dedicated nursing team cared for patients. This outbreak illustrates that the spread of pan-resistant Enterobacteriaceae can be controlled, but may be difficult, particularly in long-term care facilities. It, therefore, poses a major threat to patient safety. Clear guidelines to control reservoirs in and outside the hospitals are urgently needed.
authors.affiliation: Laboratory for Microbiology and Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands, vweterings@amphia.nl.
authors.forename: V
authors.initials: V
authors.lastname: Weterings
authors.forename: K
authors.initials: K
authors.lastname: Zhou
authors.forename: J W
authors.initials: JW
authors.lastname: Rossen
authors.forename: D
authors.initials: D
authors.lastname: van Stenis
authors.forename: E
authors.initials: E
authors.lastname: Thewessen
authors.forename: J
authors.initials: J
authors.lastname: Kluytmans
authors.forename: J
authors.initials: J
authors.lastname: Veenemans
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics*; D003091:Colistin / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D004783:Environmental Microbiology; D005260:Female; D016680:Genome, Bacterial; D006801:Humans; D017053:Infection Control / Q000379:methods; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009426:Netherlands / Q000453:epidemiology; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase; D003091:Colistin